Health Insurance and Healthcare in France Explained

How Healthcare Works in France

Does France have free healthcare? Mostly. The French healthcare system is often considered one of the best in the world. Here are some health care facts to get you started:

• It is a well-serviced system with more than one doctor for every 1,000 citizens.
• The average life expectancy in France is 83.
• The universal system is a hybrid, and France’s healthcare costs are financed partially by the state and partly by the individual or private insurers.
• Taxes from employees and employers contribute to the health care system.

The France Healthcare System Explained

Having a high-quality healthcare system comes at a price. So, how does healthcare work in France exactly? People in France pay high tax rates, and the country spends more than 11% of its GDP on its mandatory healthcare. Nevertheless, the French enjoy their high-quality healthcare policy, and it looks unlikely to change any time soon. Patients spend comparatively very little on healthcare since most of it is subsidized by the government.

Pros and Cons of the French Healthcare System

Pros

• The system is speedy. In general, there are no long wait times at the doctor’s office, and getting an appointment is easy.
• The French healthcare system offers high-quality and affordable care.
• The healthcare system is accessible to all legal residents – even those who are unemployed.
• French healthcare becomes accessible for expats after three months or sometimes sooner if they are working and paying social security.
• France offers preventative care for all, including free medical checkups every two years.
• Specialists are accessible without a doctor referral.

Cons

• The French and those working in France have to pay a considerable amount in taxes to maintain and support their universal healthcare system.
• For the first three months, an expat will have to take out private health insurance until they are introduced to the public healthcare scheme.

What Does the Public Healthcare Cover?

When you visit the doctor in France, the healthcare system will typically cover 70% of the fees and 80% of hospital costs. If you have a major illness, 100% of the expenses are covered. This is because France operates on the principle of solidarity: the sickest will usually pay the least, preventing them from becoming financially disadvantaged. The remainder is covered by either the individual or by supplementary private health insurance. There is a small fee that is paid for by the patient: 1 EUR (1 USD), for example, per doctor visit.

If you are covered by France’s universal healthcare system, you will be protected by the 2016 PUMA scheme (Protection Universelle Maladie). If you are a legal resident in France, you will be eligible for health coverage, regardless of your employment status. This is different from the previous system, where dependents were insured only if they met certain living or employment conditions.

How to Get Public Health Insurance as a Foreigner

To qualify for this coverage, you must meet the residency requirements. An expat moving to France will not be immediately introduced into the insurance scheme. To qualify, you must have lived in France for three months or be working in the country (and offered insurance by your employer), as well as planning on living in France in a “stable and regular” manner for at least six months of the year. Until you are eligible, it is advisable that you pay for private insurance.

By entering into the French state healthcare system, you will also be able to apply for a European Health Insurance Card (EHIC). This entitles you to medical treatment while visiting another EU country, for free or at a reduced cost.

If you are an EU citizen and have an EHIC card from your home country, you can use this to access France’s healthcare system. But if you are a resident or are staying in France long-term, you will need to register with the French social security system and health insurance to access healthcare.

Does the Public Healthcare Cover Dental Care?

Basic dentistry (e.g., consultations, cavities, tooth extractions) is covered by the state, but more complex or cosmetic treatments are usually pricier, and patients will have to shoulder the costs themselves or take out private insurance. Although, dental prostheses will be fully reimbursed starting in 2021 under the system.

Children are offered free dental check-ups every three years between the ages of 6 and 18. You will receive a letter from the Caisse Primaire d’Assurance Maladie, which entitles your children to their regular examination. Take this letter to the dentist, and you will not be charged for the consultation.

Eye and Vision Care

Certain glasses will be 100% reimbursed starting in 2020, and beginning in 2021, adults will be able to receive one free pair of spectacles every two years while children will be entitled to one pair each year.

France Health Card: Carte Vitale

Once you are in the French healthcare system, you can get yourself a carte Vitale (health insurance card). The card contains the administrative information needed by medical professionals such as any other private insurance you might have, your doctor, and details of any work-related accidents or illnesses. It is linked directly to your health insurance provider.

The actual application of applying for the carte Vitale is made in conjunction when you apply for your social security number, done at your local Caisse Primaire d’Assurance Maladie (CPAM). For information on this, check out our working (link) article.

Once you have a carte Vitale, it’s important to keep it up to date. You need to update your card once a year or whenever you change any details such as the employer, address, doctor, or have become a parent. To update your card, you can do so at automatic information points called bornes, which can be found at various health facilities, or at a local pharmacy.

An Overview of Private Health Insurance

Do you need health insurance in France? Most French citizens do take out an additional policy to top up their coverage for costs that are not covered by the state. This is a way to ensure that you are 100% covered. This health insurance coverage can usually be sourced from a non-profit company and is known in French as l’assurance complémentaire santé or mutuelle.

Be aware, however, that one of the most significant differences between private health insurance in France versus other European countries is that private does not necessarily mean faster service. It is merely a means to get people 100% coverage and not have to pay anything out of pocket (or at least get reimbursed for it in case they do have to pay something upfront).

