Living in France: International Medical Care and Health Insurance
How much do expats love their life in France? A lot! A generous 78% report being satisfied with their new life and their new country. Considering that their top three reasons for relocating were for the quality of life, employment, and – of course! – love, it’s no surprise that France agrees with expats. In fact, 40% of them have no plans of ever leaving. With this in mind, it’s crucial that expats have a thorough understanding of medical care and health insurance in France.
An Overview of Healthcare in France
France administers a system of universal health care funded by taxation. The standard of care is considered superb. In fact, France is the first in the world according to the World Health Organization’s ranking of healthcare efficiency. From preventative care to emergency surgery, France offers excellent health care.
In addition to outstanding public health care, most people in France pay to carry French supplemental private insurance. This is known in France as “mutuelle” and it’s designed to offset additional health care costs. One of those additional costs comes from doctor visits. The state only pays 70%, leaving the patient to cover the remaining 30%. Thankfully, that works out to only 7 Euros or so! But in a large family, these small costs can quickly add up and it’s nice to have some extra coverage through the mutuelle. And the mutuelle also covers much bigger expenses like physiotherapy and private hospital room accommodations.
Where Do Expats Fit In?
So where to do expats fit in this system of universal health care and supplemental insurance? A big change in regulations in 2016 brought welcomed news to expats. Since then, any expat who has lived in France for at least three months in “a stable and regular manner” and plans on remaining in France on a permanent basis can apply for public health care coverage.
Of course “apply” is really a code word for paperwork! The new system is known as Protection Universelle Maladie (PUMA), while the old system was Couverture Maladie Universelle (CMU). CMU required residency of up to 5 years. There was also a paperwork-heavy annual renewal process. No wonder expats are pleased with the new changes! But it’s important when you’re gathering the documents that you’re following the new PUMA regulations and requirements. A lot of expat focused websites still offer recommendations based on the CMU era.
Understanding Insurance Paperwork Required of Expatriates in France
If you’re an expat, you’re going to need extra documents. You must demonstrate that you intend to reside in France permanently and legally. You must prove that you anticipate residing in the country for at least half the year (as anything less means you are not a permanent resident.) As you are settling into your new life in France, registering for classes and signing up for volunteer work, hold onto your receipts and application forms. They will all help to support your claim. And, like with most government based applications, you’ll need to provide proof identification, address, and income.
The paperwork fun doesn’t stop there. All expats must register with a primary care physician. You’ll need proof of this registration when applying for public health care at your local CPAM (Caisse Primaire d’Assurance Maladie) office.
Once you’ve been approved, you can apply for your national health insurance card, the carte vitale (green card). Since 2017, having your green card with you when you go to the doctor means that that you’ll avoid having to pay up front and in cash for services and then going through a tedious paperwork process for reimbursement.
Of course, there is some fine print… Expats can only apply to the PUMA program if they’ve been in the country for less than five years, do not have paid employment, are under retirement age of 65 years and do not receive a pension from a European country. Non-European students who are older than 28 years with no salaries and British early retirees are also eligible if they receive no salary. If you need global coverage, if your application is rejected, or if your time in France will amount to less than 50% of the year, you will require privately held international health insurance to cover your needs.
Best Private International Medical Plans for Expats in France
Private international medical insurance offers a few additional benefits over and above local plans. First, they are global and will cover you anywhere in the world. Further, they can be more comprehensive and provide you with access to a wider variety of healthcare facilities and doctors. For expatriates moving to France, we would recommend two options. Cigna Global is a leading global insurer with great service and benefits. Cigna Global offers a modular plan design allowing you to pick and choose different modules to tailor the plan to your needs and budget. The second suggested plan, primarily for US citizens living abroad, would be GeoBlue Xplorer, which offers similar benefits and service to Cigna. GeoBlue Xplorer is offered in association with Blue Cross and Blue Shield of America and comes with the excellent BCBS network of doctors and hospitals and the highest quality of doctors worldwide. For other options, view our list of the best international health insurance companies.
Best Insurance for US Citizens Living in France
- Premium Benefits, Coverage and Service
- Define your deductible and prescription benefits
- For Foreigners in the US or US Citizens Abroad
Best Global Medical Plan for Expatriates Living in France
- The flexibility to tailor a plan to suit your individual needs
- Access to Cigna Global’s network of trusted hospitals, clinics, and doctors
- The convenience and confidence of 24/7/365 customer service
For visitors to France, see: Health, Safety and Travel Insurance Advice for Travel to France
Mental and Social Wellbeing for Expats in France
While France has outstanding healthcare ratings, many expats report that it is challenging to break into French social circles. Language barriers and the small, tight-knit nature of French friendships are primarily to blame. Nearly 60% of expats in France say it’s challenging to get used to the local culture, a figure that’s similar to what expats experience on average across the globe. This can take many by surprise. They assume it will be easier to adapt to life in France than, say, China or Nigeria but that’s not always the case. And language can be a big part of that. 76% of expats report that it’s hard to live in France if you don’t speak French.
In short, expat life can be isolating and lonely. And it doesn’t help when friends and family back home can’t appreciate that life in Paris is anything but perfect. Signing up for small group language classes is a good place to start. Joining more than one, perhaps with a focus on grammar or conversation, is even better. Volunteer work with a cause that’s dear to your heart will help you meet locals who share your values and interests. And making sure your friendship circle includes other expats, as well as locals, will help you expand your network of support.