Those moving to France will undoubtedly have many questions regarding how the French healthcare system works, as well as whether private health insurance is necessary. This guide provides information on how expats can access the French healthcare system, and further outlines the key France health insurance options available. Read on to learn more, or click below to obtain a no obligation, free quote.

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Healthcare for expats living and working in France

France is renowned for having one of the best health systems in Europe. This is mainly attributable to the country’s relatively high physician to population ratio (3.227 per 1,000 people), low wait times, as well as its statutory health insurance, which enables all residents and most expats to access a vast range of public and private health services.

The French healthcare system

Key medical services covered by statutory health insurance in France include but are not limited to:

• Targeted preventative health services (e.g. immunization, mammography, colorectal cancer screening), which are tailored to each individual according to their gender, age, and a range of other factors (e.g. work). For example, all women aged between 50 and 74 years old are eligible for a free breast cancer screening every two years.
• Inpatient care. Statutory health insurance will pay for around 80% of hospital charges, which means you will either need to pay for the remainder amount out of pocket, or through a supplementary private health insurance plan.
• Outpatient care, including General Practitioner (GP) visits and most specialist visits. Please note here that patients can choose among specialists upon referral from their primary doctor, or médecin traitant, with the exception of gynecologists, ophthalmologists, psychiatrists, and stomatologists. Bypassing referral results in a lower reimbursement rate (namely the general doctor’s rate, and not the specialist’s rate).
• Costs for prescription medication are generally covered, and coinsurance rates vary from 15% to 100% depending on whether the medicine is deemed completely essential and effective. Highly effective drugs, such as insulin, carry no coinsurance.
• Basic forms of dental treatment are generally covered, but in most cases you will need to pay the charges up front and claim back the costs later. Most adults can claim back 70% of their dental care costs, but certain dental procedures like orthodontic work are not covered by state healthcare.
• Those with major illnesses that require long term care may be eligible to receive 100% reimbursement for their treatment costs.
• All medical costs associated with the delivery of a child, including compulsory prenatal and postnatal examinations, are covered in full by the national health system. Some specialists, however, may impose additional charges not covered by statutory health insurance.

Besides the fact that statutory health insurance covers an extensive range of medical services, healthcare in France tends to be inexpensive because of government-set caps on service fees. That said, the national health insurance scheme does not cover every medical service. In addition to this, most services are subject to a copayment of around 20%.

The excess fee that patients will need to pay for most medical services can in certain circumstances be very high, especially if they seek care at a private hospital or clinic. As such, securing private health insurance can be the best way of complementing and filling the gaps in your national health insurance coverage. For a free quote, access our online plan comparison tool, or read our France Health Insurance Options section below for further information.

Types of medical care in France

Public and private hospitals, as well as doctors and other specialists who offer medical services to residents in France are all part of the French healthcare system. Here, we look at the main aspects of medical care in France:

Public and private hospitals in France

As with most other countries, there are two types of hospital in France: public and private hospitals. 80% of hospital care are funded by statutory health insurance, while the remaining 20% are paid for out of pocket or funded by supplementary private health insurance. While most types of hospital care are covered by national health insurance, those staying overnight will in most cases still have to pay an obligatory contribution fee of EUR 18 for board and lodging. Additional miscellaneous costs like private hospital rooms and bedding charges will in most cases need to be paid for out of pocket.

Public hospitals in France offer a high standard of care, and a broad range of services and surgeries. One thing to note here is that not all hospitals will have an Accident & Emergency (A&E) department, so it’s important that you are familiar with the locations of the nearest available A&E departments in your area. Those living in rural areas should also be aware that public hospital facilities in these parts of the country are generally not as well equipped as their city counterparts, and may lack medical staff who speak English, or any other language besides French.

Profit-making private hospitals and clinics tend to offer more specialized services (e.g. specialist dermatological services), as these areas are primarily where profit opportunities lie. As such, there are very few full-service private hospitals in France, with the exception of a select few, such as the American Hospital of Paris.

The majority of private hospitals are state approved, and therefore can be part of the national health service. While most private health services are subsidized, the excess cost that patients will need to pay can become exorbitant, especially if you require extensive and/or specialist private care. This is where private health insurance can really help in taking care of these charges, as well as offer extra benefits not covered by the national health system (e.g. major dental treatment benefits).

Pharmacies

There are over 22,000 pharmacies in France, and they are usually open between 9 am to 8 pm, Monday to Saturday. In order to obtain prescription medicine from a pharmacy, patients will need to bring with them a prescription from their GP or specialist. While prescription medication generally costs less in France than in many other European countries, in most cases the national health system only covers a fraction of its costs. The percentage reimbursed depends on the importance and effectiveness of the medication, but usually the rate will be at 65%. If you have complimentary private health insurance, this may take care of the remainder amount.

