Guide to healthcare in France

The French healthcare system

If you are coming to live in France with a salaried position in a company,  the road to healthcare coverage is fairly smooth - especially if your company helps set you up in the system which they often do, though they are not obliged to. 

Otherwise, there are other ways to access the French healthcare system. Expats equipped with the right tools and info, who are coming to work in France will be able to get a numero de securité sociale and then a carte Vitale, the French state healthcare card that grants you access to doctors, hospitals, pharmacies and other medical services. 

And, of course, if you forgo insurance you still won’t be denied healthcare but you will be personally billed for services.

Ameli.fr, the website portal for the French health insurance programme will prove to be an invaluable resource to you. Typically you open your health insurance account through Ameli. Some of the information on Ameli is in English, to assist foreign nationals opening accounts.

Who can access the French healthcare system?

All legal residents of France have access to the public healthcare system through contributions to French Health insurance, the Caisse Primaire d’Assurance Maladie. The CPAM is the department level of the French national insurance fund and will be your first line of contact. If you’re employed, you can apply for healthcare as soon as you start work.

French residents access the French healthcare system by making French social security contributions through their place of employment, or as a self-employed person. You can find all the details in French on the second page of the application form.

Non-EU citizens living in France on a long-stay visa working or residing in France on a stable basis will also be covered by health insurance. In other words, once you are granted a long-stay visa, the road forward for applying for healthcare in France is the same for EU, EEA or non-European nationals. For example, you must have a document attesting to 'the regularity of your situation’,  (ie you have a job and the proper residency visa). And you’ll need to fill out a form to apply for entry into the health insurance system. This can be found on the official French public service website.

How to open a French healthcare account

To open your account with Ameli, you’ll need to include several documents with your application form. These include a copy of your passport, your visa, a certified or authenticated birth certificate (it’s helpful to have this officially translated), proof that you’ve lived in France more than three months (a utility bill, or a rental agreement can help with this) and a bank account, the latter so you can get reimbursed for any medical costs, covered, but which you might have paid for out of pocket. 

If you, and not your employer, are taking care of your own registration into the CPAM system, you need to do so within the first eight days of employment in France though you are generally entitled to healthcare coverage as soon as you start your job. You’ll need to take proof of employment and your long-stay visa with you to the CPAM office. See this link for further information: https://www.service-public.fr/

A European Health Insurance Card (EHIC) or carte européenne d’assurance maladie can be obtained through your Ameli account as well and is useful if you travel in the EU and ever get sick or need to be repatriated.

Since 2020, the CPM has also handled health insurance for the self-employed. If you are a travailleur/se indépendant/e you’ll pay for health coverage through social security contributions. After registering as self-employed, your business number will be forwarded to the CPM through which you will then apply for registration in the healthcare system.

Parallel healthcare coverage also exists for non-permanent residents, this includes expats after three months of legal residence in France who can also provide proof of their plan to continue living in France on a “stable and regular basis (specifically, 183 days per year). This coverage, known as The Protection Maladie Universelle (PUMA) replaced the the universal health cover scheme (CMU) and was introduced in 2016. A carte vitale through PUMA is now available to any person living in France, employed or not, with the proper visa as long as they do not otherwise benefit from French health insurance coverage or are covered by another country.

British citizens, no longer part of the EU since Brexit, can also access health care through a Global Health Insurance policy such as the UK’s Global Health Insurance Card (GHIC) in the case of a temporary stay, for example, if you come for temporary posted work, or as a student. 

It can feel a bit like a  Catch-22 when applying for a long-stay visa, in that you must show proof of healthcare cover with your application (in fact you’ll have to as healthcare coverage is a prerequisite for working and living in France) but once you have a French visa or carte de sejour (residence card) you must register in the French healthcare system. Visit the Sécurité sociale indépendants website.

How to register for healthcare in France

If you are a British or other non-EU national, you can apply for PUMA through your local CPAM office and unless you are already working in France, you’ll need to live in the country to establish residency before you apply. Typical paperwork you may need to provide for this could include:

1. Proof of identity and legal residence (passport and visa, if applicable). 
2. Original and copies of birth and marriage certificates. 
3. Proof of three months residence in France  (utility bills or a rental agreement work). 
4. An employment contract.
5. Evidence of income and your declaration de médecin traitant (registration with your general practitioner).
6. You need a French bank account in your name. There’s more information about how to register here.
    

