Healthcare & health insurance in France: Your 2026 guide

Health insurance is essential for everyone living in France, and securing the right coverage is one of the first things to sort out when you move here.

In France, there are three main options:

• Public health insurance (l'Assurance Maladie — part of Sécurité Sociale), accessed through a Carte Vitale once you've lived in France for at least 3 months.
• Complementary private insurance — a Mutuelle that covers what the public system doesn't.
• Expat health insurance — international coverage you can take out before you arrive and that keeps you insured during the long months before your Carte Vitale is issued.

Here's a quick overview of how to get health insurance in France as an expat:

1. Before moving: Take out expat health insurance — it's visa-compliant and covers you from day one.
2. At 3 months: Apply for public health insurance (Assurance Maladie) at your local CPAM — expect 3–9 months of processing.
3. While waiting: Keep your expat insurance, so you're not stuck with full-price bills.
4. Once you have your Carte Vitale: Cancel your expat plan and sign up for a Mutuelle for fuller coverage.

Below, we break down how the French system really works in 2026 — including the new visitor-visa healthcare contribution introduced by the 2026 Social Security Financing Law, updated reimbursement rates, and practical tips most guides skip.

2026 update: What's changing for expats this year

Several 2026 reforms affect how expats register for and pay for healthcare in France. If you're moving to France in 2026 — especially on a visitor visa — these are the changes to know about.

• New healthcare contribution for non-EU visitor-visa holders. LOI n° 2025-1403 du 30 décembre 2025 (the 2026 Social Security Financing Law) created a new Article L.160-1-1 of the Code de la sécurité sociale. It requires non-EU nationals on long-stay "visitor" visas (VLS-TS visiteur) to pay a mandatory annual flat contribution before they can access PUMA and be issued a Carte Vitale. The measure specifically targets inactive residents — retirees, rentiers, and digital nomads — who previously accessed French healthcare for free after three months of residency. The fee is expected to land in the €300–€600 per year range, but the implementing decree setting the exact amount had not been published as of April 2026, so the measure is enacted but not yet enforceable in practice. S1 form holders (EU/UK state pensioners), employees paying cotisations, refugees, and nationals of countries with a bilateral social security agreement with France are exempt.
• Hospital daily fee increased to €23. From 1 March 2026, under the Arrêté du 27 février 2026, the forfait journalier hospitalier rose from €20 to €23 per day in general hospitals and clinics (€17/day in psychiatric units). This fee is not reimbursed by Assurance Maladie — a Mutuelle typically covers it.
• Specialist fee increases (Convention médicale 2026). From 1 January 2026, pediatrics rose to €40, geriatrics to €42, gynecology (coordinated care) to €40, dermatology (melanoma screening) to €60, and punctual specialist opinions to €60. A new €60 long consultation is available for patients aged 80 and over.
• 100% Santé expansion. Wheelchairs joined the zero-out-of-pocket basket on 1 December 2025. Zircone crowns on molars were added to the dental 100% Santé basket on 1 January 2026, alongside a 3% uplift of 100% Santé fee ceilings.
• What didn't change. The proposed doubling of the participation forfaitaire (€2 → €4) and franchise médicale (€1 → €2) was abandoned during the December 2025 budget debate. These stay at their current levels throughout 2026.

Why is health insurance compulsory in France?

Health insurance is mandatory in France to ensure universal healthcare. The goal is for everyone to access care, regardless of income or health status — a principle baked into French law since Sécurité Sociale was founded in 1945.

For expats, this has two practical consequences. First, long-stay visa applications require proof of health insurance — you can't file without it. Second, once you're resident, you must be registered with either the public system, an equivalent (e.g. a work-based scheme), or a recognised private/international policy. Going uninsured is not a legal option, even for people who think they won't need care.

How the French healthcare system works

France's healthcare system is a mix of public and private providers working off the same public-insurance foundation. In 2024, France spent 11.5% of its GDP on healthcare — 2.2 points above the OECD average — which funds one of the widest-access systems in Europe.

Public healthcare: l'Assurance Maladie (PUMA)

The public healthcare system, l'Assurance Maladie, is funded through payroll cotisations (around 6.5% split between employers and employees), the CSG (contribution sociale généralisée) on all income, and government subsidies. It's the safety net for virtually every resident of France, and covers a large share of medical costs: typically 70% of doctor's visits, 80% of hospitalisation, and up to 100% for maternity care and long-term conditions.

