The French healthcare system

An introduction

France’s public healthcare system is one of the best in the world and is highly subsidized by the French government. Thanks to a new universal healthcare system introduced in early 2016, expats are eligible for public healthcare providing they can prove they've been consistently living in France for at least three months.

The French healthcare system

Medical expenses in France need to be paid in advance and are then reimbursed according to your level of coverage. There are some exceptions to this which are explained further in this article. 

Protection Universelle Maladie (PUMA)

Protection Universelle Maladie (PUMA) is France’s universal healthcare scheme. Introduced in January 2016, it grants all French residents (employed, unemployed, retired, expats) subsidized healthcare. Under PUMA, 70% of medical costs are reimbursed (100% for long-term treatment such as diabetes or cancer). Contributions -known as la cotisation subsidiaire maladie (CSM)- are set at 8% of an individual's annual eligible income. 

Complementary cover

The following schemes can be taken out alongside PUMA.

Couverture Maladie Universelle Complémentaire (CMU-C)

While PUMA covers about 70% of costs, the rest is to be paid by the patient, unless you are a recipient of CMU-C. This covers the remainder of medical charges and is available only for residents who are below a certain income. You can find out the income ceiling to apply for CMU-C on the CMU website  (in French). Recipients of CMU-C do not need to pay any up-front payments for healthcare.

Aide au paiement d'une Complémentaire Santé (ACS)

If you earn up to 35% more than the cut-off point for CMU-C, you may be eligible for ACS. The amount depends on place of residence and household composition. You can find the applicable thresholds on the CMU website  (in French). ACS gives financial assistance to help pay for complementary cover, which allows you to at least significantly reduce your health costs. It also includes a dispensation from advance payment of health costs.

Aide Médicale d’Etat (AME)

AME covers foreigners who have been living in France for at least three months, but do not have a residence permit (titre de séjour) and are not in the process of getting one. The AME has 'recommended' prices for healthcare, and will cover 100% of these costs. If you are charged more than that, you are responsible for the remaining fee. As with ACS, no advance payment is required. To qualify for AME, you need to be below a certain income level, which can be found on the CMU website .

Special circumstances

Under 25s: if you are under 25 you have to make an application for CMU-C or ACS with your parents. You only have to file a separate application if:

  • You have dependent children.
  • You are a student and receive aid by CROUS  (in French).
  • You don’t live with your parents, you don’t appear in their tax returns and you don’t receive a state alimony.

Students: if you are enrolled in a higher education institution you must pay a fixed fee at the time of registration, which allows you to be covered by the French social security system. You must pay your bills upfront, of which around 70% will be reimbursed. In some cases you might benefit from free CMU-C or ACS. Check out this page  for an explanation of the various cases (in French).

Mutuelle (private insurance)

To cover the cost of medical fees not covered by PUMA, and if you don’t qualify for any other kind of coverage, you can take out a private insurance. Companies’ employees are usually covered by the company’s policy, so this is something to check when moving to France to work.

Private health insurance in France is only a means to cover the 30% of fees that are not covered by the social security system, it does not guarantee faster treatment or affiliation with private practitioners.

Medical expenses in France need to be paid in advance and are then reimbursed according to your level of coverage. There are some exceptions to this which are explained further in this article. 

Protection Universelle Maladie (PUMA)

Protection Universelle Maladie (PUMA) is France’s universal healthcare scheme. Introduced in January 2016, it grants all French residents (employed, unemployed, retired, expats) subsidized healthcare. Under PUMA, 70% of medical costs are reimbursed (100% for long-term treatment such as diabetes or cancer). Contributions -known as la cotisation subsidiaire maladie (CSM)- are set at 8% of an individual's annual eligible income. 

Complementary cover

The following schemes can be taken out alongside PUMA.

Couverture Maladie Universelle Complémentaire (CMU-C)

While PUMA covers about 70% of costs, the rest is to be paid by the patient, unless you are a recipient of CMU-C. This covers the remainder of medical charges and is available only for residents who are below a certain income. You can find out the income ceiling to apply for CMU-C on the CMU website  (in French). Recipients of CMU-C do not need to pay any up-front payments for healthcare.

Aide au paiement d'une Complémentaire Santé (ACS)

If you earn up to 35% more than the cut-off point for CMU-C, you may be eligible for ACS. The amount depends on place of residence and household composition. You can find the applicable thresholds on the CMU website  (in French). ACS gives financial assistance to help pay for complementary cover, which allows you to at least significantly reduce your health costs. It also includes a dispensation from advance payment of health costs.

Aide Médicale d’Etat (AME)

AME covers foreigners who have been living in France for at least three months, but do not have a residence permit (titre de séjour) and are not in the process of getting one. The AME has 'recommended' prices for healthcare, and will cover 100% of these costs. If you are charged more than that, you are responsible for the remaining fee. As with ACS, no advance payment is required. To qualify for AME, you need to be below a certain income level, which can be found on the CMU website .

Special circumstances

Under 25s: if you are under 25 you have to make an application for CMU-C or ACS with your parents. You only have to file a separate application if:

  • You have dependent children.
  • You are a student and receive aid by CROUS  (in French).
  • You don’t live with your parents, you don’t appear in their tax returns and you don’t receive a state alimony.

Students: if you are enrolled in a higher education institution you must pay a fixed fee at the time of registration, which allows you to be covered by the French social security system. You must pay your bills upfront, of which around 70% will be reimbursed. In some cases you might benefit from free CMU-C or ACS. Check out this page  for an explanation of the various cases (in French).

Mutuelle (private insurance)

To cover the cost of medical fees not covered by PUMA, and if you don’t qualify for any other kind of coverage, you can take out a private insurance. Companies’ employees are usually covered by the company’s policy, so this is something to check when moving to France to work.

Private health insurance in France is only a means to cover the 30% of fees that are not covered by the social security system, it does not guarantee faster treatment or affiliation with private practitioners.

Further reading

Does this article help?

Do you have any comments, updates or questions on this topic? Ask them here: