Health Insurance in France: A Comprehensive Guide

France is widely recognized for having one of the most efficient and comprehensive healthcare systems in the world. The cornerstone of this system is its health insurance, which ensures access to high-quality medical care for both residents and visitors. Whether you're a French citizen, an expatriate, or a tourist, understanding how health insurance works in France is crucial to navigating the country's healthcare landscape. This article offers an in-depth look into the structure, coverage, costs, and options available under France’s health insurance system.

1. Overview of the French Healthcare System

The French healthcare system, often referred to as “Sécurité Sociale” or “l'Assurance Maladie,” is primarily a public system that provides universal coverage to residents. It operates on a solidarity-based model, where contributions are pooled together to provide health services to all, regardless of income or health status.

The system is funded by a mix of employer and employee payroll contributions, as well as government funds. This ensures that everyone has access to a wide range of medical services, including general practitioner (GP) visits, specialist consultations, hospital care, prescription medications, and preventive care.

2. Public Health Insurance (Assurance Maladie)

Eligibility

Public health insurance in France is available to:

• French citizens

• Legal residents who have lived in France for over three months

• Employees working in France

• Self-employed individuals

• EU/EEA citizens with valid documents

• Retirees under certain conditions

Since the implementation of the Protection Universelle Maladie (PUMA) in 2016, almost all residents are eligible for health insurance, making the system more inclusive and accessible.

How It Works

When you register for public health insurance, you receive a Carte Vitale — a green smart card that contains your medical information. This card is used at clinics, hospitals, and pharmacies to automatically process your reimbursements.

The Assurance Maladie usually reimburses 70% of most medical costs. However, some services such as hospitalization or long-term treatments may be reimbursed up to 80% or even 100%, depending on the case.

3. Complementary Health Insurance (Mutuelle)

While public insurance covers a significant portion of healthcare expenses, there are out-of-pocket costs. To minimize these expenses, most people in France opt for complementary health insurance, known as a mutuelle.

Key Features of a Mutuelle:

• Covers the remaining 30% of costs not reimbursed by the public system

• Some plans cover dental, optical, and hearing services, which are poorly reimbursed by the public system

• Offered by private non-profit or for-profit insurers

• Often provided by employers as part of employee benefits

As of 2016, employers in France are legally required to provide a group mutuelle to their employees, covering at least 50% of the premium.

4. Cost of Health Insurance in France

Public Insurance Contributions

The contributions to public health insurance are primarily taken from salaries. On average:

• Employees contribute around 0.75% of their gross salary

• Employers contribute 13% or more

Self-employed individuals pay contributions based on their income, typically through the URSSAF system.

Cost of a Mutuelle

The cost of a complementary health insurance plan depends on several factors, including:

• Age

• Health status

• Level of coverage

On average, a mutuelle can cost between €30 and €100 per month. Family plans and premium coverage options tend to be more expensive.

5. What Does Health Insurance Cover in France?

Included in Public Insurance:

• Doctor Visits: 70% reimbursed

• Specialist Consultations: 70%

• Hospital Stays: 80–100%

• Prescriptions: 15–100% depending on the drug

• Maternity and Childbirth: Largely covered (100% in many cases)

• Mental Health Services: Increasingly included

• Preventive Care: Screenings and vaccinations

Services with Lower Reimbursement:

• Dental Care: Around 70%, but limited for complex procedures

• Glasses and Lenses: Minimal coverage

• Hearing Aids: Low reimbursement unless complementary insurance is used

6. Private Health Insurance in France

Although the majority of people rely on public insurance plus a mutuelle, there are private insurance options available, especially for:

• Tourists

• International students

• Expats not yet eligible for PUMA

• Those who prefer private healthcare facilities

Private insurance plans can offer faster access to specialists, single rooms in hospitals, or global coverage — useful for frequent travelers.

7. How to Apply for Health Insurance in France

Step 1: Register with the CPAM (Caisse Primaire d'Assurance Maladie)

This is the local branch of the national health insurance. You must provide:

• Proof of identity

• Proof of address

• Residence permit or visa

• Proof of residence in France for over three months

Step 2: Receive Your Social Security Number

Once your application is approved, you’ll get a French Numéro de Sécurité Sociale — necessary for all medical and social services.

Step 3: Apply for the Carte Vitale

Once you have your social security number, you can request your Carte Vitale, which simplifies payments and reimbursements.

Step 4: Choose a Primary Care Physician

It is required to register with a médecin traitant (primary doctor) to receive full reimbursements. Not doing so can reduce your reimbursements by 30–40%.

8. Healthcare for Tourists and Temporary Visitors

Tourists from the EU/EEA can use their European Health Insurance Card (EHIC) for urgent medical care in France. Non-EU visitors are advised to purchase travel insurance that includes health coverage before entering France, as healthcare can be expensive without insurance.

9. Health Insurance for Students and Expats

International Students

• Students from the EU can use their EHIC.

• Non-EU students must enroll in the public health insurance system unless they are under a private plan from their home country.

Expats

Expats can register with PUMA after staying in France for at least three consecutive months, provided they meet residency and income conditions. Until then, they can rely on private insurance.

10. Strengths and Challenges of the French Health Insurance System

Strengths

• Universal Coverage: Almost everyone has access to healthcare

• High-Quality Care: Consistently ranks among the best systems globally

• Affordable Services: Due to heavy public subsidization

• Choice and Access: Patients can choose their doctors and specialists

Challenges

• Administrative Delays: Paperwork can be slow for foreigners

• Out-of-Pocket Costs: Without a mutuelle, expenses can add up

• Underfunded Public Hospitals: Staff shortages and waiting times in some regions

Conclusion

Health insurance in France is a critical component of a system designed to ensure the well-being of all residents. With its dual structure of public coverage and complementary insurance, France achieves a balance between accessibility, affordability, and quality. While there are still some gaps — particularly in dental and optical care — the overall system remains one of the best in the world. Whether you're planning to move to France, study, work, or simply visit, understanding how health insurance works will help you navigate the healthcare system more confidently and securely.