Healthcare for pre-existing conditions in France

When moving to France, many expats are surprised to find that France's Assurance Maladie (public healthcare) doesn't ask about your medical history.

Unlike other countries, there's no medical underwriting, no health questionnaire, and no exclusions. Once you're in the system, you can access care just like any French resident.

If your condition qualifies as an ALD (which we'll explain in detail below), care related to that condition is covered at 100% of the standard Sécurité sociale rate after approval. That means no co-pays on ALD-related treatment — though some costs like specialist fees above standard rates and the daily hospital charge still apply, which is where a mutuelle comes in.

In this guide, we'll cover:

• How the French system handles pre-existing conditions
• What happens during the waiting period before your coverage starts
• France's ALD and mutuelle systems
• How to find a specialist
• Mental health care and specific conditions
• And how to plan your move so you're never left without care

French public healthcare (PUMa): the basics

France's universal healthcare system, PUMa, covers anyone who has lived in France legally for at least three consecutive months.

How you enrol in PUMa depends on your situation:

• Employees are enrolled through their employers, who start the process automatically.
• Self-employed workers must register for public health insurance through URSSAF.
• Students and non-working residents can apply for public health insurance through the standard CPAM route.
• Retirees can apply directly for PUMa through CPAM, or through pension coordination. EU retirees may use S1 forms from their home country.
• Spouses and children can also be enrolled under PUMa through the working family member.

You'll need to provide some key documents in your application, including:

• Valid ID and proof of legal status (visa, residence permit)
• A full birth certificate with both parents' names
• Proof of French address
• Proof of 3 consecutive months of residence (utility bills, rent receipts, bank statements)
• French bank account details (RIB/IBAN)

A note on timing: while three months is the standard eligibility threshold, the process isn't always straightforward. Some visa types (particularly visitor visas) have seen CPAM applications questioned or delayed. Keep your private insurance active until your French coverage is confirmed.

Private expat insurance and pre-existing conditions

Insurers typically define a "pre-existing condition" as any condition that existed, was treated, or showed symptoms in the 2–5 years before your policy started.

This includes conditions you're actively treating, as well as those in remission.

Most international expat health insurance handles pre-existing conditions in one of these ways:

At Feather, we don't ask for medical information upfront on our expat health policy. However, if you file a claim that appears related to a pre-existing condition, we may ask for further information.

What to do while waiting for public health insurance

After moving to France, you'll typically wait 3–6 months before you receive your Carte Vitale and benefit from full coverage.

During this time, you'll have to pay out of pocket or rely on coverage from your home country. For someone managing a chronic condition, this gap creates real concerns.

The good news is that once your CPAM application is submitted and processed, coverage is backdated to your application date. This shortens the uncovered gap and means you'll eventually be reimbursed, even if you do have to pay upfront initially.

The key is to submit your application as soon as you're eligible.

Managing the transition period

If you need ongoing treatment or medication while waiting for your Carte Vitale, here are a few practical tips:

• Bring supplies from home. For non-controlled medications, bringing up to 3 months' supply for personal use is common practice. Controlled substances have stricter rules — check with French customs before travelling.
• Know that France is often cheaper. Many medications cost far less in France than elsewhere. Even paying out of pocket, you may spend less than you expect.
• Apply to the public system immediately. Submit your CPAM application as soon as possible, since coverage is often backdated to your application date.

For more complex conditions, maintaining coverage from your home country during the transition is the safest option if possible. It's also a good idea to bring complete medical records with you — translated into French if you can.

ALD: France's long-term illness programme

ALD (Affection de Longue Durée) is one of the best parts of the French healthcare system for people with chronic conditions.

If your condition qualifies, all care related to that condition is covered at 100% of the standard Sécurité sociale rate. This means you won't pay the usual 30% co-pay (ticket modérateur) on ALD-related consultations, treatments, and medications.

However, "100%" refers to the Sécurité sociale tariff base — not 100% of whatever a doctor charges. Specialist fees above standard rates (dépassements d'honoraires) and the daily hospital charge (forfait hospitalier, €20/day) still apply, which is why a mutuelle remains important even with ALD status.

The official ALD list — still called "ALD 30" for historical reasons — originally included 30 conditions. It now includes 29 after severe hypertension was removed in 2011. Conditions on the list include cancer, diabetes (type 1 and 2), HIV, multiple sclerosis, chronic kidney disease, Parkinson's, Alzheimer's, and more. A full list is available on the Ameli website.

Beyond the main list, there are two additional categories:

• ALD 31 (hors-liste): For serious conditions not on the main list but requiring ongoing expensive treatment — for example, severe endometriosis or chronic ulcers. Your doctor can request this if your condition meets the criteria.
• ALD 32: For patients with multiple conditions that, taken together, create an invalidating state requiring prolonged costly treatment.

To apply for ALD status:

1. Enrol in French public healthcare (CPAM).
2. Register with a médecin traitant (your designated GP).
3. Your GP (or a specialist) files an ALD application with a protocole de soins.
4. CPAM's medical adviser reviews and approves. This typically takes a few weeks to a couple of months.
5. Once approved, related care is covered at 100% of the standard rate.

Mutuelle: top-up insurance for chronic conditions

A mutuelle is supplementary insurance that covers what the public system doesn't — co-pays, hospital daily charges, specialist extra fees, and dental/optical treatments.

Unlike private expat insurance, French mutuelles can't exclude pre-existing conditions under France's contrat responsable regulations. Some mutuelles have waiting periods for specific benefits, but your chronic condition won't be excluded.

