How the French healthcare system works
If you’re thinking of moving or retiring to France, you’ll need to know that you can easily access the healthcare you need now or in the future. Health isn’t something to leave to chance, so the French healthcare system is one of the main topics to research before making the move across the channel.
The good news is that, although the French healthcare system differs slightly from the UK’s, it is generally straightforward to navigate and provides a high level of care for UK expats.
- France offers universal healthcare coverage through the Protection Universelle Maladie (PUMA). It’s funded through social security contributions and “co-payments” – fees charged for services and prescriptions.
- The important thing to note is that healthcare in France is not free, though it is subsidised. In most cases, you’ll pay for appointments and treatment upfront and then be partially reimbursed by the state insurance scheme (the Assurance Maladie).
- PUMA provides healthcare for all residents, including expats. But as a foreigner, you can’t be registered for healthcare until you’ve been a legal resident for three months1 so ensuring you understand your retirement visa eligibility is also important.
- Public vs private healthcare in France is not a black and white issue. Many people take out private healthcare insurance to top up their state coverage.
We’ll explain all the nuances of healthcare in France in this article, including who is eligible for public healthcare and how to access the care you need.
Who qualifies for healthcare in France and how to get it
Eligibility for public healthcare in France is broad and based mostly on residency. You can apply to be covered by PUMA if you’ve been a legal resident in the country for more than three months.
After registering with Assurance Maladie (aka Caisse Primaire d’Assurance Maladie, or CPAM) – the public health insurance scheme – you’ll be eligible for cover on the same basis as a French citizen. And, like a French citizen, you’ll pay for cover through social security payments.
- If you’re not employed, self-employed or retired, you may have to pay into the scheme yourself. 2
- Healthcare access for foreigners in France is usually administered through CPAM. Register at your local CPAM office by presenting proof of residence, your passport or ID, and, in some cases, a birth or marriage certificate.
- If you’re eligible for an S1 form (more on that later), you’ll also need to register for that at the local CPAM office.3
Once registered, you’ll have access to a full range of health services, including primary care, emergency treatment and hospital visits.
Using an S1 form to access public healthcare
If you’re drawing a UK state pension, you can also use an S1 form to access French public healthcare. An S1 entitles you to state healthcare funded by the UK government.
- Again, you need to be a resident in France to benefit from the scheme and you should register the S1 form at your local CPAM office.
- You can request an application for an S1 form from NHS Overseas Healthcare Services on +44 (0)191 218 1999.4
Private healthcare in France for expats
Private healthcare in France is common because many people top up their public cover with a mutuelle. That’s private insurance that covers costs not reimbursed by the Assurance Maladie.
- The mutuelle system is well established and is a very good way to make sure you’re not hit by unexpected healthcare costs.
- Remember, public healthcare in France does not cover the full cost of treatments and medicines. A mutuelle can fill the gaps.
- It can also cover you for care that isn’t included in the public system, such as anything beyond basic dental care and optical care (glasses and contact lenses). Some mutuelle coverage will give you access to private hospital rooms and doctors.
The benefits of private insurance in France are obvious. Many residents choose a mutuelle to top up public cover and avoid or significantly reduce healthcare costs at point of need. Mutuelle costs range from around €35 and €150 a month, depending on the extent of cover.
Cost of healthcare in France for UK expats
As we’ve seen, healthcare in France is not free. Most people have to pay a percentage of the cost of their care, or top up their cover with private insurance.
So how much will you pay? According to the Assurance Maladie website, you will be reimbursed 65% of the cost of “important” medicines, 80% of the cost of most hospital stays, and 70% of the cost of a consultation under the coordinated health pathway.5
As that suggests, those in need of ongoing or long-term medical care could be left with significant co-payment costs, which is why many expats in France opt for the peace of mind given by private mutuelle coverage.
Is healthcare free in France?
The short answer is no. Public health insurance covers a significant portion of healthcare costs, but not all. You will have to pay some of the cost of any treatment, which is why private top-up insurance (mutuelle) is common. There’s more information on mutuelle insurance on the French government website.
French healthcare system vs NHS
The main difference between the French healthcare system and the NHS is the principle of “free at the point of use”. This applies in the UK but not in France, where residents pay up front and are then reimbursed for some or most of the cost through public and/or private insurance.