Since 2016, public healthcare access has been organised through PUMA (Protection Universelle Maladie), which replaced the older CMU (Couverture Maladie Universelle). You'll still see both terms in older articles, but PUMA is the current legal framework. A third acronym, AME (Aide Médicale de l'État), is something different entirely — it covers undocumented foreign residents after three months in France, and is not relevant to expats on a long-stay visa.

Expats who have been in France for at least three months and can prove they live here "stably and regularly" (de manière stable et régulière) can register with their local CPAM to access PUMA. In practice, the full enrolment — from application to Carte Vitale in hand — typically takes another 3 to 9 months, so expect a total waiting period of up to a year from your arrival date.

Private healthcare: La Mutuelle

On top of the public system, 95% of French residents hold a Mutuelle — a private, complementary health insurance plan that covers the ticket modérateur (the portion Assurance Maladie doesn't reimburse) and the extras the public system barely touches: dental prostheses, glasses, hearing aids, private hospital rooms, and dépassements d'honoraires from Sector 2 specialists.

Mutuelles are heavily regulated: most are contrats responsables, meaning they meet minimum-coverage standards (full coverage of the hospital forfait journalier, a defined basket of dental/optical/hearing care known as 100% Santé, etc.) in exchange for tax advantages. If you're a private-sector employee in France, your employer is legally required to offer you a group Mutuelle and pay at least 50% of the premium.

Important to know: a Mutuelle is a top-up, not a substitute. You generally can't take one out until you're already in the public system — which is why expat health insurance is what you actually need for your first 3–9 months in France.

Key French healthcare terms to know

• Médecin traitant — your declared GP. Once declared via the CPAM form or on Ameli, using them for referrals unlocks full reimbursement.
• Parcours de soins coordonné — the coordinated care pathway. Going through your médecin traitant = 70% reimbursement; going outside it = 30%.
• Secteur 1 / Secteur 2 — conventional (regulated tariff) vs non-conventional (can charge extra). More on avoiding surprise bills below.
• Dépassement d'honoraires — the extra a Sector 2 doctor charges above the regulated tariff. Not reimbursed by Assurance Maladie; partially covered by most Mutuelles.
• Tiers payant — direct payment by Assurance Maladie/Mutuelle to the provider, so you don't pay upfront.
• Carte Vitale — the green chip card that proves your public-insurance registration and enables automatic reimbursement.
• CPAM (Caisse Primaire d'Assurance Maladie) — your local Assurance Maladie office.
• Ameli.fr — Assurance Maladie's online portal (and app).

Who is eligible for French health insurance?

Eligibility for PUMA depends mostly on your nationality, residency status, and visa type. Here's how it breaks down for the four main expat profiles — with a dedicated section on the 2026 visitor-visa change at the end.

EU / EEA / Swiss citizens

For short stays (holidays, business trips, short-term study), your European Health Insurance Card (EHIC / CEAM) gives you access to French public healthcare on the same terms as French nationals — but only for medically necessary care, not elective treatment.

For long stays, once you've lived in France "stably and regularly" for three months, you register with your local CPAM and access PUMA on the same terms as French nationals. Employees pay cotisations through payroll; inactive residents may be liable for the cotisation subsidiaire maladie (CSM — see the cost section below) if they have significant capital income.

UK citizens (post-Brexit)

UK state pensioners moving to France can apply for an S1 form from the NHS Business Services Authority up to 90 days before moving. With an S1 registered at your CPAM, your healthcare is funded by the UK and you access PUMA on the same terms as French residents — no additional contribution owed to France.

UK working-age expats without an S1 follow the non-EU long-stay visa path below. The UK Global Health Insurance Card (GHIC) replaced the EHIC for most UK nationals after Brexit — it's valid for temporary stays in France but not for residency.

Non-EU citizens with a long-stay visa

If you hold a work, student, family-reunion, or salaried-activity long-stay visa (e.g. passeport talent, salarié, étudiant, vie privée et familiale), you can register with CPAM after three months of legal residence and access PUMA on the same terms as French nationals. Employees pay cotisations sociales through payroll, which funds your access automatically.

Non-EU citizens on a "visitor" visa — the 2026 change

If you hold a long-stay visitor visa (VLS-TS visiteur) — the most common route for retirees, rentiers, and digital nomads — the 2026 Social Security Financing Law (LOI n° 2025-1403) requires you to pay a mandatory annual healthcare contribution before you can access PUMA. The fee is expected to be in the €300–€600/year range, with the exact amount set by an implementing decree that had not been published as of April 2026.

Who is exempt from the new contribution: S1 holders, employees (who already contribute through payroll), refugees, and nationals of countries with a bilateral social security agreement with France.

