Is new healthcare fee for Americans still on the way in France?
Last year French MP told how he put forward plan aimed at ‘visitor visa’ holders
Some people are expected to pay a new fee towards healthcare
Unai Huizi Photography/Shutterstock.
Reader question: You previously ran articles on how Americans in France might have to pay a new fee towards their healthcare. Is that still going to happen?
In late 2025, The Connexion reported on plans for a new healthcare fee originally aimed at individuals – notably Americans – who come to France on ‘visitor’ visas and are able to gain French healthcare rights on the basis of residency, often without any specific requirements for financial contribution.
This situation arose due to the way the Protection Universelle Maladie (PUMA) scheme was set up, as of 2016.
This established a principle of residency-based healthcare as default in France, whereas prior to this healthcare rights were closely linked to what people had paid via social security contributions. A stop-gap scheme formerly existed for legal residents lacking healthcare rights from work (called CMU de base) but this was abolished with the creation of PUMA, which was intended to simplify the situation.
Under PUMA, workers do, however, continue to help fund the healthcare system via the CSG social charge paid on their salaries as well as part of the cotisations sociales paid by employers for each employee. Retirees with French-taxable pensions also partly fund it via CSG on their pensions.
Some non-workers are eligible to pay a specific ‘PUMA fee’ (officially cotisation subsidiaire maladie), but only if they have high levels of income from sources such as investments or rental property income.
This meant some people could now move to France and obtain French healthcare for ‘free’. This includes American retirees, whose pensions are not French-taxable under the US/France double tax treaty, as well as people with British ‘government’ (state sector) pensions.
Last year, a French MP, who was informed about the situation by a constituent, suggested a new fee with Americans in mind, in particular those who come on ‘visitor’ visas. This kind of visa/residency card is aimed at people able to support themselves from pensions or investments, and who will not work in France.
Many Americans said they considered this fair, as long as the fee was set at a reasonable level.
This idea was suggested as an amendment to the 2026 social security finance law.
Final version was adopted
After its journey through parliament, the idea was adopted in December 2025, with its final form aiming not at ‘visitor visa’ holders specifically, but at anyone living in France from incomes that are exempt from the French social charges due to international treaties.
The wording says this principle applies, bearing in mind relevant EU rules and international treaties, which likely refers to:
Situations where certain immigrants’ healthcare is paid for by their country of origin (eg. UK or EU state pensioners with S1 forms), so their care is not at a cost to France.
Possibly, also citizens of countries that a French person could move to and obtain ‘free’ state healthcare. This is not the case for the US, and in the UK is not the case in the first years after moving, when an ‘immigration health surcharge’ now applies.
The law as adopted said if eligible people do not pay the new fee during a given period, their CPAM state health insurance body will inform them, after checking their situation, that their healthcare rights will be suspended.
It said that a ministerial decree would be prepared, explaining details such as:
The principle is now in force as part of the 2026 social security law. However, the government department in charge of social security, DSS, confirmed to The Connexion that the application decree is still being prepared, with input from the governing body for the CPAM network that will put the system into operation.
Among other points, officials are deciding on how frequently the fee must be paid.
The DSS said publication is expected in the first half of this year.
The officials told us that the new fee is expected to apply to people who:
have settled and legal residency in France
do not work
are exempt from the social charges (CSG, CRDS) due to international agreements and also exempt from the PUMA fee.