Both national systems are publicly funded, but by including co-payments and – in many cases, private insurance cover, the French system potentially offers more choice and shorter waiting times at a greater expense. Research has shown that France outperforms the UK on certain health indicators, such as avoidable mortality, while the NHS is ahead on protection from high medical costs.6
For expats, the key message is that France offers very good healthcare, but you may end up spending more on medicines, treatments and insurance than you did in the UK.
In addition, the French system can be quite complex to navigate for outsiders, and language barriers can be an issue in rural areas.
How to register with the French health system
French health system registration is relatively straightforward.
- Register for PUMA at your local CPAM office. You can only register after you’ve been a resident for at least three months. There’s more on registering for PUMA.
- You should receive a temporary Social Security number in 4 to 12 weeks.
- You’ll then receive the “attestation de droits à l’assurance maladie”, which shows you have a right to French state healthcare.
- Use that document for your carte vitale (health card) application, either online at ameli.fr or by post.
- Take your carte vitale with you whenever you see a doctor or use a pharmacy.7
Prescriptions, pharmacies, and co-payments
It’s important you take your carte vitale with you to pharmacies in France, as well as GP surgeries. The French co-payment system means that you will usually pay towards the cost of prescriptions. Your carte vitale ensures that you’ll be able to claim a large portion of the costs back.
Finding doctors, clinics, and hospitals
Before trying to register with a GP, make sure you’ve registered with PUMA and with a local CPAM office. After that, you can choose a GP (médecin traitant) of your choice.
- Ask for recommendations from friends and expat communities or search an online database like Doctolib.
- If you need an English-speaking doctor, expat networks are again a good resource.
- Alternatively, talk to private insurers about the availability of English-speaking doctors or translation services.
As in the UK, your GP is the gatekeeper to many public health services. If you need to see a specialist, it is likely to be arranged through your GP practice.
Mutuelle insurance will often give you access to private hospitals, where care can be faster and more personalised.
If you need emergency care, dial 112 or 15 (SAMU) for immediate assistance. SAMU (Service d’Aide Médicale Urgente) is the French 24-hour emergency medical service and can also send ambulances.8 You can also go directly to hospital emergency departments.
Managing healthcare costs as a UK expat
Managing healthcare costs in France as a UK expat can take some planning. Remember, even if you’re using the French public healthcare system, you will have to pay towards prescription costs and most services and treatments. It’s worth considering potential healthcare costs in your budget planning when thinking about your move to France.
In addition, patients often pay for treatment upfront and then apply for reimbursement, so you’ll need to budget for the delay between payment and reimbursement. If you’re using a mutuelle or full private insurance, the costs will also have to be factored into your financial planning.
If you need to send money to France, remember that exchange rates and currency fees can impact the amount you will actually have to spend. A currency specialist like Lumon can help you transfer money in a seamless and cost-effective way.
Long-term health management in France
If you have long-term or chronic medical issues you should mention them at your first GP appointment. GPs are the gatekeepers for chronic illness care in France and will arrange any hospital referrals. Your GP will coordinate long-term care in France and help you get access to the services you need, including mobility and rehabilitation support.
Your GP should also be the first port of call for preventative healthcare in France, including screenings, health check-ups and vaccinations.
French healthcare system: pros and cons
Healthcare in France is ranked among the best in the world, but it is not perfect. Here are its pros and cons.
| Pros | Cons |
| Universal coverage – nearly every legal resident is covered | Cost – while costs are relatively low, treatment is not free at the point of need and private insurance is often required |
| High quality care – hospitals are generally well-equipped and well-staffed | Uneven cover – some areas have better healthcare than others |
| Life expectancy – France ranks highly in life expectancy tables9 | Bureaucracy – the system can involve quite a lot of paperwork |
Currency and money management for healthcare costs
Managing healthcare costs in France as a UK expat takes planning. Even if you’re using the French public healthcare system, you may need to pay towards prescription costs and for certain services and treatments. It’s worth considering potential healthcare costs in your budget planning when thinking about your move to France.
If you need to send money to France, we can help you do it in a seamless and cost-effective way
1 UK government – Healthcare in France
2 UK government – Healthcare in France
3 UK government – Healthcare in France
4 UK government – Healthcare in France
5 Assurance Maladie – Reimbursements
6 Kingsfund – Comparing health systems
7 UK government – Healthcare in France
8 US embassy – Emergency services9
World Population Review – Life expectancy by country
