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National Health Services for Expats in France

Submitted: October 2013

France has very good public hospitals. There is no need to go private if you are looking for high-quality healthcare.

As per the continental corporatist tradition, France’s public healthcare system is primarily insurance-based rather than tax-financed. Accordingly, French public hospitals are not free unless you are an insured person.

As per the English/Nordic tradition, there is a universal entitlement to healthcare benefits for any individual who has been in France for at least six months.

French health insurance (sécu) is socialised and contributions are income-tested. Health insurance is generally paid along with any other social security contributions, such as unemployment, maternity, etc. Special rules may apply for students or non-working individuals (e.g. retirees, unemployed, etc.).

France’s social security system is quite redistributive. Typically, there is redistribution from:

Insured persons

All employees in France, along with employers, must contribute towards French social insurance. Employee contributions are deducted from pay and are passed on to URSSAF. Self-employed individuals must generally pay their contributions to RSI (regime social des indépendants).

Any worker who pays his/her social insurance contributions is an insured person. His/her spouse or dependants may also be treated as insured persons.

Students must pay a flat fee upon registration at university, which is a bit more than €200 per year. Pensioners are also insured.

If you do not fall within any of the above categories, you should insured through the universal coverage scheme (CMU de base) or the medical assistance scheme for illegal immigrants (aide médicale d’Etat). To qualify, you need to prove that you have been resident in France for at least three months, for example through a utility bill or a rent receipt. This is increased to six months for illegal immigrants.

If you are an insured person, you should be issued a green health card (carte vitale). You simply need to show it up to your doctor or hospital. The benefits you are entitled to are then processed automatically. You should have your health card with you at all times.


As a general rule, the employee pays 22% and the employer pays 44%. Self-employed workers pay 45%. This includes all social security contributions and social taxes (CSG/CRDS). These premiums only apply on income from labour sources.

Pensioners must generally pay social taxes (CSG/CRDS/CSA) at a rate of 7.4% of their pension payouts. There is an additional 1% tax on any pension other than the basic state pension (retraite de base). Exemptions may apply for low-income pensioners (below €10,024 per year).

In reality, France’s healthcare system is also financed by social taxes on income from capital sources, at a rate of 15.5%. This flat tax is levied on:

It is worth noting that social security contributions are tax-deductible. Social taxes, on the other hand are tax-deductible only on the first 5.1% (4.2% on pension income).

If you are on the universal coverage scheme, you will have to pay 8% on any yearly income in excess of €9,534.


Apart from hospitalisation, social insurance will only cover you partly. Typically you are covered on 60 to 80% of total costs, unless your doctor is keen to overcharge. See Doctors and Hospitals for Expats in France.

For a non-exhaustive overview, see the applicable rates on:

If you require admission to a hospital, you will be fully covered, even if you attend a private hospital. However, you would normally have to pay a flat fee of €18 (forfait hospitalier) for any hospital stay exceeding 24 hours.

Practical use

The basic rule is: you pay at user-point to be reimbursed later on.

If you can show up your health card in due course, the refund is processed automatically and should appear in your bank account in about a week. Otherwise, you should ask for a reimbursement form (feuille de soins) at user-point.

If you need to go to the hospital emergency room, there is no need to pay upfront if you can show your health card. See Health Emergencies for Expats in France.

International agreements

If you are an EEA resident travelling temporarily to France, you should apply for a European Health Insurance Card (EHIC) in your home country. EHIC is designed to grant you access to subsidised state healthcare on the same basis as French residents. You can use EHIC only for medical necessities arising whilst you are in France.

France has also concluded many bilateral social security agreements with non EEA countries. International agreements may exempt you from being subject to French social security legislation if you are on secondment in France. In such cases, you remain subject to the social security legislation of your home country.

A few international agreements (but not all) may also cover you if you require urgent care in France. Many agreements (e.g. the US/France agreement) do not have such a clause. In most cases, this is because the foreign national health service is not generous enough.



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