Medical charges and rates of reimbursement

The cost of a medical service must in many cases be paid for upfront. The state-insured part of that cost is then reimbursed through the state health insurance system, usually within a few days.

The state-insured part represents a percentage of a state-fixed rate for a given medical act or service, called the tarif de convention. The part of the tariff that is not state-reimbursed is referred to as le ticket modérateur.

For a standard GP visit costing €30 (as of December 2024), 70% is reimbursed at the time of writing, although there are proposals to cut this to 65%. In comparison, 80% of the main costs of inpatient care in state hospitals and clinics accredited by the state is reimbursed.

Doctors come under different 'sectors' with regards to their policy on reimbursements and are in most cases sector 1 or sector 2. Sector 1 means they only charge the tarif de convention, whereas sector 2 doctors can charge more on top of this, called dépassements d'honoraires.

A good top-up / mutuelle insurance policy will generally refund you the out-of-pocket costs represented by le ticket modérateur and any dépassements d'honoraires (see Chapter 2 for information on these policies, which are optional although the vast majority of people in France have one of these). 

Whether you are fully refunded for a given service depends on the level of any dépassements, and the level of top up / mutuelle cover you opted for.

For example, a ‘100%’ policy will top-up your reimbursement to 100% of the tarif de convention (if the state did not reimburse it all). A ‘200%’ mutuelle will top up to twice this sum if the doctor's fee was more (within the costs actually incurred, it will not pay out more that you paid).

Healthcare providers usually check if a patient has a top-up / mutuelle and can transmit details to the insurance company for reimbursement of this part of the costs.

Some people are exempt from having to advance their medical expenses for the state-funded part of their costs. This is called le tiers payant. In this case, whether there is anything left to pay upfront depends on the status of the patient and whether or not any dépassements are charged.

Notably, people with low incomes who benefit from a form of state-funded 'top-up' called complémentaire santé solidaire (CSS) are relieved from making any kind of upfront payment for the tarif de convention part of their care. Doctors should also not charge those on CSS any dépassements, apart from in rare circumstances.

Le tiers payant also applies to the whole of the tarif de convention for care for victims of work accidents as well as to people suffering from designated long-term illnesses (affections de longue durée; ALD) or occupational illnesses. Dépassements d'honoraires may, however, in some cases still be chargeable and payable.

Hospitalised patients who are treated in state hospitals or state-accredited private clinics generally now do not have to advance their costs for the state-funded elements. This also applies to patients receiving preventive care services, such as mammograms carried out as part of a breast cancer screening programme.

Others benefiting from this include girls aged 15 to 18 requiring sexual-health check-ups or contraceptive-related consultations, and pregnant women. Pharmacies also generally practise le tiers payant.

This however does not apply if people insist on a branded medicine rather than an equivalent generic drug. On presentation of mutuelle details, the part covered by the mutuelle does not have to be advanced in this case.

Moves to generalise the tiers payant for all doctors appointments did not amount to much, although they may choose to offer it. Doctors generally believe advancing money is a good way for patients to value their care – and saves the doctors having to wait for reimbursement from the state. 

If in doubt, take a chequebook or cash to appointments. Most – but not all – doctors accept bank cards.

Both the state social security and the mutuelle will issue refunds as direct electronic transfers to your bank account. If this is not happening, you should check with your local Cpam to make sure they have your bank details.

For early-retirees who move to France and opt for a comprehensive private healthcare policy instead of state care the reimbursement is all obtained through your private insurer, depending on the level of cover.

Note that you may be reimbursed at a lower-than-usual rate if you see certain specialists without referral from your médecin traitant. Failing to obtain referral, or to register with a GP at all, means you fall outside the so-called pathway of care (parcours de soins). This penalty is not picked up by mutuelles.

For example, if you visit your own GP you will be reimbursed based on a set fee of €30, at 70% (minus a fixed €2 deduction called the participation forfaitaire), ie. €19. If you go hors parcours (outside the pathway) then the reimbursement is reduced by €10.60, so is just €8.40.

If your GP is on holiday, a designated replacement doctor or another member of the surgery is acceptable. If you are away from home you are not bound by the médecin traitant rule. The same applies to emergency care.

Franchises and participation forfaitaire

The French state has introduced several automatic levies over the years that reduce reimbursements. These include:

The participation forfaitaire – this is a tax to help fund the health system. It was introduced in 2005 at €1 and in 2024 doubled to €2. If you are aged 18 or more it is deducted from your reimbursement for each consultation, medical act, examination or test (with the exception of dentists, nurses, speech therapists, physiotherapists or for surgery in hospital). There is a ceiling of €8 a day for ‘acts’ by a single doctor or blood test laboratory. It is capped at €50 per calendar year per person. Mutuelles do not usually reimburse this charge, which was brought in to discourage people from consulting too many different doctors unnecessarily.

The franchise deduction is €1 on each box of medicines, €1 on each 'paramedical act' by, for example, nurses and physiotherapists (not doctors) and €4 for each ambulance journey. You cannot be charged more than €50 in franchises levies annually, more than at €4/day for paramedical acts and €8/day for transport. These franchises were introduced in 2008 and are used to finance research into cancer, Alzheimer’s disease and the improvement of palliative care.

For people in the French system, the state’s part of funding for medicines is deducted directly at the pharmacy and there is no need to pay in full and obtain a refund as you do when visiting the doctor. This means that franchise deductions for medicines are taken off the next reimbursement you receive for a medical service for which you have to hand money over for, such as a visit to a doctor. Most mutuelles do not reimburse these deductions.

Note: These levies have exemptions, such as for pregnant women or people on the aide médicale de l’état (AME). The latter gives free ('100%') healthcare cover to undocumented immigrants with low incomes. There has been debate over changing it to a version for emergencies only.