Understanding the French Healthcare System
The French healthcare system is founded on the principle of universal coverage, known as Protection Universelle Maladie (PUMa). It is a "state-sponsored" system where the government provides basic health insurance to all residents, funded through social security contributions and taxes. Foreign nationals residing in France for more than three consecutive months on a stable basis are generally eligible for this coverage.
The system is characterized by a high quality of care and a dual-layer insurance structure: the mandatory state insurance (l’Assurance Maladie) and optional supplementary private insurance (la mutuelle). While the state covers a significant portion of medical expenses, the remaining "out-of-pocket" costs are typically covered by the private insurer.
Eligibility and Registration for Foreigners
To access the public healthcare system, foreign nationals must fall into one of the following categories:
- Employees: Individuals working in France are registered automatically via their employer from their first day of work.
- Self-employed: Individuals registered as "Auto-entrepreneurs" or business owners contribute through the Urssaf system.
- Non-active residents: Individuals living in France without professional activity (e.g., retirees or partners) can apply for PUMa after residing in France for at least three months.
- Students: Foreign students are usually required to register on a dedicated platform at etudiant-etranger.ameli.fr.
The primary administrative body managing these rights is the Caisse d’Assurance Maladie (CPAM). Once registered, individuals receive a Social Security Number and eventually a Carte Vitale—a green electronic card containing all necessary information for billing and reimbursement.
Costs and Reimbursement Rates
The French system does not provide entirely free care at the point of service; patients usually pay the provider and are later reimbursed by the state. As of late 2024 and projected into 2025/2026, the standard consultation fee for a General Practitioner (GP) is 30 EUR ($32.40 USD, Jan 2026).
Standard reimbursement rates by the state (l'Assurance Maladie) generally include:
- GP and Specialist visits: Approximately 70% of the regulated fee.
- Hospitalization: Approximately 80% (though this can be 100% for major surgeries).
- Prescription Medications: Between 15% and 100%, depending on the necessity of the drug.
- Dental and Vision: Usually reimbursed at very low rates by the state, requiring a strong private mutuelle.
It is important to note the "Ticket Modérateur," which is the remaining amount the patient must pay. For a 30 EUR GP visit, the state reimburses approximately 21 EUR, leaving 9 EUR ($9.72 USD, Jan 2026) for the patient or their private insurance to cover.
Private Supplementary Insurance (Mutuelle)
Because the state only covers about 70% of routine costs, approximately 95% of the French population holds a mutuelle. For employees in the private sector, employers are legally required to provide and pay for at least 50% of a basic supplementary health insurance plan.
For those not employed (unemployed, students, or retirees), purchasing a private plan is highly recommended. Monthly premiums vary significantly based on coverage levels and age, typically ranging from 30 EUR ($32.40 USD, Jan 2026) for basic student coverage to over 100 EUR ($108 USD, Jan 2026) for comprehensive senior plans.
Official information regarding the types of coverage and assistance for low-income residents (CSS - Complémentaire Santé Solidaire) can be found on the official Ameli website.
Practical Steps for Newcomers
To navigate the system efficiently, newcomers should follow these steps:
- Declare a Primary Doctor: You must choose a Médecin Traitant (GP) and register them with CPAM. Failing to do so results in lower reimbursement rates (the "coordinated care pathway").
- Wait for the Carte Vitale: After your initial application, you will receive an "Attestation de Droits" (certificate of rights). Use this paper document for reimbursements until your physical card arrives.
- Open an Ameli Account: This is the digital portal where you can track your reimbursements, download certificates, and order a European Health Insurance Card (EHIC).
- Check Provider Categories: Doctors are classified as Secteur 1 (fixed state rates) or Secteur 2 (allowed to charge extra fees, known as dépassements d’honoraires).
Exceptions and Special Cases
EU/EEA/Swiss citizens may use their European Health Insurance Card (EHIC) for temporary stays. For stays longer than three months, they should register for PUMa like other residents. Foreign nationals on short-stay "Schengen" visas (under 90 days) are not eligible for PUMa and must maintain private travel insurance that meets visa requirements.