Understanding healthcare and health insurance in France

Moving to France is an exciting step that offers many new opportunities and experiences. For anyone wishing to emigrate to this attractive, cosmopolitan country, it is crucial to familiarise themselves with the French healthcare system and the various health insurance options in advance. This comprehensive guide is aimed at anyone daring the adventure of emigrating to France, as well as professionals, families and retirees who plan to make it their new home.

The French healthcare system is considered one of the best and most accessible in the world. It is based on the principle of universal health insurance (Protection Universelle Maladie – PUMA) and ensures that practically all legal residents have access to high‑quality medical care – regardless of income, age or state of health. The system is solidary: there is no risk assessment or refusal due to pre‑existing conditions.

The system is financed through social security contributions (cotisations sociales), borne roughly equally by employers and employees. The majority of the population – about 90% – is insured under the Régime Général (general system), managed by the regional CPAM (Caisse Primaire d'Assurance Maladie). CPAM is the local branch of the national health insurance system, which manages your insurance cover, issues the social security number and provides the "Carte Vitale". Separate insurance schemes exist for farmers, self‑employed persons and certain professional groups. The French system operates on the reimbursement principle: you pay upfront at the doctor or pharmacy, then submit a claim to your health insurance fund, and receive part of the costs reimbursed (usually 70% of the official rate).

After registering with your CPAM (which you do via the online service ameli.fr and your local CPAM office), you will receive a lifelong, unique social security number (numéro de sécurité sociale). This is a prerequisite for obtaining a Carte Vitale. The Carte Vitale is a green chip card in credit card format that stores your insurance rights and enables electronic billing with doctors, laboratories and pharmacies. With the Carte Vitale, reimbursement is automatic and without paperwork, processed within a few days. Without the Carte Vitale, you must fill out a paper form ("feuille de soins") and send it by post to your CPAM – a cumbersome and slow alternative. The Carte Vitale is free. Currently, you receive it within 3–6 months of your initial application (in the Paris region it may take longer). During the waiting period, the so‑called „attestation de droits“ serves as valid proof of your insurance cover.

The e‑Carte Vitale App: In addition to the physical card, there has also been a smartphone app since 2025/2026, which can be ameli.fr downloaded from ameli.fr. It fulfils the same function as the plastic card and is optional for all insured persons. Important: If anyone demands money for the issue, application or renewal of the Carte Vitale, it is a fraudulent attempt.

The French system differs from the German one in one crucial respect: it rewards adherence to a "coordinated care pathway" (parcours de soins coordonné) with higher reimbursement. To do this, you must choose a médecin traitant (general practitioner) and register them with your CPAM. If you always consult your GP first and obtain a referral to specialists, the CPAM reimbursement is generally 70%. If you consult a specialist directly without involving your GP, reimbursement falls to 30% (or even less) – so you pay significantly more.

Registration of the médecin traitant can be done during the doctor's visit (the doctor transmits the data electronically to the CPAM) or by completing form Cerfa N°12485 and having it signed by your doctor. The online declaration via ameli.fr ameli.fr is the fastest method, confirmed within 24–48 hours, while the paper form can take several weeks. Choosing a médecin traitant is mandatory for each adult family member in order toreceive the maximum possible reimbursement. Exceptions exist in emergencies (emergency number 112), during inpatient hospital treatment, for gynaecologists (women for certain preventive examinations), for ophthalmologists for certain preventive examinations, and for psychiatrists.

Statutory insurance (Assurance Maladie) generally reimburses 70 % of the official rate for a doctor's visit. The remaining 30 % is the Ticket Modérateur (personal co‑payment). The official rates are standardised: a GP visit with a sector 1 doctor (conventionné) recently cost €26.50, with a planned increase to €30.50 in 2026. A specialist visit in sector 1 costs about €31.50. These rates are legally fixed. Higher fees for private doctors (sector 2) can lead to a significantly higher patient contribution.

Mutuelle (private supplementary insurance): Since the Ticket Modérateur can represent a noticeable financial burden in practice, most French people and almost all expatriates take out a private mutuelle ab. A mutuelle covers the difference between the CPAM reimbursement rate (70%) and 100%, covers statutory co‑payments (forfait journalier) in hospital, and, depending on the tariff, also reimburses additional benefits such as alternative medicine, dental treatment, new spectacle lenses, treatment by the head physician and a single room in hospital.

