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The essentials
- Universal coverage via PUMa (Protection Universelle Maladie) since 2016, replacing the older CMU ;
- 70% of GP visits and 80% of public hospital fees are reimbursed by Sécurité Sociale ;
- A mutuelle complémentaire (top-up insurance) covers the remaining 20-30% and most dental and optical costs ;
- Ameli's English-speaking line: 09 74 75 36 46 (Mon-Fri 8:30 am to 5 pm, standard rate).
Explore the healthcare guides
Three detailed guides cover the steps every newcomer eventually faces. The current page is the overview — pick the one that matches your situation.
Carte Vitale Application
Eligibility, documents, the four-step Ameli process and realistic 2026 processing times for the green health card.
European Health Insurance Card
How the EHIC (and the UK GHIC) covers short stays in France, what it does and does not pay for, and how to apply at home.
Hospitals in France
Public versus private, emergency rooms, tiers payant, the daily forfait hospitalier and what English-speaking patients should expect.
How the French Health System Works
France runs a Bismarckian model: healthcare is funded through compulsory social contributions (cotisations sociales) deducted from wages, pensions and self-employed income, then redistributed by the public insurer. Two layers of cover sit on top of that.
Sécurité Sociale, the first layer
The Assurance Maladie (universally called Sécurité Sociale or Sécu) reimburses a regulated share of every consultation, prescription and procedure delivered by a conventionné practitioner. It is administered locally by the CPAM (Caisse Primaire d'Assurance Maladie) and managed online via Ameli (Assurance Maladie en Ligne). The Carte Vitale is the physical key: presenting it triggers automatic reimbursement to your French bank account, usually within five working days.
The mutuelle, the second layer
Sécurité Sociale rarely covers the full cost. A private complementary insurance — a mutuelle — picks up the remaining 20-30%, plus most of what Sécu pays poorly (dental work, glasses, hearing aids, hospital co-payments). Most French employers are required by law to offer a group mutuelle and to cover at least 50% of the premium ; self-employed, retirees and the unemployed buy an individual policy.
Tiers payant: no upfront payment
When tiers payant applies, the provider is paid directly by Sécu (and your mutuelle for the top-up share), so you don't pay upfront. It is automatic at pharmacies, hospitals, labs and most specialists for the Sécu share, and partial at GP surgeries. Without tiers payant, you pay first and the reimbursement lands a few days later.
PUMa: Who Is Covered
Since January 2016, PUMa (Protection Universelle Maladie) has replaced the older CMU. It opens healthcare rights to anyone who lives in France regularly and stably — a deliberately broad principle that captures most expats once they've put down roots. Two conditions must be met:
- Legal residence: a valid visa, titre de séjour, or EU/EEA/Swiss citizenship ;
- Stable presence: at least three uninterrupted months in France, with the intention to stay (typically at least 183 days per year).
A few profiles bypass the three-month wait or follow a dedicated registration route:
- International students register from day one through etudiant-etranger.ameli.fr ;
- EU/EEA/Swiss pensioners use the S1 form from their home country to transfer healthcare rights to France without paying additional contributions ;
- Asylum seekers are covered as soon as their application is registered, ahead of the three-month threshold ;
- Workers on a French employment contract are typically registered by their employer from the first payslip.
Households on low incomes can apply for the C2S (Complémentaire Santé Solidaire), which since 2019 has replaced the CMU-C and ACS. C2S is either free or capped at around 30 euros per month per person depending on income, and it bundles the Sécu share with a state-run mutuelle equivalent. For the residency conditions themselves, see our guide to French visas and residency.
Reimbursement Rates by Service
Reimbursement is based on a regulated tarif de convention, not the price you actually paid. If a specialist charges above that tariff (a so-called dépassement d'honoraires), Sécu refunds 70% of the regulated amount only, and your mutuelle decides whether to absorb the excess.
| Service | Sécu rate | Top-up needed |
|---|---|---|
| GP visit (with médecin traitant) | 70% | 30% |
| Specialist (with referral) | 70% | 30% |
| Specialist (without referral) | 30% | 70% |
| Public hospital stay | 80% | 20% + room costs |
| Generic medication | 65-100% | remainder |
| Branded medication | 15-65% | remainder |
| Routine dental care | 70% on tariff | most of the extra |
| Glasses and lenses | minimal | almost all |
Two reforms reshaped the picture in recent years. The 100% Santé programme guarantees zero out-of-pocket costs on a basket of dental crowns, hearing aids and glasses (provided you hold a responsible mutuelle contract). And in 2024, the penalty for skipping the médecin traitant route was tightened: specialists consulted directly are reimbursed at 30% instead of the previous 30-70% range.
Finding a Doctor (Médecin Traitant)
The French system runs through a registered GP — your médecin traitant. Declaring one with Sécu is what unlocks the 70% reimbursement rate on consultations and the standard rate on specialist referrals. Without a declared médecin traitant, you stay in the parcours de soins non coordonné and Sécu reimburses only 30% of any consultation.