While you wait for the decree — and certainly during your first three months, before you're even eligible to register — comprehensive expat health insurance is the only way to stay covered. For more on visitor-visa logistics, see our guide to France's visa application process.

Important: whichever category you fall into, the EHIC/GHIC is not a substitute for residency registration. It only covers medically necessary care during temporary stays.

Can expats access healthcare in France?

Yes — and in practice, expats use three overlapping routes into the French system.

To use the public system, you need a Carte Vitale, which proves your registration with Assurance Maladie. The card triggers automatic reimbursement after each medical visit.

For the complementary private layer, you need a Carte Mutuelle issued by your Mutuelle provider. It helps cover the co-pays, hospital forfaits, dental, optical and vision expenses the public system doesn't fully reimburse — and is used in tandem with your Carte Vitale at most clinics.

What if you don't have either?

If you haven't yet received these cards — because you've been in France for less than three months, you're still waiting for CPAM to process your application, or you haven't yet moved — you need expat health insurance (also called international health insurance).

Expat insurance is what closes the gap: it provides full coverage while you wait to enter the French healthcare system, satisfies visa requirements, and gives you access to private healthcare networks.

How does expat health insurance work?

• Covers medical expenses in both public and private facilities across France (and usually across Europe)
• Often reimburses 100% of costs rather than a set percentage
• Includes additional services like medical evacuation and English-speaking support
• Meets visa requirements for French long-stay visas
• Useful for expats who travel frequently and need seamless coverage across Europe
• Can be cancelled anytime, so you can switch off the day your Carte Vitale arrives

For expats who need flexibility, fast access to care, and a visa-compliant policy, Feather's expat health insurance is built for exactly that gap. Families moving to France can also look at family health insurance plans.

Public vs. private vs. expat health insurance in France

What does French public health insurance cover?

Assurance Maladie reimburses part — not all — of most medical costs. The percentages below apply when you use your médecin traitant and follow the parcours de soins coordonné (coordinated care pathway). Going outside it cuts reimbursement from 70% down to 30%.

On top of these reimbursements, everyone pays:

• A €2 participation forfaitaire per consultation or medical act (capped at €50/year)
• A €1 franchise médicale per medication box (capped at €50/year)

The 100% Santé reform (dental, optical, hearing)

Since 2019 (dental) and 2021 (optical and hearing), a defined "basket A" of products and procedures — basic crowns, bridges, glasses, hearing aids — is fully reimbursed by the combination of Assurance Maladie + any contrat responsable Mutuelle, leaving zero out-of-pocket cost. In 2026, wheelchairs and zircone molar crowns joined this basket.

ALD: 100% coverage for long-term conditions

If you're diagnosed with one of ~30 recognised chronic conditions (affections de longue durée) — cancer, diabetes, heart disease, chronic hepatitis, severe mental illness, etc. — all related care is reimbursed at 100% by Assurance Maladie, with no participation forfaitaire. Your GP applies for the ALD recognition with your medical file; once granted, it typically lasts several years.

What public insurance doesn't cover well

• Dental prostheses outside the 100% Santé basket (higher-end crowns, implants)
• Vision beyond the 100% Santé basket
• Hospital daily fee (€23/day)
• Sector 2 dépassements d'honoraires
• Private hospital rooms, TV, extra comfort
• Alternative medicine (osteopathy, chiropractic — some Mutuelles reimburse a fixed number of sessions)

This is why 95% of French residents — and virtually every well-informed expat — eventually sign up for a Mutuelle on top.

How to get health insurance in France: step-by-step

Here's the sequence we recommend for expats moving to France. For a broader look at the logistics of relocating, see our how to move to France and types of insurance you need in France guides.

Step 1: Get bridge coverage before you move

Before you even land in France, you need some kind of health coverage. Your long-stay visa application will require it (see France's visa requirements), and so will every medical provider you visit before your Carte Vitale arrives.

Your options depend on how long you're staying:

• Short-term visits: Travel insurance covers basic medical needs.
• Moving to France long-term: Get expat health insurance — it's more comprehensive, visa-compliant, and designed to bridge the 3–9 months until your Carte Vitale arrives.

Even if you plan to apply for public health insurance, you won't be eligible immediately — French law requires at least three months of residency first.

Step 2: Apply for your Carte Vitale after 3 months

Once you've been in France for at least three months, you can apply for public health insurance (Assurance Maladie). This is how you'll get your Carte Vitale — the green chip card that proves you're covered and enables automatic reimbursement. Our dedicated walkthrough on how to join the French healthcare system has the full step-by-step.

