France is well regarded for its healthcare system but unlike the NHS in the UK, you must pay upfront for many day-to-day healthcare costs before being reimbursed.
While the social security system covers a set percentage of the cost of medical procedures and medicines – for example, 70% of a visit to the doctor – you have to pay for the remainder yourself.
This remainder includes a part called the ticket modérateur, which is the shortfall between the state’s usual fixed rate for a given procedure/treatment and the amount of this it reimburses (eg. 30% of a standard GP visit). On top of this, some doctors are allowed to charge dépassements d’honoraires, ie. amounts on top.
To cover the non-state-reimbursed elements most people take out a mutuelle ‘top-up’ health insurance policy.
Costs vary depending on the provider, what is included in the policy and the policyholder’s age – but not based on prior health conditions. They are roughly €50/month for a young adult and often €100-plus for a retiree.
If you are on a tight budget, one option is to shop around, for example, by using comparison websites, and to look for a policy centred on essentials such as hospital cover (likely to be the most costly eventuality, especially if you were to go in for a complex procedure and extended stay without a mutuelle). Note that some mairies offer deals for low-cost mutuelles communales in a grouped deal.
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Healthcare for lower-income households
Another option is complémentaire santé solidaire (CSS), which aims to make quality healthcare accessible to all by minimising costs for lower-income households. Also referred to as C2S, those entitled to it receive free or subsidised mutuelle cover.
In addition, they do not have to advance any part of the state-funded element of their healthcare (this scheme is referred to as le tiers payant; the Assurance Maladie pays the doctor on your behalf) or the ticket modérateur, as these will automatically be covered by their CSS ‘free/subsidised’ mutuelle.
They are also exempt from franchises and participation forfaitaire levies that are usually payable on healthcare procedures and tablets, and doctors cannot charge them dépassements. There are no upfront costs for stays in a state hospital.
A range of good-quality glasses, hearing aids and dental work is also provided at no cost. Cover lasts for one year once granted and will either be completely free or require a small monthly contribution. In the latter case, the amount depends on age and income but at most costs €1 per person per day.
To apply, you must be registered in the French health system, with a social security number. Just one C2S policy will cover a household including spouse/partner and children living with you. However, eligibility is based on household income from all sources (not just taxable), minus various welfare benefits and certain other incomes such as children’s educational grants.
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What is a forfait logement?
You should also bear in mind that a forfait logement (fixed amount to account for housing) will be added when calculating your household income if you own your house, are living free with someone or are in receipt of housing benefit.
To qualify, your total household income must remain under the relevant thresholds inclusive of this. Currently, the annual income threshold for two people to receive C2S at no cost is €15,508, or up to €20,936 with a contribution. For other examples see here.
You can check if you are likely to receive C2S and whether you would have to contribute by filling in household details and incomes using the simulator at Mes Droits Sociaux.
If, for example, you apply in July 2025, income from June 2024 to May 2025 will be required. It helps to sign in using a FranceConnect account as some details will be automatically pre-filled.
If the simulator confirms eligibility, you can apply through your Ameli account (if need be, set one up using your social security number). Once logged in, select Mes démarches from the menu at the top of your account, then Faire une demande de complémentaire santé solidaire. The form must be completed in one sitting and is in French.
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English-speaking helpline for Cpam
Alternatively, a paper form is available to download. It can be handed in or posted with any supporting documents to your local Cpam (state health insurance office). If you need guidance, you can make an appointment through your Ameli account by clicking Prendre un rendez vous beneath Mon Agenda. The Cpam’s English-speaking helpline is another resource: call 09 74 75 36 46.
When you apply, you are required to choose a body that will act as your top-up insurer, but this can simply be your Cpam.
You will need income information ready, whichever method you use. For the simulator, a figure has to be entered for each month, but the actual application form lets you enter total income amounts for the 12-month period. You may also be asked to upload your most recent avis d’impôt (tax statement).
Once your application is submitted, you will receive an acknowledgement in the secure messages section of your Ameli account, followed by a decision. It can take two months, though it is often quicker.
The response will let you know whether your application has been accepted and if you need to contribute. In the latter case, you must confirm by completing and posting the attached joining form and direct debit mandate for the contributions.
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How to appeal
If you think there has been a mistake, you have two months to send a written appeal with supporting evidence. Alternatively, you can reapply if your income changes in future.
Cover will start from the first of the month after your confirmation is received and lasts for a year. You should update your carte Vitale at a pharmacy. Renewal is not automatic; you will have to make a fresh application the following year (except for those in receipt of RSA, ASPA or ASI benefits). It can be done four to two months before your current year runs out.
For those on lower incomes, this scheme is well worth the work involved.