Dental services

France has a high standard of dental care, and treatment charges tend to be very affordable and in line with the official rates set by the government. For instance, the official rate for a dental consultation is EUR 23, which is reimbursed at the rate of 70% by the national health system. That said, some dentists charge more than the official rate, so it’s important to double check your dentist’s price list.

Typically speaking, unless your dentist has direct billing arrangements with your insurer, you will need to pay for your dental treatment first and then claim back the reimbursed amount later. Specialist services like orthodontics, as well as cosmetic dental services like teeth whitening are not covered by the state system.

France health insurance options

First and foremost, it is important to note that health insurance coverage in France is required by law. Most expats are eligible to apply for state health insurance, which affords them access to the French healthcare system. Individuals who are not covered by state health insurance, as well as those looking to increase their health coverage, should consider securing private health insurance. Here’s a summary of how each of the two options work:

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Statutory health insurance

All residents including foreign workers who plan to stay long-term in France are eligible for state medical insurance. Since January 2016, statutory health insurance is universally granted under the PUMA (protection universelle maladie) law.

Universal healthcare has actually been around since 2000, but before 2016 the system required households to switch insurance plans if they experience a major change in personal or employment circumstances, which could result in a temporary loss of cover. In order to ensure continuity of health cover, the new PUMA reform guarantees that any resident is allowed to remain with their health insurance despite any changes in circumstances. Additionally, under the new PUMA law, legal residents including foreigners who have lived in France for more than three months and plan to carry on living in the country for at least six months yearly thereafter are eligible for state health insurance.

To register for the French national health insurance system, simply visit your local CPAM (Caisse Primaire Assurance Maladie) office. You’ll need to supply certain documents, including your national ID or passport, proof of long term residency, proof of address, marriage/ birth certificates if you wish to register your family, evidence that you have chosen and submitted a declaration to your chosen insurer, and evidence of income. While not a legal requirement, if you are employed your employer will most likely take care of your healthcare registration arrangements.

As discussed in the preliminary sections, statutory health insurance covers a large proportion of healthcare services, including inpatient and outpatient care, maternity, basic dental treatments, prescription medication, targeted preventative services, as well as pre-existing condition treatment, medical appliances and prosthesis, prescribed healthcare related transportation and home care. Mental health services and long term hospice are also partially covered.

While an extensive list of services are covered by the French health system, most residents will still need to pay an excess fee for medical services out of pocket, or through an additional private health insurance policy. Another thing to note here is that some residents cannot claim French healthcare until after three months of residency, meaning that they may have to secure a private health plan to protect them in the interim.

Private health insurance

Due to the fact that universal health coverage does not cover 100% of medical treatment costs, many expats will consider taking out a private health insurance plan in France even if they are covered by statutory health insurance, as a private plan will provide further protection against additional fees, as well as access to a wider range of services with comprehensive benefits such as cover for major dental treatment, additional preventative care services, alternative therapies, etc.

It is worth noting here that since January 2016, it became mandatory for private companies to secure top-up private health insurance coverage (widely known as a mutuelle collective) for employees, which helps finance the personal contribution element of the national health system. The company must pay a minimum of 50% of the mutuelle’s cost, but are not legally obliged to secure coverage for the employee’s family members. The rest of the population, such as civil servants, the self-employed, students and job seekers can choose to be covered by their family member’s mutuelle (if applicable) or secure their own private health insurance in France.

One major limitation with relying solely on statutory health insurance and/or a local private plan in France is that it only covers the policyholder in one country. Those looking to access care both in France and overseas should therefore consider obtaining an international health insurance policy, which offers comprehensive healthcare benefits in virtually any country, anywhere in the world. This type of policy also grants policyholders access to exclusive features like medical evacuation and repatriation benefits. To get an idea of how much international health insurance costs for individuals and families in France, download your free copy of our Cost of International Health Insurance 2018 report.

How to find the best private health insurance in France

There are many insurance options available in France, which is why it can be a daunting task to find the best private health insurance policy all on your own. When it comes to selecting the best policy, one of the best decisions you can make is to consult an experienced insurance broker like Pacific Prime.

With almost two decades of experience matching expats with the most optimal insurance solutions on the market, Pacific Prime leverages their close partnerships with all major insurers and has an extensive portfolio of all the best plans. In addition to having the best insurance policies, Pacific Prime also offers unparalleled service and outstanding claims support. Contact us today so we can help you find the best insurance solution for your budget and healthcare needs.