The PUMA is a relatively new level of bureaucracy, and there’ve been reports that the process can be lengthy and that officials aren’t entirely up to speed on all the details. So it’s wise to come equipped to any meetings with official information about the PUMA and all that you want or that you’re entitled to. If something the official says doesn’t sound right, go through this information with them. You can print it out from their website.  

Once registered, you’ll get a temporary social security number sent in the post within 1 to 3 months. Then you’ll receive a document called an ‘attestation de droits à l’assurance maladie’. This confirms your right to French state healthcare and your French social security number. 

Once you’ve got the ‘attestation de droits à l’assurance maladie’, you can apply for the ‘carte vitale’.  This can easily take six weeks to get. (If you need healthcare before you receive your carte vitale, use your social security number. Ask your healthcare provider for a ‘feuille de soins’ and send it to your CPAM office to be refunded for any treatment you’ve paid for out of pocket). If you have questions about your application, your local CPAM office is your point of contact for questions.

How do I use the French healthcare system once I am registered?

The carte vitale is your key to accessing care and gaining reimbursements efficiently. It’s a green card with a microchip containing your necessary social security information. You will need to show it at any doctor’s appointment, hospital visit or for any prescriptions from a pharmacy.

How much does health insurance cost in France?

Standard state French healthcare is free in France, however, most people opt for top-ups, known as mutuelles. These can be paid either by an employer or through a combination of government insurance companies and private contributions. 

Opting for a mutuelle ensures that most, if not all, your costs are covered, including dental and ophthalmology care which are usually charged additionally. Otherwise how much you’ll be reimbursed depends on the cost of your consultation, procedure, and treatment, all of which are determined by France’s Social Security System. Typically but not absolutely, the repayment rate (‘taux de remboursement’) is 70% of the flat fee for a consultation, 65% for medication, and consultations or procedures with specialists. Repayment forms are automatically sent to Sécu, through your carte vitale. There’s information (in French) about reimbursements online.

If you are coming to France and cannot benefit from French health care coverage through any of the above scenarios, you can, and should always, of course, take out private health insurance. This varies depending on the age, health, and the policy chosen. Some are specifically designed for expats. Shop around, ask for recommendations from people you know in similar situations or get ideas through expat online forums to find a policy that best fits your needs.

Choosing a doctor

The general practitioner is your front line for referrals to specialists, and in France you can choose your GP (assuming they are taking new patients of course). Get referrals from friends and colleagues, or do your own research. Ameli offers a comprehensive directory of doctors and specialists.

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Doctolib platform to schedule medical appointments

Doctolib is a completely free digital platform in France. Designed to increase doctor availability by scheduling medical appointments with various healthcare professionals. It's rapidly grown to become a favourite medical platform in France. 

Whether you need an urgent consultation or you’re planning ahead, Doctolib connects you with available doctors in your area, even on short notice (subject to availability). You can choose the best-suited physician by reading each professional's background, and viewing their qualifications, certifications, and areas of expertise.

Doctolib overcomes the shortage of doctors that certain regions in France face. Several practices are overwhelmed and can't take on new patients. But with Doctolib, you can easily discover which doctors are welcoming new patients, sparing you endless hours of research and phone calls.

Navigating Doctolib: A quick guide
If you've just landed in France and Doctolib is a completely new concept to you, here's a quick rundown:

1. Platform access:
Begin by exploring the official Doctolib website. For those on the go, there's a handy mobile app for both Android and iOS.

2. Find a healthcare professional:
On the main page, input the medical speciality and either the city or postal code to find professionals nearby.

3. Choose your doctor:
Read all about the practitioners. Some even showcase reviews from their patients, aiding you in making a well-informed selection.

4. Schedule an appointment:
Once you've settled on a doctor, pick an appointment slot that fits your calendar. Adhere to the on-screen prompts to finalize your booking. Remember, certain doctors might seek confirmation, while others instantly approve the appointment.

5. Virtual consultations:
With the digital age in full swing, numerous healthcare providers on Doctolib extend online consultations. If you can’t find a local doctor, if you’d prefer an online appointment then you can filter your search to doctors available for virtual appointments.

