How to register for healthcare in France

Sarah Daly, a British expat in France explains how to register for healthcare in France and about the various systems you’ll need to be au fait with.

How to register for healthcare in France – get in the system

If you are, or are planning to become, a French resident, there are two main ways of accessing the healthcare system. France offers a form of universal healthcare known as Protection Universelle Maladie (PUMA) and any legal resident of the country is eligible to receive this care. That doesn’t mean it is completely free, but it usually means that the core element of it is covered by contributions you make in France, or have already made in your country of origin. The UK and the US for instance, both have reciprocal health care agreements with France, which apply to retirees (and posted workers in some cases). If you work in France, these contributions take the form of social charges. Most French citizens and residents, top this basic cover up with a mutuelle. This bespoke form of insurance is priced according to the type and level of cover it provides.

Universal health card – la Carte Vitale

In order to access the healthcare system as a resident, your first port of call will be your local Caisse Primaire d’Assurance Maladie (CPAM). You should be able to have health-care fees back-dated to your date of application to CPAM, or to the date of your S1. You will need to retain all care sheets and any accompanying paperwork such as prescriptions to submit to CPAM once you have a social security number.

Once you are accepted by CPAM, you will get your carte vitale. This universal healthcare card is presented to everyone from the pharmacy and the GP, to the physiotherapist, community nurse or hospital admissions desk. It ensures that up-front costs are refunded to your bank account automatically or – if you have a long-term condition (affection long durée, or ALD) – you may not pay at all. Certain services such as some vaccines, child mental health services and cancer screening are completely free when you present your carte vitale. On the other hand, you usually pay to visit the GP (médecin traitant or MT) and then receive the majority of the fee back automatically.

To access your CPAM account online (via desktop or app) you will need an Ameli account. Via this account, you can check your payments and reimbursements, download proof of your rights and keep track of appointments.

Health insurance – La mutuelle

Health insurance, known as a mutuelle, tops up state provision and can therefore reduce the cost of medications, specialist appointments and hospital stays. Unlike in some other counties, having insurance doesn’t allow you to jump the queue for care, it just affects your out-of-pocket expenses. A policy may cover just you or your whole family and it will vary according to your circumstances. My mother lived with us in France for two years and, as she had an ALD, she paid very little for medication but often ended up in hospital, so her policy reflected this. My daughter had a brace on her teeth and my son and I wear glasses so we adapted our family policy to reflect these factors too. If you need to upgrade your policy, for instance due to an unexpected hospitalisation, contact your insurers as some allow you to alter cover straight away without penalty and some apply a waiting period. As with most insurance, the more you pay, the higher the level of cover you will receive, so it’s always a case of balancing the likelihood of treatment with security of cover.

Calculating percentages

In France, everything has an index of official fees and these are calculated on a base de remboursement du régime obligatoire (a system of mandatory reimbursement). CPAM refunds 70 per cent of the index fee and insurance will top that up to 100 per cent.

A complicating factor is that policies can sometimes cover 200 or even 400 per cent of costs. This is because the cost of dental work, as an example, may be much higher than the index level. A policy that offers higher cover will therefore pay more of the costs, leaving you with less to pay. There should always an option that means you don’t pay anything, but you may choose to pay extra, for instance for more expensive frames for your glasses, and this is where a higher level of mutuelle may be useful.

Make a note

Whereas in the UK your medical history is held within the NHS, in France it very much belongs to you and the onus of care tends to lie with you as the patient. If your GP refers you to a specialist or for a test, you will usually arrange that follow-up yourself, although if you ask, the GP may provide some names or contact details. Often you will wait only days or weeks for an appointment, although this will vary according to where you are and the nature of the appointment. You will be given test results yourself (either online or as hard copies and often immediately or within a few hours depending on the test) and you are then expected to take these results with you to any further appointments, although copies are often sent to the health professional who requested the test.

Most medical organisations, such as nurse practices, opticians and physiotherapists, are run as private businesses but will be paid largely through the social security system. The same is true of hospital transport. If you are unable to drive or get to an appointment, you can arrange transport directly and, in many cases, you pay nothing. You will need a bon de transport (travel pass) from the doctor or specialist you’re seeing, and you can travel in a normal taxi or lying down in an ambulance. You can usually take someone with you to appointments, although it’s worth checking this in advance.

Finding English-speakers

Most doctors in France speak English to a reasonably high level as it will have been required during their training. You may find it tricky to discuss a complex condition or situation though, so taking a fluent French-speaker to appointments can be helpful. In most cases however, while some nurses, carers and other health professionals may be keen to practise their English with you, most will speak very little at all.

Home help

If you are caring for an elderly relative, recovering from an operation or dealing with a disability, you may want to organise personal care at home. Again, your GP may be able to suggest care agencies locally. ADMR for instance is a national organisation that operates at a local level across France, with carers who will come to your home, usually at a time to suit you. You will probably be asked to pay directly for care, but you can declare any costs on your annual tax return and these will be taken into consideration when calculating tax.

Clean bill of health

As a Brit living in France, people often ask me whether things are better in the UK or France in terms of healthcare. It’s not hard to reply, as I’ve found that health professionals I’ve met in both countries are, almost without exception, professional, knowledgeable, efficient and compassionate. But in my experience healthcare in France is better funded, better organised and more focussed on disease prevention. Waiting times are much shorter and you have far more control over who you see and when you see them.

If this all sounds too complicated, French Admin Assistance (FAA) can take care of the administration necessary to get you into the system, helping you obtain a social security number, get a carte vitale and set up an Ameli account, as well as tackling health insurance.

Useful information

If you ring 112, the Europe-wide emergency number, your call will be directed according to the service you need and where you need it.
Dialling 15 in France goes through to Service d’Aide Medicale d’Urgences (SAMU), which also acts like the UK’s 111 number. Responders triage patients, dispatching an ambulance or directing less urgent calls to the right medical service. Even if you are making your own way to Accident and Emergency, known as urgences in France, it is advisable to ring 15 before you arrive.
To apply for a GHIC from the UK, visit gov.uk/global-health-insurance-card
To apply for an S1 from the UK, call the Overseas Healthcare Services on 00 44 (0)191 218 1999.
For guidance on applying to the French system as a UK national, visit gov.uk/guidance/healthcare-in-france
For guidance on applying to join the French healthcare system from overseas, visit service-public.fr/particuliers/vosdroits/F12859 you can then choose to view the information in English.
To find out more about CPAM, visit ameli.fr and choose your local office. The English-speaking helpline offers support on 09 74 75 36 46

Note: If you are here on holiday, or as a second home owner, begin before you travel with a Global Health Insurance Card (GHIC), or equivalent if you live outside the UK. If you combine this with comprehensive travel insurance, it should be enough to allow you to access care when you need it, without an excessive bill. In this case, you’ll need to provide ID and evidence of your right to access health care and then retain medical paperwork, known as the ‘feuilles de soins’ or care sheets, together with prescriptions and receipts. You will probably pay up front for care you receive, claiming some or all of it back, depending on your circumstances, afterwards.

Sarah Daly is a freelance writer who lives in the far north of France.