If you have a chronic condition, prioritise:

• Strong hospital coverage (including the daily hospital charge of €20/day, or €15/day in psychiatry)
• Good specialist coverage (for doctors who charge above standard rates)
• Solid dental/optical if you need it

Even with ALD covering 100% for your condition, the mutuelle handles:

• The forfait hospitalier (€20/day hospital charge)
• Specialist fees above standard rates
• Co-pays for non-ALD care
• Dental and optical

Employer mutuelles are generally good value. If you're buying individually, compare plans carefully.

If you're not sure where to start, check out Feather's mutuelle plans, or book a call with one of our experts to discuss your situation.

Accessing medications in France

When getting medications in France:

1. Bring documentation. Your medication list and prescription from home.
2. See a French GP. They'll prescribe the local equivalent.
3. Expect substitutions. Pharmacists may provide generics, and brand names often differ from what you're used to.

Some controlled or specialist-restricted drugs require specialist follow-up. Rare medications may need prior authorisation, so check in advance.

Most diabetes medications cost between €9–€15 out of pocket without ALD. With ALD, the co-pay drops to around €1. More broadly, medications for most conditions are relatively inexpensive in France compared to countries like the US or UK.

Finding specialists and continuing treatment

The best way to find a specialist after moving to France is to use Doctolib, France's main booking platform, which lets you filter by language, location, pricing, and availability.

It's also helpful to understand France's care pathway system:

1. You register with a médecin traitant (your GP).
2. Your GP refers you to specialists as needed.
3. Following this pathway means better reimbursement. You can see specialists without a referral, but you'll pay more.

Wait times vary by region and specialty. To speed things up, try widening your geographic search, calling hospitals directly, or having your GP mark your referral as urgent.

If you're currently undergoing treatment for a serious condition:

• Arrive with complete records (translated into French if possible).
• Ask your GP to coordinate with the right hospital service.
• Apply for ALD status to streamline cost coverage.
• French hospitals are experienced in continuing treatment plans from other countries.

Mental health care

French public health insurance covers mental health, including:

• Psychiatry visits (reimbursed as specialist consultations)
• Psychologist sessions through Mon Soutien Psy — a government programme offering up to 12 reimbursed sessions per year at €50/session. No doctor's referral is required; you can self-refer directly via the Ameli directory. Sessions are covered 60% by Assurance Maladie and 40% by your mutuelle.
• Psychiatric medications
• Hospital psychiatric care

However, while coverage exists, access is limited by capacity. Wait times for psychiatrists can stretch to months, so many expats start with private practitioners and transition to reimbursed pathways later.

If you need English-speaking mental health care, use Doctolib or ask your GP for a referral.

Guidance for specific conditions

If you're looking for more information about your specific condition, here's a brief overview:

• Diabetes: Both type 1 and type 2 qualify for ALD. After approval, diabetes-related care and medications are covered at 100% of the standard rate.
• Cardiovascular conditions: Major cardiac conditions qualify for ALD. France has strong hospital networks for cardiac care.
• Cancer: Active cancer treatment qualifies for ALD. Bring all records and treatment protocols so your GP can coordinate with the right oncology service.
• Autoimmune conditions: Many qualify for ALD or ALD hors-liste depending on severity. Coverage for biologics and speciality medications is generally good once you're enrolled.
• HIV: HIV qualifies for ALD, and France has strong HIV care networks with antiretroviral coverage at 100%.
• Chronic pain: This can be more challenging. Coverage exists, but access to pain specialists can be limited in some areas. Check directly with your GP.
• Rare diseases: France has a network of rare disease reference centres. Research which centre handles your condition before you move.

What to do if you're denied coverage

PUMa application rejections are almost always administrative, caused by:

• Incomplete documents
• Gaps in residence proof
• Applicant still attached to another EU system
• Unclear legal status

To fix your application, identify what went wrong, gather the required documents, and submit a written review request to CPAM's CRA (Commission de Recours Amiable). Most rejections can be resolved by fixing the documentation issue.

If your ALD application is rejected:

• Ask your doctor to review their submission.
• Make sure your condition is properly documented.
• If it doesn't qualify for the main list, ask about ALD hors-liste (ALD 31) or ALD 32 if you have multiple conditions.
• Appeal through CPAM's standard process.

Planning your move

To make things as easy as possible, here's what to do when moving to France with a pre-existing condition, broken down by stage.

Before you leave:

1. Gather complete medical records (translated into French if possible)
2. Make copies of all current prescriptions
3. Stock up on medications (up to 3 months for non-controlled)
4. Research your condition's treatment in France
5. Set up (or maintain) home-country insurance for the gap period
6. Get a full birth certificate with both parents' names
7. Open a French bank account

During your first month in France:

1. Once you've found accommodation, gather proof of address
2. Register with CPAM as soon as you're eligible
3. Find a médecin traitant (GP)
4. Get prescriptions reissued by your French GP

During the first three months (the gap period):

1. Continue gathering 3 consecutive months of residence proof
2. Start specialist referrals if needed
3. Manage the gap with self-pay or bridge insurance

After receiving your Carte Vitale:

1. Confirm your coverage is active
2. Apply for ALD status if your condition qualifies
3. Choose and enrol in a mutuelle
4. Set up your regular care (GP, specialists, pharmacy)

Further help

Need expat health insurance for the transition period? Explore Feather's expat health insurance

Looking for a mutuelle once you're in the system? Explore our private health insurance plans

Not sure what coverage you need? Book a call with one of our experts to discuss your situation.

This guide was created with input from healthcare and insurance experts specialising in expat coverage in France. Requirements and programmes can change — always verify current details with Ameli or your local CPAM.