Several Americans in France have told The Connexion most would be happy to pay more for their French healthcare if asked to – as long as the amount is reasonable.
The comments came as the French députés (MPs) voted in favour of an amendment to the social security finance law for 2026, calling for a new minimal levy on foreign people who come to France on visiteur status visas, often used by retirees and early-retirees.
Due to France’s ‘Puma’ principle of healthcare rights via settled residency, in force since 2016, it is possible for people to join the health system despite not paying French social cotisations, such as paid by those working in France.
However a ‘Puma tax’ is already payable by those with substantial ‘capital’ income such as share dividends and capital gains or money from renting out property.
In some cases, newcomers also do not pay French income tax, as US pension income is only taxable in the US under the US-France double taxation convention, which is not the case, for example, with the UK-France treaty (other than UK public service pensions).
The députés putting forward the amendment claimed some ‘relocation agencies’ have been encouraging Americans, in particular, to come for ‘free access completely funded by the French taxpayer’ due to this ‘loophole’.
An online search by The Connexion found a handful of websites that mentioned the possibility of low/free healthcare inscription costs as part of other information on moving to France, but none blatantly promoting this as the main reason to come.
Many think the députés 'have a point'
Allison Grant Lounes of YourFranceFormation, who helps Americans move to France, said: “I think most people feel the députés have a point and have often wanted to contribute to the healthcare system.
“A lot are really surprised to discover they can get healthcare for free if they only have pension income.
“In fact, some do not apply for state healthcare but continue with fully private coverage, because they are uncomfortable with not paying for it. However, I recommend that they do apply, as soon as possible, as getting into the system is one thing the prefectures will look for [when you apply for a residency card] as proof you are now living in France.
“Plus, even if they send in their forms after the first three months, it can take until month eight, nine or ten before they are registered.”
Ms Grant Lounes, who also founded the Americans in France Facebook group, said the US-France tax convention is unusual in the fact US pension income (and some other US income) is not taxable in France.
Furthermore, all common US pension types are exempt from assessment for the ‘Puma tax’ as they are not deemed to be from ‘capital’.
“So, say, someone has mostly pensions, but even as much as $1,000/month in rental income, they would still be well under the Puma tax threshold. If they are letting a house in the US for several thousand dollars a month they will pay it, but that is not the case for the majority.”
She has seen no estimates of what the new minimal contribution may be, but would assume it would be “extremely reasonable”.
It comes as the Trump administration in the US is making cuts to Democrat-era health programmes, meaning many people face paying more for health insurance policies in the US.
“I cannot imagine what they would come up with in France would be more expensive than what would be payable in the US,” she said, although she has seen no evidence of Americans moving solely due to cheaper healthcare.
“US citizens do deeply admire and appreciate the system and the fact it is universal and not exploitative. They want to support that system and feel it is what healthcare should look like in the US.”
With regard to taxation she noted that once Americans are French residents their estates are subject to French inheritance tax, whereas in the US there is no inheritance tax below $14million.
Americans feel singled out
Susan Maine-Descamp from the Association of American Women in Europe (AAWE) said: “There is a lot of discussion on this in our group WhatsApp chats.
“I’m seeing confusion and a sense of us being singled out, when we as Americans have no problem with paying a reasonable amount into the system.
“However we do not believe we are the number one problem the French healthcare system faces right now.”
Many would be willing to pay up to around €3,000/year, if necessary, she said.
“Most Americans, if they are retirees, are on a fixed income, so are willing to pay a contribution as long as it is fair and reasonable. We are not coming over here in order to leach off the system; we are coming because we like France.
“Also, American retirees love to go out to eat, so we are spending our money here.”
She added most Americans also pay for a mutuelle (top-up health insurance) policy, as do most other people in France.
She also stressed that Americans in France who are retirees on a visiteur status and who have not paid social cotisations represent a minority of Americans in France.
“In our association, most of our members have worked (in France) and have contributed.”
Doris Speer, president of the Association of Americans Resident Overseas (AARO) said: “Americans I have spoken to say ‘I have no problem with this’, ‘it is only fair’ and ‘I am happy to contribute to my home country’.
“It is, however, unfortunate that Americans are targeted in the messaging around this bill, especially since it would encompass many nationalities.
“I know of no one who has come to France to take advantage of ‘free healthcare’. Americans come to France for many reasons: work, school, love, the culture, the beauty of the country, cost of living, quality of life, etc.
“French healthcare certainly has a good reputation, but people do not come because they think that they can get it for free.”
She added that some Americans are already paying via the cotisation subsidiaire maladie (‘Puma tax’), which is 6.5% of capital income over €23,550/yr in 2025.
Despite the name visiteur, those who come on a VLS-TS (visa de long séjour valant titre de séjour) with this status can apply before the end of their year to stay on, at which point they are issued with an equivalent one-year carte de séjour (residency card), also renewable.
After five years in France it is possible to change status by applying for a 10-year long-stay resident’s card.
The new amendment has not yet been debated by the Senate.
If passed in the final social security law by the end of the year, a minister would set the amount of the ‘minimal contribution’.