Do I Need Private Health Insurance in France?

Private health insurance is a good option for those with chronic illnesses, as the state will not cover things like chiropractors, osteopaths, or psychologist consultations. It is also beneficial for some types of prescription medication because the state will only cover a percentage of what they consider “essential” medication. Some prescription medication can cost more than 100 EUR (112 USD), so for these cases, private insurance is recommended.

How to Sign-Up

Apart from signing up for private health insurance on your own, other ways to get health insurance in France is through your French’s spouse’s plan or through your job’s benefits package.

Healthcare coverage has been compulsory for private French companies to provide employees since 2016. This type of medical insurance will typically cover the remaining 30% of your medical fees including emergency hospital care. If you are a duly registered self-employed worker (link) in France, then you will have access to France’s medical insurance through the Régime Social des Indépendants (RSI). If you are a student in France, it is best to take out private insurance to cover the remainder.

In the case that someone cannot access the state system or is ineligible, they may be required to take out a private health insurance policy. Private coverage is much more expensive than the hybrid system, and not everyone qualifies for it. The cost for private health insurance depends on a few factors including the applicant’s age and health details. Before being approved for any policy, you will be subject to a medical questionnaire and, depending on your answers, your premium may be higher, or you may even be denied.

How Much Does Health Insurance Cost?

In France, the average cost of health insurance for one person is 40 EUR (45 USD) per month. Of course, prices vary depending on the policy too: the stronger the policy is, the more you will pay for your health insurance. There are many types of health insurance plans. Some cater to specific job occupations while others are specifically designed for expats and English speakers. It is best to shop around, ask for recommendations, compare prices online, and find a policy that best fits your needs.

What are the Documents Needed for a Hospital Visit?

If you go to the hospital, you will need to show your carte Vitale, EHIC, or some proof of insurance. If you are at a public hospital, you will also need to bring a copy of the notice you would have received stating you are entitled to state health care. If you not insured at all, you cannot be denied healthcare in France, but you will be expected to pay for everything yourself. In this case, you may also be eligible to apply for assistance under Aide médicale d’Etat (AME), which is a social benefit that helps cover medical expenses for low-income foreigners (non-residents) in irregular situations in the country. To be eligible, you must have lived in France for at least three months.

If you have forgotten your Carte Vitale, you can still be treated and attended to. You will be given a feuille de soins (a document containing information about medical costs incurred) to fill out. Afterward, you will be able to send the form to your health insurance provider to be reimbursed.

Are there English-Speaking Hospitals?

If you live in Paris and do not speak French, you are in luck. There are a few hospitals in Paris with bilingual doctors and medical staff. Institutions such as the American Hospital of Paris and Hertford British Hospital are options for English-speaking expats.

Outside of the capital, bilingual hospitals may be harder to find, and it cannot be guaranteed that your doctor will speak English. In this case, it is advisable to bring a French-speaking friend with you or learn some basic phrases related to your condition before your visit.

How to Find a Doctor or Dentist

Getting sick abroad is always a hassle, but the extra stress can be prevented if you know how to find a doctor and dentist should you have to. Here are some guidelines for getting hold of a doctor and a dentist in France.

How to Find a Family Doctor

When you sign up for health coverage, you need to pick a so-called “treating doctor” or médecin traitant. If not, you risk being penalized with higher medical fees and being reimbursed at a lower rate. Children will typically have the same doctor as their parents, but this is not obligatory.

Doctors’ offices are known as cabinets. These practices are often joint enterprises between multiple doctors. You can ask at your nearest pharmacy where the closest office is, or you can locate a doctor’s office online.

If your French is still pretty rusty, you may want to consider choosing an English-speaking doctor, although this might only be feasible in big cities. Both the Australian and American embassies in France have a published list of English-speaking doctors on their websites. For expats who have more confidence in their French, you can source a local doctor using the Pages Jaunes and searching for “médicin” or use Doctolib.

How to Find Specialists

Your médecin traitant will keep track of your medical history and can refer you to specialists or other doctors if needed.

While it is possible to bypass the médecin traitant and source your own specialist, the reimbursement rate will be lowered if you do not follow the pathway system, and you should expect higher healthcare fees. However, there are exceptions to this rule if you want to consult an ophthalmologist, pediatrician, gynecologist, or are in emergency situations, and in those cases, you will be spared any financial penalty for finding your own specialist without a referral.

What if You Get Sick Outside of Working Hours?

If you get sick out of ordinary working hours, you will not be able to simply turn up at the cabinet. Like shops, pharmacies, and all official services in France, doctors’ offices are typically closed in the evenings and on Sundays. However, if you require assistance after hours, some doctors remain on duty in all big cities and even in some smaller ones.

To access this service known as Maisons médicales de garde (MMG), you will need to phone your local gendarmerie (police station). You will be forwarded to the doctor on call. There is information available online for those living in Paris as well as some other major cities. At an MMG, there is usually an extra fee incurred for treatment out of office hours, but this can often be reimbursed through France’s social security system thanks to private health insurance.