Women’s healthcare in France

Gynaecologists in France are accessible through the Sécu (in France you don’t need a referral to see a gynaecologist.) Ameli, again, is a good resource for choosing a gynaecologist, as is the website Gyne, which has a list of gynaecologists in the country with reviews and recommendations from fellow patients. Routine examinations for breast cancer are recommended for women aged 50 to 74 and are available through gynaecologists, as are cervical cancer screenings. 

Contraception is easily accessible in France. Birth control pills and other contraception choices are available through a doctor, gynaecologist, or midwife (prevalent in the country). Birth control pills are partially reimbursed through the first-tier health coverage. Condoms are readily available in pharmacies and supermarkets, and are free at family planning centers and sexual health clinics.

France has the highest birth rate in Western Europe and supports pregnant women with care. Pregnant women in France are offered a minimum of seven obligatory medical check-ups including at least three scans. The majority of pregnancy costs are covered by insurance, but you need to declare the pregnancy to the Health Insurance Fund (Casse d’Assurance Maladie or CAM) and Family Allowance Fund (Caisse d’Allocations Familiales or CAF) within the first 14 weeks of pregnancy to receive health and monetary benefits. The French government will pay for IVF for women up till age 43.

Termination of pregnancy is legal within the first 14 weeks of pregnancy; doctors, hospitals, or private clinics can carry out abortions. Paid maternity leave is 16 weeks in France and typically starts 6 weeks before the due date. This can be extended depending on what your company’s union has negotiated. New mothers are entitled to a postnatal examination within two months of giving birth, and, if necessary, physiotherapy. Postnatal psychiatric and emotional care is also widely available. 

Children’s healthcare in France

Expats might be surprised at first by what seems a rather laissez-faire attitude to children’s health. Kids are readily exposed to muddy germs, for example, to build immunity.  But, children’s healthcare is first-rate in France, starting with well-thought-out, nutritious lunches at school (the week’s menu is posted outside and includes three courses including a cheese section),  through to mandatory vaccinations (the usual jabs), scheduled at fixed times between birth and 13 years of age, and available through maternal and child health clinics,  as well as free health and dental check-ups to age 18,  through their parent or guardian’s coverage.

Children in France are also given twenty compulsory screenings between birth and age 6 to check for genetic diseases such as sickle cell disease and cystic fibrosis as well as to test their hearing and sight; reveal any language or learning problems early; and diabetes. Three Child Health Certificates (certificats de santé de l’enfant – CSE) are given within eight days of birth; after 9 months; and after two years of age, and will need to be provided when enrolling children at school, for example.

Private healthcare

Despite its quality universal healthcare, private hospitals such as the American Hospital of Paris in the suburb of Neuilly,  or the Hertford British Hospital have been popular with expats who can afford the private fees. The care is premium and the staff are fully bilingual. That said, many of the major public hospitals in the city will have some English-speaking staff on shift. Outside of Paris, it is not as easy to find English-speaking hospital staff, although you are likely to do so in major tourist centres such as Nice. 

Healthcare emergencies 

If you go to the hospital, you will need to show your carte vitale, EHIC, or other proof of insurance. And if you are uninsured, have low or no income or even your residency status is irregular, you still will not be denied healthcare. You might also be eligible to apply for assistance under Aide Médicale d’Etat (AME), a social safety net that helps cover medical expenses for low-income individuals in irregular situations in the country. People who have lived in France for at least three months may be eligible for this service.

Covid

France had some of the strictest quarantine rules from the start of the Covid pandemic. At certain points of the pandemic, lockdowns and curfew were imposed and a passe sanitaire (health pass) was required to step out of your home for the time you were allowed each day. 

Throughout those challenging times, the health system had provided psychological aid. In the summer of 2020, the country reopened to tourists and second homeowners whose primary countries might have been on a French Red list, but it rolled back into lockdowns and re-introduced various restrictions several times in the subsequent year with various waves. The country had a high vaccination rate, and proof of vaccine is still required at many public and private institutions. The official Coronavirus (COVID-19) website is a necessary resource for the latest developments in the fight against the Pandemic in France.

Summary

Getting set up in the French Health Care system at first can prove to be challenging for people moving to France, especially for self-employed or non-working residents. If you are hired by a French company you have the advantage of them having to guide you through the necessary steps. 

The good news is that it’s more straightforward than it used to be!  And once in the system (or covered with a good insurance policy), you will benefit from one of the world’s top medical systems.  

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