How to choose and declare one
- Search by postcode and specialty on Doctolib, the dominant booking platform in 2026 ; filter for English-speaking practitioners ;
- Or use the official Ameli annuaire santé at annuairesante.ameli.fr — it lists every conventionné doctor near you ;
- At your first appointment, ask the doctor to fill in the Déclaration de Médecin Traitant (Cerfa S3704) ;
- Sign it and either let the doctor transmit it electronically, or upload it yourself in your Ameli account.
Direct-access specialists
A few specialists are en accès direct — you can see them without a referral and still get the 70% rate. The list includes gynaecologists, ophthalmologists, dentists, paediatricians (for under-16s) and psychiatrists (for under-26s). Everyone else requires a referral from your médecin traitant to avoid the 30% penalty.
Pharmacies in France
French pharmacies do far more than dispense medication. The neon green cross signals a pharmacien who is also a first-line health adviser, trained to triage symptoms and recommend over-the-counter treatments. Since 2019, pharmacists can also administer the seasonal flu vaccine on the spot, and in 2026 most can perform rapid tests for COVID and angina.
- Many medications sold over the counter elsewhere (paracetamol, ibuprofen, decongestants) are behind the counter in France — ask the pharmacist by name ;
- Prescription medication is reimbursed automatically when you present your Carte Vitale, with tiers payant on the Sécu share ;
- For nights, Sundays and public holidays, the pharmacie de garde rota covers each commune — find the nearest open one at monpharmacien.sante.gouv.fr ;
- Many pharmacies also offer Doctolib appointment booking for specific services (vaccination, family planning, smoking cessation).
Bring your ordonnance (prescription) and Carte Vitale together — without the card, you'll pay upfront and reclaim later through the Ameli portal.
Mental Health Support
Mental health has moved up the public-health agenda in France over the past five years, and several free national lines are worth saving in your phone before you need them.
- 3114 — national suicide prevention line, free, 24/7 ;
- 3919 — domestic violence helpline, free, anonymous, multilingual support available ;
- SOS Help: 01 46 21 46 46 — France's only English-language emotional-support line, daily 3 pm to 11 pm.
MonSoutienPsycho: subsidised therapy
Since 2022, the MonSoutienPsycho programme reimburses up to 12 sessions per year with an approved psychologist, with no upfront payment. Each session is set at €50 and is fully covered by Sécurité Sociale and your mutuelle, provided you start with a referral from your médecin traitant. Find approved psychologists on monsoutienpsy.ameli.fr.
Psychiatrist or psychologist?
A psychiatre is a medical doctor, can prescribe medication, and is reimbursed by Sécu like any other specialist (70% of the regulated tariff). A psychologue is not a doctor, charges freely, and is only reimbursed under MonSoutienPsycho or by a generous mutuelle. For long-term therapy beyond the 12-session window, a private mutuelle with a psychologie guarantee is the practical solution.
English-Speaking Healthcare
Most French doctors speak basic English, but the gap widens at administrative front desks and specialist clinics. A few resources fill the void:
- Ameli's English helpline: 09 74 75 36 46 (Mon-Fri 8:30 am to 5 pm, standard rate) — for any Carte Vitale or reimbursement question ;
- American Hospital of Paris in Neuilly-sur-Seine — fully bilingual, accredited as a French private hospital, expensive without a strong mutuelle ;
- Hertford British Hospital in Levallois-Perret (now Hôpital Franco-Britannique) — historically British, English-speaking staff still available ;
- Doctolib lets you filter by spoken language at the booking step — useful in Paris, Lyon, Bordeaux, Nice and other expat-heavy cities ;
- The English-speaking helplines directory covers banks, energy, telecoms and admin lines beyond healthcare.
In a genuine medical emergency, dial 112 (operators are trained in English) or 15 for SAMU. The full list is on our emergency numbers page.
Mutuelle: Top-Up Insurance
A mutuelle is the single most consequential health decision an expat makes after the Carte Vitale. It is what stops a routine root canal, a pair of glasses or a hospital co-payment from becoming a four-figure bill.
Three routes to a mutuelle
- Group mutuelle through an employer — at least 50% of the premium covered by the employer, mandatory enrolment in most cases ;
- Individual mutuelle for the self-employed, retired or unemployed — bought directly, fully out of pocket ;
- C2S (Complémentaire Santé Solidaire) — the means-tested public mutuelle, free or up to 30 euros per month per person depending on income.
In 2026, individual mutuelle premiums run roughly 20 to 50 euros per month for a single adult and 60 to 150 euros per month for a family, depending on age and the level of cover (notably for dental and optical). Compare two or three quotes before signing — guarantees, exclusions and waiting periods vary widely between insurers, and the cheapest contract is rarely the best value once you read the fine print on dental crowns and hospital private rooms.
The digital Carte Vitale (apCV)
Since 2023, France has been rolling out a smartphone version of the Carte Vitale called apCV. It is being deployed département by département and is expected to cover most of the country by 2027. The physical card remains valid throughout — apCV is a complement, not a replacement — but it spares you reaching for a wallet at every appointment.