There is a secondary out-of-hours service run by SOS Médecins which will send a doctor to your home in under an hour. The fee for this is roughly 70 EUR (78 USD).

In rural areas, there is often no out-of-hours medical care. In this case, call Service d’Aide Médicale Urgente(Urgent Medical Aid Service) by dialing 15 for emergency medical treatment.

How to Find a Dentist

Finding a dentist in France is pretty simple. Consult the yellow pages, search online, or inquire at your local town hall for some recommendations. Since dentists are free to set their own rates, it is best to pick out a few different dentists and compare prices. Ensure they have a good reputation and the right experience.

Average Wait Time to See a Doctor in France

Depending on your reason for seeing a doctor and the treatment you need, wait times for seeing a doctor in France can range from 6 to 80 days, but on average, from the time you contact the doctor to the time of the consultation itself, it is usually around six days. For certain specialist doctors, wait times are generally longer.

• Pediatrician or radiologist – three weeks
• Dentist – one month (average 17 days)
• Gynecologist – six weeks (average 32 days)
• Cardiologist – 50 days
• Dermatologist – two months
• Ophthalmologist – 80 days

Giving birth in France

France has a great reputation for childbirth — even non-residents (as long as they have met the residency requirement) can benefit from giving birth in France. So, whether you are a non-resident or a permanent resident giving birth in France, with France’s universal healthcare system in place and its endless check-ups and services available throughout and well beyond the pregnancy, you need not worry.

How to Give Birth in France as a Foreigner

A pregnancy test in France is called a test de grossesse and is available in most pharmacies and supermarkets. Once you have confirmed the good news, it is advisable to choose a gynecologist who is also an obstetrician, known as an accoucheur.

If you are having a baby in France as a foreigner, you may find it tough to locate a gynecologist who speaks English, but it is not impossible. Ask for some recommendations. You can either choose one on your own or be referred to one by your doctor. Also keep in mind that the actual childbirth is not always handled by your chosen gynecologist but instead the team on duty, if giving birth at a public hospital.

In France, it is typical for the sex of the baby to be revealed, so if you want this to be a surprise, inform your gynecologist beforehand.

Prenatal Care

Following the first prenatal examination, you will be given a three-page document known as your declaration de grossesse (proof of pregnancy). This is needed to claim social security and health insurance coverage. It is crucial that you send these documents off to Caisse d’Assurance Maladie and Caisse d’allocations familiales no later than your 14thweek of pregnancy. Otherwise, you risk losing some of your benefits. Your health insurance fund will then send you a pregnancy guide with dates for medical examinations and maternity leave (For more information on parental leave benefits, check out our Working section).

Following the first check-up, mothers are entitled to a further eight examinations preceding the birth, which will include ultrasound scans and delivery preparations. For this purpose, your gynecologist will provide you with a maternity record book, called the carnet de santé maternité, where each medical examination and its details will be recorded.

Other benefits to giving birth in France, aside from the healthcare benefits, are the three payments new mothers receive from the CAF, which is the Family Allowance Fund.

Costs of Having a Baby in France

Many women in France choose to give birth in the hospital. Public health insurance for hospital births — excluding deliveries in private hospitals — covers all expenses for the first twelve days spent in the hospital, meaning the birth will likely be completely free. The average hospital stay after childbirth is three days. Furthermore, mothers discharged within five days are entitled to home visits from a midwife. If you choose to deliver in a private hospital, giving birth in France without insurance can reach up to 5,000 EUR (5,604 USD) in private hospital fees alone. Therefore, coverage is vital in this case.

Alternatively, mothers who choose to give birth at home should be aware that it is tricky to get full insurance in this case, due to the risks that a home birth entails. Nevertheless, your social security will partially cover the costs of giving birth at home, and the delivery will still take place with a midwife present.

Cause for Celebration: After the Birth

Following birth, babies must be registered within three working days. This is known as the Déclaration de Naissance and can be done at the local town hall, known as the mairie. If you plan to give birth in France for citizenship, be aware that the child may only acquire French nationality at birth if one of the parents is also French. Otherwise, non-French children who are still residing in France at 18 years of age are eligible to obtain French citizenship, provided that they have lived in France for at least five years since the age of eleven. A child can also get citizenship earlier, at the age of 16, if requested by the child, and provided that they have also lived in France for at least five years since the age of eleven.

Mothers in France are entitled to a postnatal examination within the first eight weeks following birth, and, if necessary, physiotherapy. The child will then continue to have examinations up until they turn six years old. Local maternal and child health clinics are also available to provide vaccinations, health, and nutritional advice.

Unwanted Pregnancies

In France, abortion is legal up until twelve weeks in the pregnancy, or 14 weeks since the last menstruation cycle. However, abortions at later stages are possible if two physicians confirm that the birth puts the child or mother at severe risk of an incurable illness or death. Provided the mother is registered with the French social security, the termination at public hospitals will be paid for by the state.

The morning-after pill, known as la contraception d’urgence, is also available and can be purchased at pharmacies without a prescription.