France plans to double out-of-pocket medical fees cap to €200
Measure would increase cap on medicine and appointment levies for first time in 20 years
Renewed plans to double annual limits on France’s out-of-pocket levies for medicines, care, and appointments are set be implemented in the coming months, Health Minister Stéphanie Rist announced on Thursday (July 23).
France wants to increase the caps for the franchises médicales and the participation forfaitaire de €2 from a combined €100 to €200 annually.
This would increase the Social Security budget by around €775 million per year, counteracting some of the mounting debt in the sector.
Raising their respective annual caps from €50 each to €100 is one of a number of healthcare measures being considered by the government to reduce debt before discussions on the 2027 budget begin in autumn.
Other plans include reducing reimbursement rates for older or less effective medicines – although there is debate over the effectiveness of newer drugs in relation to their higher cost.
Increases to the franchises médicales and paticipation forfaitaire de €2 were originally included in the 2026 Social Security Budget before being removed during fierce debates on the matter.
Defending plans to increase them, Ms Rist told media outlet RMC that the caps have not increased ‘in 20 years,’ so needed to reflect the current state of France’s social security budget.
The changes are set to be introduced via a government decree, and not voted on by MPs, she added.
No set date has yet been given however Ms Rist indicated this could be published as early as this summer.
Caps to double but not costs
There are two types of out-of-pocket payment made by patients subscribed to France’s public social security system.
These payments are deducted from reimbursements paid by the state insurance (Assurance Maladie) to patients.
The first of these - the franchise médicale - covers solidarity payments of €1 per prescribed box of medicine, €1 for care from professionals such as nurses or physiotherapists and €4 per use of medical transport. It has a combined annual cap of €50.
The second - the participation forfaitaire - is a flat-rate contribution paid for medical appointments (€2 each visit) as well as for examinations (such as x-rays) and blood tests, also with an annual cap of €50.
Note that some French media in their reporting lump all these together under the term franchises médicales.
These costs apply regardless of a person’s insurance status – patients with long-term illnesses are not exempt – and the payments are not covered by top-up mutuelle insurance policies. However, those attached to France's state top-up insurance (complémentaire santé solidaire) are exempt from the fees.
Certain other exemptions exist, including for children, heavily pregnant women (from six months of their pregnancy to 12 days after birth), and recipients of France's state medical aid (aide médicale de l'État) scheme.
Unlike a text previously proposed in the 2026 social security budget law, there are no reports that France is planning to increase the non-reimbursable amount of these payments per charge, only the total cap.
Increasing these caps to €100 each – a €200 total – would therefore impact those who use healthcare services the most, whereas those who do not typically reach the cap across a year will remain unaffected.
More changes on the way?
While these are the main changes announced so far, other groups have differing ideas on how to reduce Social Security spending (or increase the revenue/budget) as France faces mounting debts.
The total accumulated Social Security debt is projected to reach some €175 billion by 2028, with the annual social security budget deficit reaching €23 billion in 2025 alone.
A proposal by state auditors the Cour des comptes would see certain medical payments (including franchises médicales) deducted directly from a patient’s bank account.
Currently, these sums are usually deducted from reimbursements, or, if necessary, from a future reimbursement.
However, some people never receive ‘reimbursements’ because they are not required to make any upfront payments (for example, if they are on the complémentaire santé solidaire scheme for low earners).
In those cases Cpam sends a bill they are asked to pay separately, but in reality many of these small debts are never collected.
Amounts owed but not recovered cost around €1.5 billion annually and direct deductions from bank accounts are estimated to be likely to reduce this by €500 million to €1 billion per year.
The Caisse nationale de l’assurance maladie (Cnam) wants the government to reassess its spending on expensive, new drugs, which it says only rarely offer significant improvements to those already available.
It says, by way of illustration, that there are now some 25 drugs that cost more than €80,000/year, while there was only one ten years ago.
Instead, it wants reimbursements to ‘prioritise the most cost-effective treatments and protocols, where efficacy is comparable.”
This would include favouring medicines and treatments that did not require hospital visits, as well as making as much use as possible of generics and other cheap drugs with the same action instead of expensive new drugs.
Cnam estimates that a €128 million saving could be achieved by taking this approach for treatments for four specific serious diseases (which it did not name).
