Americans in France: do 'visitor' visas enable 'free' healthcare as French MPs claim?

Two French MPs are calling for France to bring in a new healthcare charge for certain newcomers to the country, claiming that Americans, in particular, are getting "free" healthcare despite paying "no income tax".

They have tabled an amendment for debate as part of France's social security budget law for 2026, but it has not yet been debated and there is no indication at present that the idea has strong parliamentary support. 

The proposal has, however, led to several articles in the French press looking at the healthcare status of Americans in France on VLS-TS 'visitor' visas. 

Here we look if the assertions by the MPs are true. 

What is proposed?

The MPs, from the centrist Horizons group, say "American retirees, notably" have been coming to France and obtaining healthcare "with no financial contribution" and "paying no income tax in France".

They say this "loophole" is being "exploited by certain expatriation agencies" that highlight these advantages.

They propose therefore that there should be a "minimal financial contribution" required of non-EU citizens who move to France on a visa de long séjour valant titre de séjour 'visiteur' in order for them to access the French healthcare reimbursements system.

This is a kind of visa suited to people who can live in France supporting themselves and not working.

What are the current rules?

These visas are deemed equivalent to a first residency card and and can be renewed at the end of the first year for a first physical residency card. This can then be renewed annually if the holder continues to meet the requirements. 

After five years in France on this status it is possible to apply for a 10-year resident’s card. 

The VLS-TS does not come with the right to work, and holders must prove they have a monthly income higher than France’s minimum wage. As of November 2025, this is €1,426.30 net per month.

For retirees, this will come from pensions, investments, and other income sources.

When applying for the initial visa, you must prove you have medical insurance covering at least €30,000 for your stay in the country.

After three months of living in France, holders can apply for a social security number and subsequently a carte Vitale, coming under the coverage of France’s state healthcare system. 

This includes the same coverage as any other carte Vitale holder, such as 70% of many doctors’ appointment fees.

Many holders then choose to cancel their original health insurance in place of a less expensive top-up mutuelle to ensure they are fully covered. 

While the MPs, and French media, have highlighted the case of Americans, this is the same process for retirees from many countries, provided they do not have an S1 health form (in the latter case the country paying their state pension pays for their healthcare in France, which applies notably to people with British or EU pensions). 

However, high healthcare costs in the US are often cited as one attractive factor for Americans moving to France. 

Is the measure controversial?

This is not a ‘loophole’ and has been in place since 2016 via the creation of protection universelle maladie (Puma).

The rules state that anyone in France for more than three months (and resident in the country on a settled basis) is entitled to be covered by state healthcare.

At the time this aimed to simplify the French health system and to ensure that all residents were covered. Several countries have residency-based healthcare, including the UK, although in recent years the UK introduced additional annual NHS charges for newcomers of around £1,000/year.

However, well-off Americans, and others who do not have social security rights via work, a French pension or an S1 form, are in fact required to pay a ‘Puma tax’ (official name Cotisation subsidiaire maladie) if they have ‘capital’ incomes above a certain level. 

This includes, for example, income from rent, shares, bank accounts and other investment schemes or capital gains from the sale of property.

There is an allowance of €23,550, after which the fee is charged at 6.5% within a certain ceiling. This means it is possible for wealthy individuals to pay up to €24,492 per year to belong to the French health system.

The issue of American beneficiaries “not paying income tax” is separate, and is based on the US-France double-tax treaty, ratified in 1995. 

However, this does not exempt them from French tax on all forms of income, only certain kinds such as American pensions, which are taxable only in the US.