The French health system has a reputation for being among the best in the world, and a reputation for paperwork that matches. Both are earned. The first time you hand over your carte Vitale at a pharmacy and walk out having paid almost nothing for your prescription, you start to understand why people stay. Getting to that moment takes a few steps, and they depend on whether you work.
How does healthcare in France work?
The state health insurance, the Assurance Maladie, reimburses care at set base rates. It does not pay everything. A visit to the doctor is reimbursed at 70% of the base rate in mainland France, and the rest is paid by you or by a complementary insurance called a mutuelle. You choose a médecin traitant, a doctor who coordinates your care. Ameli, the official site, is clear that you must name one to be properly reimbursed.
The carte Vitale is the green card that carries your rights. You show it to doctors and pharmacists, who send the claim directly. Without it, you pay and ask for a refund on paper.
How do you register for French health insurance if you work?
Ameli explains it simply: once you work in France, you fall under the French system and no longer under your home country's, and your employer handles the registration. The sequence:
- Your employer opens your rights. You give a copy of your ID and a birth certificate.
- You get a social security number. If you were born abroad, you may first receive a temporary identification number, then a permanent one once the documents are checked. Documents from an EEA country or Switzerland need no translation. The rest need a French translation.
- Create your ameli account, order your carte Vitale and name your médecin traitant.
Your family members living with you in France for more than three months are covered for benefits in kind. There is no CPAM in the overseas departments: the local fund is called CGSS in Guadeloupe, Martinique, French Guiana and Réunion, and CSS in Mayotte.
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If you are an inactive EU, EEA or Swiss citizen, ameli says you can be attached to the French system if you have lived in France stably for more than three months, if your home state's health insurance no longer covers you, and if your household resources are at least equal to the amount of the RSA or the ASPA. If they are lower, you cannot be attached, but you may have access to the State medical aid (AME) for some care.
You apply on the inactif-europeen.ameli.fr online service, or by sending the "Questionnaire recherche de droits" with documents to your local fund. Your rights are reviewed every year. During the first three months, keep your home cover or a private insurance. And if your home country is still responsible for your health (a pension from that country, a posted worker), ameli says you cannot claim French cover as an inactive person: you need an S1.
Which cards unlock healthcare in France: EHIC, GHIC or S1?
- EHIC (European Health Insurance Card). For temporary stays in another EU country. It is not a way to live in France. Ask for it before you leave if you need it for the first weeks.
- GHIC. The British card that replaced the EHIC for new applications. The Cleiss describes it as a card for temporary stays, not a route to residence cover.
- S1. A form that tells the French fund that your home country pays for your care. It is for pensioners, some posted workers and their family members. You request it from the body that pays your pension, then register it with the CPAM where you live.
If you are British with a UK State Pension, the NHS Overseas Healthcare Team issues the S1. If you are British and neither work nor draw a UK pension, you must first have a regular right of stay (see moving to France from the UK).
Do you need a mutuelle in France?
The Assurance Maladie reimburses within its base rates only. A mutuelle covers a part of the rest: the share of the consultation, dental, glasses. If your employer offers a company group plan, you can generally join it, and refusal is only possible in specific cases on written request. Low-income households may qualify for the Complémentaire santé solidaire, which depends on household income.
Mutuelles vary a lot in price and cover. Compare the reimbursement levels for what you actually use, such as dentist, optician and specialists, before you sign.
Common mistakes with French healthcare
- Using the EHIC as an insurance for residents. It is not.
- Waiting for a letter. Nobody will register you unless you or your employer starts the process.
- Forgetting the médecin traitant. You are less well reimbursed without one.
- Ignoring the three-month rule for non-workers. Keep a private policy or your home cover until you qualify.
If you want to see your own situation (employee, pensioner, remote worker) laid out step by step, Moovy can walk you through it. For the wider picture, see the moving to France checklist.
What about emergencies?
Call 112, the European emergency number, which routes you to the right service. In France the medical emergency number is 15 (SAMU), police is 17 and the fire brigade is 18.
What happens in your first weeks, before you are registered?
Your first weeks are the gap that worries people most. If you come from another EU country, the European Health Insurance Card covers the necessary care during a temporary stay, which is useful while your file is processed, but not the planned treatment, private care or repatriation. Ask your home insurer how long it keeps you covered and whether it will give you an S1 form. If you are an inactive person with no cover, keep a private policy during the first three months of stable residence, because you cannot be attached to the French system before that.
If you are an employee, your employer opens your rights, so give your documents on the first day. Delay in the paper file is the most common reason for a slow start, in particular for people born abroad, who are first given a temporary identification number.
Who is covered in your family when you register?
Your family members who live with you in France for more than three months are covered for all benefits in kind (care, treatment, hospitalisation). For inactive people attached to the French system, ameli lists the spouse or partner, dependent children under 21 (including those of the spouse) and dependent parents or grandparents (including those of the spouse). If your family stays in another EU or EEA country, they can receive care there with an S1 form issued by your French CPAM, when you work in France.
What help exists with the cost of healthcare in France?
The French fund reimburses at base rates and, for large costs, the share left to the patient can still be high, so a mutuelle matters. Households on low incomes can apply for the Complémentaire santé solidaire, which depends on household income, and the affiliating service sends the form if you qualify. If your household has fewer resources than the RSA or ASPA and you cannot be attached, the State medical aid (AME) may cover care.
At the doctor's, the practical sequence is simple: show your carte Vitale, pay if asked, and follow the reimbursement on your ameli account. If you received care in your home EU country and want to claim in France, ameli explains that you can send the invoices, proof of payment and form S3125 to your CPAM, and you will be reimbursed at French rates.
How is healthcare in France different in the overseas departments?
The principles are the same, but the funds are named differently (CGSS or CSS), and Mayotte has its own fund with some local amounts. Read living in the French overseas departments before you settle there.