How many people in France do not have a top-up mutuelle?

Reader Question: I do not have a mutuelle in France, but I am subscribed to Assurance Maladie. Do I need to get a mutuelle? I have not spoken to anyone who does not have one but they seem expensive

Information published by France’s Health Ministry and statistics body Drees in April 2026 estimates that 3.4% of the population (excluding Mayotte) did not have a top-up mutuelle health insurance, equating to 2.3 million people.

The data only covers up to 2023, but is the most detailed as it comes directly from the Ministry.

This is down from 13% in 1996, but still covers a significant minority of the population.

There were large discrepancies between groups, however.

For example, around 10% unemployed people in France and non-French citizens did not have a mutuelle, as did 5% of single parents.

Of those living below the poverty line, 7% did not have top-up insurance.

Men who lived alone (6%) were considerably more likely than women (2%) to not have a mutuelle.

However, those with a long-term illness (affection de longue durée, ALD) are more likely to have a top-up mutuelle, despite a higher percentage of their healthcare costs being covered by state health insurance.

Note these figures are only for top-up mutuelle schemes, and not adherents to France’s state health insurance Assurance Maladie.

Assurance Maladie does not cover all healthcare costs, but a percentage – for example, 70% of the cost of a visit to a doctor.

Do you need a mutuelle?

Among those who did not have a mutuelle, a third said it was because they could not afford it, with only 12% arguing it was because they did not need it.

It is not a legal requirement for full-time residents in France to have a mutuelle, but some visitors on temporary visas must have health insurance covering their stay.

However, many people obtain a mutuelle to ensure a higher percentage or even all of their health costs are covered.

Mutuelles will, in most cases, ‘top-up’ coverage to 100% of costs.

This can include fees such as the franchise médicale, depending on the type of contract you have.

Employees at a French company have their mutuelle provided by their employer, however those in other circumstances must subscribe themselves.

Costs have risen several times in recent years, including up to 10% in January.

People on lower incomes can benefit from the complémentaire santé solidaire, a national top-up insurance scheme.

Alternatively, our article here provides tips on reducing mutuelle costs.