Living in France: How Does the Health System Work?

France boasts one of the world's finest health systems: virtually universal, it insures a large portion of the population against the costs of medical care and medications. But how does this system operate, what types of care does it cover, how much does it cost for beneficiaries, and what about foreign residents? Here, we explain how the French social security system functions.

How Does the French Health System Operate?

Health coverage in France is primarily based on a compulsory health insurance system, funded by social contributions deducted from salaries, as well as taxes and levies. The Health Insurance, managed by the National Health Insurance Fund (Caisse Nationale de l'Assurance Maladie, CNAM), is the main entity administering this system. All residents in France, whether French citizens or foreigners, are generally covered by Health Insurance.

What Types of Care or Interventions Does It Cover?

Health coverage in France is comprehensive and covers a wide variety of medical care and interventions:

• Medical Consultations: Visits to general practitioners or specialists are covered up to 70% of the conventional price. The remaining cost can be reimbursed by supplementary health insurance.
• Medications: A significant portion of the cost of medications is reimbursed by Health Insurance.
• Hospitalization: Hospital stays are covered, including surgical care, medical treatments, and maternity stays.
• Dental and Optical Care: Although partially covered, dental and optical care are reimbursed to a certain extent.
• Preventive Care: Vaccines, screenings, and preventive care are also included in the coverage.

How to Get Reimbursed?

To receive a full reimbursement from social security, two things should be considered:

Social security reimburses based on a conventional tariff. When seeking a doctor, ensure they are contracted in sector 1, meaning they do not charge extra fees. For example, a general practitioner consultation costs 25 euros at the conventional rate, and you will be reimbursed 16.50 euros, or 70% of the cost. But if your consultation costs 30 euros, you will still be reimbursed 16.50 euros.

To be properly reimbursed by a specialist, you must first consult your general practitioner who will provide a prescription. Without this prescription, you will be considered "outside the care pathway" and reimbursed less.

Reimbursement is automatic if you have your vital card (the green card of health insurance). Without this card, you can fill out a care sheet and send it either by mail or through your personal space on the website or the Ameli app.

How Much Does It Cost?

The costs of health coverage in France vary depending on your personal situation, income, age, and professional status. Social contributions are deducted directly from salaries and through taxes and levies.

Are There Any Out-of-Pocket Expenses?

Yes, there are generally out-of-pocket expenses for most medical care in France, except for patients who benefit from 100% coverage due to special circumstances, such as certain serious illnesses.

To reduce or avoid these out-of-pocket expenses, there are private supplementary insurances called mutual insurance companies. Mandatory for employees (and reimbursed at a minimum of 50% by the company), they are entirely the responsibility of individuals without employment or independent, students, unemployed, seniors, and retirees.

How to Benefit?

As a resident in France, you generally automatically benefit from health coverage. To obtain a vital card, which facilitates the reimbursement process, you will need to provide certain documents and complete forms. You will be affiliated with a Health Insurance fund according to your place of residence. Health professionals are generally familiar with the system and can help you navigate the administrative procedures.

And for Foreign Residents in France?

Foreigners in France can benefit from health coverage, but the eligibility conditions and rights may vary depending on their residence status, nationality, and personal situation. Here are some important points to consider:

I am a resident in France:

Generally, to benefit from health coverage in France, it is necessary to reside in France stably. This means you must live there permanently and declare your fiscal residence in France. Tourists and people on temporary stays are generally not eligible.

To benefit, you must reside in the territory for at least 3 months, then at least 6 months per year.

I am not a French citizen:

Nationality is generally not a determining criterion for benefiting from health insurance in France. Foreigners, whether they are EU members or not, can have access to the health system depending on their residence status.

I am an EU member:

Citizens of the European Union (EU) and the European Economic Area (EEA) generally benefit from health coverage in France under the rules of coordination of social security systems within the EU. They can use the European Health Insurance Card (EHIC) to access healthcare in France. However, they may have to pay a co-payment.

I am British:

Before Brexit, British citizens enjoyed the same rights as other EU citizens regarding health coverage in France. Since then, specific agreements have been negotiated, and British residents must meet residence requirements (affiliation is made after 3 months and under the condition of living 6 months per year in the territory).

I own a residence in France:

Simply owning a primary or secondary residence in France does not guarantee automatic access to health coverage, with the main criterion being effective residence in France.

In conclusion, the health system in France can be complex, and specific rights may depend on many factors. Foreigners wishing to benefit from health coverage should inquire with the Health Insurance (CPAM) and, where applicable, their specific health insurance fund to understand their rights and the steps to follow according to their particular situation.