Since 2016, all employers in France are legally obliged to offer their employees a mutuelle ("complémentaire santé d'entreprise"). The employer must cover at least 50% of the premiums. The contract is mandatory for the employee unless there is a valid exceptional reason (e.g., you are already insured through a spouse). The average monthly employee contribution for a mutuelle via the employer was about €40–€70 in 2026 (depending on the chosen benefit package). Self‑employed persons, freelancers and non‑employed persons must take out a mutuelle privately.

For low earners: Die The Complémentaire santé solidaire (C2S) is a state‑funded supplementary insurance that covers the Ticket Modérateur for persons with a monthly income of at most approx. €880 (for a single person). It is free (up to 1.3 times this threshold) or costs a maximum of €1 per day. In practice, this is relevant primarily for non‑employed persons or certain foreigners who do not benefit from the comprehensive employee mutuelle.

The mutuelle is your partner to close the gap between CPAM reimbursement (70%) and your actual costs. A mutuelle can have different benefit levels: basic tariff (covers the Ticket Modérateur for doctor visits and medicines, plus daily hospital charges), standard tariff (basic plus basic cover for dental and optical care, inpatient stays at private clinic level), or premium tariff (almost full cover for dental treatment, spectacles, psychotherapy, alternative medicine, etc.).

The market for mutuelles in 2026 is characterised by rising contributions: contributions for supplementary insurance rose by an average of about 4% at the beginning of 2026 (somewhat less strongly than in 2025). The reasons are a new statutory levy of 2.05% on insurance premiums and higher CPAM expenditure. The cost of a mutuelle varies depending on tariff, age and region. For a basic mutuelle for a 30‑year‑old employee (via the employer), you can expect a monthly co‑payment of about €30–€50; for a premium mutuelle (all benefits, treatment by head physician, single room) about €60–€120.

– MAKING APPOINTMENTS: Most doctors' practices use Doctolib (online portal or app) to book appointments – this is the fastest way, even for specialists.

– PREPARATION: Be sure to take your obtaining Carte Vitale (or the attestation de droits) with you. If available, bring a list of your current medications and allergies.

– EMERGENCIES: Dial 112 for emergency medical services. For general medical emergencies outside office hours (evenings, weekends), contact SOS Médecins (in every major city) – an emergency practice that makes home visits.

– THE DOCTOR'S APPOINTMENT: The doctor will greet you politely, take your history, examine you and, if necessary, recommend treatment. Do not hesitate to describe your symptoms precisely.

– REFERRALS: For a specialist appointment, you generally need a referral from your médecin traitant in order for the CPAM to reimburse 70%. Otherwise, you will receive only 30% reimbursement. The specialist appointment can then be booked via Doctolib.

– LANGUAGE: In international practices and in cities, many doctors speak English or even German – ask beforehand or search for "English speaking doctor" via Doctolib .

– PHARMACIES: Every pharmacy in France displays a green cross. It can dispense over‑the‑counter medicines and provide advice for minor ailments. Prescription medicines require a prescription.

– No choice of insurance provider: In Germany you choose a statutory or private health insurance fund; in France, the CPAM is largely fixed.

– Reimbursement system vs. benefits‑in‑kind principle: In France, you pay upfront and receive partial reimbursement (70%).

– Higher co‑payment without supplementary insurance: Without a mutuelle, you are left with a significant portion of your medical costs.

– No termination of employment contract due to illness: In Germany, long‑term incapacity for work can lead to dismissal; in France, employees enjoy more comprehensive protection under labour law (the so‑called "inaptitude" is complicated).

– Médecin traitant: In the German system, a GP is not mandatory for full reimbursement. In France, they are formally important, even if many Germans are not familiar with the médecin traitant.

– Mutuelle via employer: In Germany, company health insurance is voluntary; in France, the mutuelle has been mandatory for employees since 2016.

Moving to France requires thorough preparation and a good understanding of the healthcare system. We at KOCH Moving Logistics are by your side to make your dream of emigrating to France as smooth as possible.