Documents you'll typically need:

• Passport + long-stay visa or titre de séjour
• Form S1106 (Demande d'ouverture des droits à l'Assurance Maladie) — the main application form
• Form S1104 if you're claiming rights through a spouse
• Proof of residency for 3+ months (electricity/gas bill, rental contract, attestation d'hébergement)
• A French RIB (bank details)
• Birth certificate (translated into French if not already in French — request an extrait plurilingue to avoid translation fees)
• Marriage certificate (if relevant)
• Recent pay slips or proof of income (if requested)

How to submit:

• Call 3646 (if in France) or +33 1 84 90 36 46 (if abroad)
• Book an appointment via the Ameli website to file in person at your local CPAM
• Or send everything by registered mail (lettre recommandée avec accusé de réception) — keep the receipt; this is your proof of filing date, which you may need if CPAM loses anything

The official CPAM English-speaking helpline has been known to be unreliable — expat forums regularly report it being down for weeks. If you don't speak French and the line isn't answering, ask to book an in-person appointment and bring a French-speaking friend, or use the Ameli-Assistance online forum to submit written queries.

Step 3: Stay covered until your Carte Vitale arrives

This is where many people get caught off guard. You've applied for public insurance, but processing is slow. In the meantime, if you get sick or have an accident, you're on the hook for the full cost of medical care unless you have insurance.

Realistic processing times in 2026: the legal minimum is three months of residency + roughly 3–6 months of processing, but 6–12 months is common, and some expats wait longer. If your file is incomplete, CPAM pauses the clock rather than flagging what's missing — so chase politely but regularly.

A few practical tips:

• Keep your expat health insurance active for the entire waiting period. Don't cancel until your Carte Vitale is in your wallet.
• Log into Ameli.fr once a month to check the status of your file (look for "Votre demande est en cours de traitement").
• If CPAM asks for a document, send it by registered mail and keep the receipt — loss of paperwork is unfortunately common.
• If you haven't heard anything in four months, file a written follow-up via your Ameli messagerie.

Some people try to "wing it" without coverage during this period. It's a bad idea: an emergency hospital admission or surgery can easily run to five figures, and you won't be reimbursed retroactively for care received before your rights are opened.

Step 4: Cancel your expat insurance

You've finally received your Carte Vitale. Congrats.

Now that you're officially covered by public health insurance, you no longer need your expat plan. Contact your expat insurer and cancel your policy to stop unnecessary payments.

Since you don't know exactly how long it'll take to get your Carte Vitale, choose an expat insurance plan you can cancel anytime. Feather's plans let you cancel, no questions asked, as soon as you're covered by the French system.

Step 5: Get a Mutuelle for full coverage

Your Carte Vitale is a great first step — but public insurance only reimburses part of your medical costs (around 70% of doctor visits, 80% of hospital stays, 60% of dental care). You pay the rest out of pocket unless you have a Mutuelle.

Unlike the Carte Vitale — which can take months — signing up for a Mutuelle takes about 1–2 weeks. Here's how it works depending on your work situation.

How to get a Mutuelle for employees

If you're employed in France, your company is legally required to provide a Mutuelle and pay at least 50% of the premium. The plan must meet the minimum coverage standards of your convention collective (industry collective agreement).

You don't get to choose your Mutuelle or its coverage level — your employer selects it, and you're automatically enrolled.

Want better coverage? Sign up for a surcomplémentaire. Because employees don't pick their Mutuelle, many top up with an extra layer of insurance called sur-complémentaire santé. It covers the extras — mainly dental and optical — that the basic Mutuelle leaves partly uncovered. If you wear glasses or expect orthodontic work, the monthly premium often pays for itself within a year.

How to get a Mutuelle for non-employees

If you're self-employed, retired, or otherwise not salaried, you aren't tied to a specific Mutuelle. You shop around and pick the plan that fits your needs best. Because of this flexibility, it usually doesn't make sense for non-employees to get both a basic Mutuelle and a sur-complémentaire — you're better off picking one high-quality Mutuelle with strong dental/optical coverage.

Alternatively, freelancers who don't need the full Mutuelle layer can stay on freelancer health insurance for as long as it makes sense for their situation.

How much does health insurance cost in France? (2026)

Costs break down across three layers: what you pay out of pocket inside the public system, what your Mutuelle costs on top, and what expat/international plans cost if you need them.

