Tips for getting cover as a US national

If you are a US national, before you arrive in France and begin the process of access to the state system you will need to ensure that you have private insurance that includes medical coverage to handle potential healthcare costs. This will cover you if you need care early.

If you urgently need to see a doctor, it is also possible to simply pay the fees out of your pocket, and if doing so you will generally find them significantly cheaper than in the US.

If you plan to make France your home, you will want to join the French system and it is advisable to apply once you have proof of your residency in order to obtain a social security number to do so.

Most people (one exemption is agricultural workers) are affiliated to a local body called the caisse primaire d’assurance maladie (CPAM).

US retirees / early retirees

A US pensioner is entitled to membership of the French system with a carte Vitale healthcare card.

The first step is to become affiliated to French social security and obtain a social security number which can be acquired by completing and submitting a form requiring proof of residency to your local CPAM. You should do this once you have proof (utility bills etc) of three months settled residency.

Once you are registered and have a social security number you can in a second step apply for a carte Vitale, which is used to simplify reimbursements.

As previously mentioned, some US retirees will have to pay fixed-rate fees towards their healthcare costs.

Until 2026, the only fee was the cotisation subsidaire maladie, or ‘Puma tax’, calculated on the basis of the previous year’s income tax return, ending December 31, and collected by social charges body Urssaf. Early retirees with ‘capital’ incomes over a certain threshold (€24,030) are the main group with a fee payable based on 6.5% of amounts over this (a cap exists for very high earners).

Examples of capital income include property income from rents and non-professional furnished letting, income from shares and bank accounts, capital gains from the sale of property, and certain other rights that bring in income and are not directly linked to work. Retirement pensions, declared as such in an annual French income tax declaration, are not concerned.

A new fee aimed especially at people living off pensions, is being worked out in the course of 2026. It is likely that those eligible to pay it will not pay the Puma tax and vice versa.

Students

International students who study in France for more than three months can be registered with social security to obtain a number and access healthcare with the carte Vitale.

Self-employed or employed

If you work for yourself in France you are eligible to join the system and obtain the card, and must register both your professional status and health coverage through official channels.

You handle your own social contributions (cotisations sociales), instead of deduction by an employer.

For employees, your cover comes via contributions taken off your salary.

Note however that those with very low annual incomes from part-time work but substantial income from non-work sources may be required to pay a Puma fee at reduced rates on a sliding scale.

Dependents

A spouse or partner (civil, pacs, or even in some cases long-term dependent), should join Puma in their own right. Dependent minors are covered by their parents’ healthcare cover, though it is possible for them to join independently from the age of 16.

Emergencies

Emergency treatment is available at the casualty section of a hospital (urgences) or, if on-the-spot assistance is necessary, from the Samu (Service d’Aide Médicale Urgente) a mobile paramedical service with its own ambulances.

Similar help can also be obtained from the fire brigade (pompiers on 18), and they are particular expert in the case of road accidents, fires or certain other major trauma situations such as severe burns or electrocutions and situations requiring rescue.

The current guidance is, where possible, to call 15 for serious medical problems so as to obtain the best response in the situation (you may be told to go to the casualty department, or a Samu ambulance may be called out etc) or 18 for the pompiers if appropriate.

The international emergency number 112 can also be used in France.