The French Healthcare System
Access to healthcare in France is available to all residents who have lived in the country for over 3 months. The French healthcare system is excellent and treatment is usually quicker and much more comprehensive than in the NHS. However, unlike the NHS, it is not free at the point of treatment.
The patient pays for the service and is then partially reimbursed by the French government, via the “Assurance Maladie” or the MSA which deals with agricultural workers.
The amount of coverage depends on the treatment, with percentages ranging from 30% for medicines considered of only moderate effect to 100% for life-saving treatment such as cancer drugs.
A tariff is set for doctors’ fees, but the doctor is at liberty to charge more if they want. Watch out for ‘dépassements honoraires’, the amount many specialists charge over
and above the rate reimbursed by the state. This should be posted up in their premises.
A full list of the percentages for reimbursement is available on ameli.fr. Top-up insurance (assurance de santé complémentaire or mutuelle) is available to purchase to make up the difference and is examined in more detail in our article how does the mutuelle work.
Rights to Healthcare
Until 2016 the right to healthcare was restricted to those who had French citizenship, were economically active in France or had an S1 form from their own government (primarily those who were retired and of pension age). The families of people who had these rights were given cover on the same social security number as “dépendants”. Others such as early retirees were forced to use their UK EHIC, get private insurance or pay as they went which could prove expensive.
From 2016 everything changed and even economically inactive people who can prove that they are legally resident in France are entitled to access the system via the PUMa or “Protection universelle maladie”.
Obtaining a Carte Vitale
Getting your social security number
If you are working for an employer, they should apply for a social security number (numéro de sécurité sociale or NIR) for you, but if they haven’t you will need to contact the CPAM office that deals with your area. If you are self-employed the body that handles your registration should contact the local CPAM on your behalf, and they will be in touch to ask for the relevant documents.
Anybody that is living in France but economically inactive (unemployed or retired) should contact the CPAM as above, you will probably be expected to fill in a questionnaire about your resources to assess whether you should pay the cotisation subsidaire maladie which is explained below, but this will be sent to you if you need to fill it in.
You will need proof of identity, your birth certificate and proof that you have been living permanently in France (résidant de façon stable et régulière) for at least the last 3 months, such as bills, bank statements, rent receipts. If you don’t have anything in your name, ask for an “attestation d’hébergement” from your landlord stating on his/her honour that you live at the address and have been for the past 3 months or more.
Getting health cover
When you are applying for a social security number you can go ahead and apply for your carte vitale at the same time. Everyone needs to fill in the form “Demande d’ouverture de droits à l’assurance maladie“. You should automatically be sent the forms by the CPAM or MSA if you are working.
If you are of state pension age and receive a UK pension, you will need to contact the International Pension Centre in the Department for Work and Pensions on 0191 218 7777 to get an S1 and then take that to the CPAM with the form. If you are an early retiree in receipt of a private pension, and can’t get an S1, you will need a letter from the same place to say that you are not entitled to an S1 so that CPAM will process you under PUMa.
You will need a French bank account to be reimbursed for what you have spent and should supply a RIB with the form.
Once you’ve handed in the forms, you will have to wait until you are sent another form to which you have to stick a photo and send back to get your actual card.
In the meantime, hold on to the brown forms that healthcare professionals give you, you will be reimbursed for any expenses by sending them in once you have your number, temporary or permanent.
Cotisation subsidaire maladie
This payment is a contribution to the cost of healthcare by those who are not contributing, or not contributing enough, through their earnings. It is paid in the 4th quarter of the year based on your tax return for the previous year. The demands are sent out in November and have to be paid within 30 days.
Those liable meet all of the following conditions which changed in 2019:
- Be working in France or be a long term resident here so that you benefit from access to the health system.
- Have income less than €8227 in 2021 (i.e. 20% of the annual social security ceiling, before this it was 10%). The individual income of both members of a married or Pacs’ed couple must be under these limits.
- Have income from savings or capital over €20568 in 2021 (i.e. 50% of the annual social security ceiling)
And have not received a retirement or disability pension or annuity, nor unemployment benefit in the year under consideration.
There are various exceptions to these rules mainly covering children, students, and “ayant droits” (dependants) from the system pre-2016. You can find out more by reading this article in French on the URSSAF site.