Public-system out-of-pocket costs (2026)

• €2 per consultation or medical act (participation forfaitaire), capped at €50/year
• €1 per medication box (franchise médicale), capped at €50/year
• €23/day hospital fee (forfait journalier hospitalier) from 1 March 2026 — €17/day in psychiatric units
• €23 emergency room fee (forfait patient urgences) if you're not admitted
• Average household out-of-pocket spending on health: about €292 per person per year in 2024 — one of the lowest figures in the EU (source: DREES)

Mutuelle: average monthly premium by age

Sources: DREES Panorama Complémentaire Santé 2024; Connexion France 2024–2025 market data. About 95% of French residents have a Mutuelle.

Expat / international health insurance (2026)

• April International MyHealth France — from €27.75/month (basic top-up to public system) up to €82.58/month (premium)
• Cigna Global — roughly €137/month (Silver) up to €420+/month (Platinum)
• Feather expat health insurance — from €72/month, with cancel-anytime flexibility

Cotisation subsidiaire maladie (CSM) — the "taxe PUMa"

If you live in France at least six months per year, have low professional income (under €9,612 in 2026 — 20% of the PASS), and have capital or patrimony income above €24,030 (50% of PASS), you owe a 6.5% contribution on the capital income above that threshold. The 2026 PASS (plafond annuel de la sécurité sociale) is €48,060.

The CSM is separate from the new 2026 visitor-visa healthcare contribution — how the two will interact is expected to be clarified by the implementing decree.

Healthcare access: a practical guide

A few things French healthcare guides tend to skip that can save you real money and frustration.

How to find an English-speaking doctor in France

• Doctolib. On doctolib.fr, use the Langues parlées filter to select "Anglais", then filter by specialty and city.
• Annuaire Santé — the official CPAM directory. annuairesante.ameli.fr lists every registered practitioner, their sector (1, 2, non-conventionné) and their fees.
• International hospitals. The American Hospital of Paris (Neuilly-sur-Seine) and Hôpital Franco-Britannique (Levallois-Perret) cater specifically to English-speaking patients.
• Consulate directories. The US, UK, Canadian and Australian consulates all maintain lists of English-speaking doctors in France.

Avoiding surprise bills: Secteur 1 vs Secteur 2

Médecins Secteur 1 charge the government-set conventional tariff (€30 for a GP, €31.50 for most specialists). Médecins Secteur 2 are allowed to charge above this — the excess is called a dépassement d'honoraires.

Assurance Maladie only reimburses on the Sector 1 tariff. So if a Sector 2 specialist charges €80, you're reimbursed based on €30 — and you pay €50 out of pocket unless your Mutuelle covers dépassements (higher-tier plans do, basic plans don't).

Before booking, check the doctor's sector in Doctolib's Conventionnement filter or directly on the Annuaire Santé. It's the single easiest way to avoid a surprise bill.

Emergency numbers in France

• 15 — SAMU (medical emergency)
• 112 — European emergency number (any language, any EU country)
• 114 — emergency SMS/fax for the deaf and hard-of-hearing
• 17 — police
• 18 — pompiers (fire brigade and paramedic first responders)

Mental health: Mon Soutien Psy 2026

The Mon Soutien Psy program gives every insured person access to up to 12 reimbursed psychologist sessions per year at €50 per session. Assurance Maladie reimburses 60% (€30/session); your Mutuelle typically covers the remaining €20. Since 2024, no GP referral is required — you book directly with a psychologue partenaire via monsoutienpsy.ameli.fr.

For other routine health services — including STD and STI testing, contraception, and most vaccines — public insurance reimbursement rules follow the same general logic (70% from Assurance Maladie + Mutuelle top-up). French centres gratuits d'information, de dépistage et de diagnostic (CeGIDD) also offer free, anonymous STI testing without requiring insurance.

A brief history of the French healthcare system

France's modern healthcare system was built over more than a century of reforms:

• Middle Ages — Religious hôtel-Dieu hospitals provide charitable care
• 1898 — First workplace accident insurance law
• 1930 — Assurances sociales extend health coverage to low-income workers
• 1945 — Sécurité Sociale founded after WWII, built on solidarity and universal coverage
• 1961 — Coverage extended to farmers
• 1978 — Coverage extended to the self-employed
• 2000 — Couverture Maladie Universelle (CMU) guarantees healthcare access to all legal residents
• 2016 — CMU replaced by PUMA (Protection Universelle Maladie), simplifying access for all stable residents
• 2019–2021 — 100% Santé reforms bring zero-out-of-pocket dental, optical and hearing baskets
• 2026 — LFSS 2026 introduces a mandatory healthcare contribution for non-EU visitor-visa holders accessing PUMA

Healthcare is also closely tied to French social security more broadly, which covers pensions, family benefits and unemployment alongside health — and to other essentials most expats eventually add, such as life insurance in France.