French MPs back new health fee for ‘visitor visas’ and target Americans

Retirees with visitor visas from the US and elsewhere outside the European Union may soon have to pay a minimal fee towards their healthcare costs under a measure adopted by MPs (députés) on Saturday (November 8) as part of the ongoing 2026 budget negotiations.

Visitor (visiteur) visas, which are typically used by foreign residents living off pensions and investments, as opposed to working in France, currently make their holders eligible for France’s Protection universelle maladie (Puma) - universal health coverage - after three months of residence, even if they do not pay French taxes or social charges.

“This measure addresses a real anomaly,” said François Gernigon, an MP from the centrist Horizons party, who tabled the amendment along with Horizons colleague Nathalie Colin-Oesterlé. 

“Today, some foreign nationals can live in France, access public healthcare without any contribution, and in some cases without paying any tax. Certain agencies, especially in the United States, even promote France as a destination for retirees by promising free access to the French health system.”

"National solidarity cannot only go in one direction," he said.

The new fee targets long-stay “visitor” visa holders from countries without reciprocal health agreements - such as the United States - who can currently access Puma after three months without contributing to the system.

The exact level of the new contribution would be set by government decree.

Due to a 'sub amendment' tabled by another MP from the centist Horizons group, Paul Christophe, which Public Accounts Minister Amélie de Montchalin said was a condition of her support,  citizens of countries covered by bilateral social security agreements would not be affected.

The exact countries whose bilateral schemes are considered sufficient for exemption were not clarified, however, it would likely include at least UK state pensioners, who participate in the 'S1 form' scheme along with Europeans, meaning the country paying their pension pays for their healthcare in France. 

Canadians and Americans were those mentioned in the debate as notably being affected by the new measure. 

Widespread support

The amendment was adopted by 176 votes to 79, with support from MPs in the ruling centrist bloc, the right and the far right. 

Left-wing parties voted overwhelmingly against it, calling it discriminatory and politically motivated.

The measure, which was included in the prospective 2026 social security law could still be rejected by the Senate.

The reasoning behind the measure was partly the fact that Americans, in particular, are said to have an especially good deal, due to the fact that the Franco-American double tax convention means that some of them do not pay any tax in France (notably, US pension income is taxable only in the US), despite them also obtaining entry to French healthcare on residency grounds. 

Ms de Montchalin acknowledged the issue of unequal treatment under existing international conventions. 

“It is true that some nationals of G20 countries can be exempt from income tax, CSG and other contributions,” she said. “The government takes this seriously and intends to revise these agreements so that all make a fair contribution.”

However, such 'revision' would have to be done in negotiations with the countries concerned. 

The change will primarily affect non-European retirees living in France on long-stay visitor visas, particularly Americans, who have become one of the largest groups of such residents. 

Many currently gain access to France’s state healthcare system after three months without paying into it, as long as they can show stable income and private health cover on arrival. 

Once the decree is issued, long-stay visitor visa holders from outside the EU will have to pay the new minimum fee to maintain access to Puma.

The debate in the Assemblée nationale did not pay any notice to the fact that a 'Puma tax' already exists for some of those concerned, but only if they have a high level of 'capital' income. 

We note also that as worded, the amendment only appears to strictly apply while a person is on a visa de long-séjour valant titre de séjour, which is the first year after coming to France. 

However, the intention may be to include those also on 'visteur' residency cards, which is the same immigration status, thus those affected would likely pay it at least until they have been in France five years and can apply for a 10-year carte de résident.