How Americans can access France's healthcare system – and why it takes patience

France’s healthcare system is widely admired, but Americans moving over should be aware that joining it can take some time. 

The Connexion spoke to US couple Raina and Jason Willick and to Andrés Ramírez Zamudio, a doctor at the American Hospital of Paris, to obtain their insights into the process. 

When the Willicks came in 2022 with their daughter, they were initially only planning to stay for a year – but the great quality of life led them to put down roots in the country of delicious cuisine and generous healthcare. 

However, setting up that last part – joining France's universal healthcare system known as Assurance Maladie – was not a quick process.

Mr Willick was successfully accepted into the system around two months after applying, but for Mrs Willick the entire process lasted some nine months. 

Along the way she said she had to send extra documentation tracking her name changes as well as three separate copies of her birth certificate.

In the end, the Willicks and their daughter all managed to get coverage in France. 

They say they now enjoy low costs and reliable care.

Even so, the application process led Mrs Willick, who runs the relocation consultancy (and YouTube channel) Baguette Bound with her husband, to offer the following advice: "This process is going to require some persistence – but you will get there."

As the US faces a growing healthcare affordability crisis, the Willicks are far from the only American family to consider relocating to a country with universal healthcare coverage. 

News outlets ranging from CNN to Le Monde have covered this phenomenon, especially as it relates to American retirees benefitting from the French system.

Those coming to do salaried work can be registered quickly because of the contributions they make to social security. People in self-employment are similarly covered, once they have set up a business in France. 

Others (including eg. retirees, early-retirees and people who are supported financially by spouses) can enter the system after three months of stable residency on a principle called Puma (Protection universelle maladie), dating from a 2016 universal health coverage law. 

Americans were the sixth largest nationality receiving new residence cards in 2025, receiving  14.3% more cards than the year before . 

For these citizens used to paying an average of nearly $9,000 per year for individual healthcare in the US, making the switch often comes as a welcome change. 

Applying

In the initial months while waiting to get into the system, foreigners on a long stay visa are often required to  have a private health insurance policy.

Depending on what this covers, you may find in these first months that there are some unreimbursed costs, however Mrs Willick said that in comparison to the US, prices in France are generally standardised and transparent.

"To be able to check your pricing and availability before you come and plan for that financially, I mean that in itself sounds simple, but it's a big relief," she said.

If you will need to buy medicines, you can check the prices of these in a national database of medicines here.

The actual application process involves filling out a paper form accompanied by required documents. 

That includes an identity document, your validated visa, a birth certificate, proof of employment in France (if working) or otherwise proof of three months’ residency (for example electricity, gas or home internet bills covering the last three months, or three rent receipts), a RIB which communicates bank account details, and a separate form if you have dependents such as children to declare. 

This list may vary based on your individual situation.

Marriage certificates are sometimes requested, especially if you are also registering dependent children or you are registering linked to your spouse’s rights (the latter does not usually apply to Americans).

Caisse Primaire d'Assurance Maladie (CPAM) - the name of France’s local public health-insurance offices - usually do not require documents in English to be translated, however, the application form states that birth certificates should be ‘authenticated, notably with a legible stamp’. 

To ensure that US birth and marriage certificates are recognised as official, the Willicks strongly recommended getting these documents apostilled. 

For a state-issued document such as a marriage certificate or birth certificate, you must request this from the Secretary of State in the state from which it originated.

Another complication the Willicks pointed out was regarding name changes. 

If the name on your birth certificate does not match what is on your passport, you should make sure to provide documentation clarifying these changes.

Despite this, the couple described the application process as being simple to complete.

Then comes the waiting, as your local CPAM processes the application. 

You do not receive updates during this time, Mr Willick noted. "We were just waiting anxiously for weeks, for months, to hear something back,” he said.

Do not be discouraged if you are asked to send additional documents, and call the Ameli health insurance help line, which has English-speaking operators, if you are worried your file may not have been properly logged, the couple advised. 

The number is : +33 9 74 75 36 46. 

Accessing care

Dr Ramírez Zamudio, an American OB/GYN, told The Connexion that many of his patients at the American Hospital of Paris are not aware they are strongly advised to have a mutuelle (or private, supplemental insurance) to cover additional costs. 

This is necessary because sometimes, Assurance Maladie only covers part of medical charges.

However, if you find yourself having to pay all or part of the costs of a medical service out of pocket, Dr Ramírez Zamudio said prices are often much lower in France than the US.

"For example, an MRI in the US is thousands of dollars, and here, getting one out of pocket is about 200 euros," he said.

While some Americans may assume that socialised health care means waiting longer for care, surgeries and other emergency procedures happen very quickly, Dr Ramírez Zamudio said.

"I've had patients say 'this is so surprising because you know I thought here everything would take much longer,'" he said.

That being said, the medical system in France requires more autonomy. 

Unlike the US, in France, patients must go to a separate laboratory for medical tests, bring the results back to the doctor and go to a separate pharmacy to pick up their treatment.

This is often where Americans meet their biggest roadblock – the language barrier. 

Metropolitan public hospitals in the US usually have interpreters, while in France – especially if you are seeing a specialist – you will probably have to speak French.

"There is a sort of frustration on the patient's part many times that when they want to discuss healthcare or sometimes very complex care, they can't do it very well if their doctor doesn't speak English or if they don't speak good enough French," Dr Ramírez Zamudio said.

The Willicks also mentioned that just because a doctor's profile on the appointment booking platform Doctolib says they speak English, it does not always mean they are fluent. 

Additionally, while your general practitioner may speak English, you may be referred to an anesthesiologist or radiologist who is not as fluent.

This is particularly challenging given that compared to the US, specialists like radiologists often ask their patients a lot more questions about their symptoms and medical history, Dr Ramírez Zamudio said.

Working around limitations

To help patients navigate French conversations with other doctors or pharmacists, Dr Ramírez Zamudio said he often provides them with a script.

"Whatever interaction I have with my patient in the office is, I know she'll get it," he said. 

"But then the moment she steps out of there, I know there can be confusion, so I have to make things very clear."

Mrs Willick suggested bringing a printed page with your medical history written out.

In terms of finding an English-speaking doctor, Dr Ramírez Zamudio recommended checking expat forums and groups to see which practitioners people recommend. 

Primary anglophone hospitals include the American Hospital of Paris and the Hôpital Franco-Britannique.

As for those few months when you are waiting to be accepted into the healthcare system, the Willicks advised trying to stay at one address and checking your mail often as you will likely receive important information via post.

Finally, keep in mind that CPAMs generally do not send back physical documents. 

So, if you only have one birth certificate to send, perhaps request a new certified copy from your state's vital records office.

"I think our takeaway from this is to just send the most complete file necessary," Mr Willick said.

If you have moved to France from the US, we would love to hear about your experience accessing healthcare. Share your thoughts with us at feedback@connexionfrance.com.