Expat insurance
Expat insurance in France
PUMA opens after about three months of residency and the Carte Vitale takes months more. Private cover exists to bridge that gap, and the gap is expensive.
France has one of the world's strongest healthcare systems, and once you are in it, care is cheap: a GP visit is set at 30 euros. The catch for nomads is getting in. The public system, Assurance Maladie through PUMA, only opens to you after about three months of legal residency, and the permanent Carte Vitale can take six to eight months more, so private cover is essential for the gap. France also has no digital nomad visa, and since mid-2025 it explicitly bans remote work on the long-stay visitor visa, which changes the honest answer about how to be here legally. Cover for France is about the months before the public system takes over, and about a visitor visa whose insurance requirement is strict.
What expat insurance covers in France
Expat insurance is built for expats with a residence permit or long-stay visa, families, retirees abroad. The lines below are the base. Exact terms are carrier-specific, so always check the policy document for the France situation you care about.
What you get
- Full inpatient and outpatient medical
- Maternity (with waiting period)
- Dental and vision (add-ons)
- Chronic-condition management
- Multi-year renewals without trip-length resets
What it won't do
- Cover in your home country (limited windows on some plans)
- Pre-existing conditions during initial underwriting
- Cosmetic procedures
Healthcare in France: what you are actually buying into
France has no digital nomad visa, so remote workers arrive on a long-stay visitor visa, which requires private health insurance and a commitment not to work locally. State cover under PUMa only opens after three months of legal residence if you are not employed. Even once you are in, the Sécu refunds about 70 percent of a fixed tariff, which is why almost everyone also buys a top-up. A sector-1 GP visit is €30.
- Private GP visit
- €30 for a sector-1 GP (the fixed national tariff). Sector-2 doctors set their own fees and commonly charge more; the Sécu still only reimburses against the €30 base.
- Emergency room visit
- €23 forfait patient urgences for any emergency visit not followed by admission (arrêté of 27 February 2026, up from €19.61). If you are admitted, the forfait journalier hospitalier is €23 per day. Uninsured foreigners are billed the full cost of care on top.
- English-speaking care
- Paris is the exception, not the rule. The American Hospital of Paris runs a 24/7 medical-surgical unit staffed by bilingual emergency physicians, and the Hôpital Franco-Britannique is the other established option. Outside Paris and a handful of large cities, assume the consultation is in French.
- Pharmacy access
- Pharmacies are dense and pharmacists are well trained. Out of hours, a rotating pharmacie de garde covers each area; find it by calling 3237. Most real medication needs an ordonnance, though since June 2024 pharmacists can dispense antibiotics for cystitis and strep throat directly after a positive rapid test.
- Emergency number
- 15 (SAMU, the medical emergency line) or 112 (EU-wide). Also 18 for the pompiers and 114 by SMS for deaf and hard-of-hearing callers.
Hospital quality
French hospital medicine is among the best in the world, and SAMU is a physician-led prehospital service: call 15 and a doctor decides what comes to you. In a genuine emergency, France is about as good a place to collapse as exists.
The catch is financial, not clinical. France does not run a free-at-point-of-use system. The Assurance Maladie reimburses against fixed tariffs, typically 70 percent, and the patient owes the rest, the ticket modérateur, plus the €23 emergency charge. That residual is why the overwhelming majority of people in France carry a mutuelle on top of state cover. A foreigner who has neither PUMa nor a mutuelle is exposed to 100 percent of a bill in a country where locals do not pay 30 percent of it.
Where people actually go
American Hospital of Paris
Neuilly-sur-Seine (Paris)
24/7 medical-surgical emergency unit with bilingual French and English emergency physicians and nurses.
Hôpital Franco-Britannique
Levallois-Perret (Paris)
The long-standing English-speaking hospital in Paris, listed by the US Embassy among English-speaking options.
AP-HP Hôpital Pitié-Salpêtrière
Paris
France's top-ranked hospital for complex and high-acuity care. Public, so expect French and expect a bill if you are uninsured.
CHU de Grenoble Alpes
Grenoble
The major trauma centre for the French Alps, where serious ski and mountain injuries are taken.
Health risks worth insuring against in France
- Winter sports trauma. Médecins de Montagne recorded 136,700 injured skiers in the 2023/24 season, a rate of 2.6 injuries per 1,000 skier-days. Sprains make up 38.5 percent and fractures 23.4 percent.
- Mountain rescue billed to the patient. On-piste rescue is charged by the commune and ranges from roughly €226 to over €1,000 for off-piste retrieval; helicopter evacuation typically runs €900 to €2,000 and more. State health insurance does not cover it.
- Ticks and tick-borne infection across forested and rural regions.
- Mosquito-borne disease. Aedes albopictus is established including in greater Paris, and autochthonous West Nile virus encephalitis cases were reported in Paris in July 2025.
- Summer heatwaves, with the cardiovascular and dehydration presentations that follow, particularly in the south and in poorly ventilated city apartments.
- The financial risk sitting under all of it: no PUMa for the first three months, and a roughly 30 percent residual on every bill afterwards.
France is not free at the point of use. The Assurance Maladie reimburses about 70 percent of a fixed tariff, so the great majority of residents buy a top-up mutuelle. Every emergency visit without admission also carries a €23 forfait patient urgences.
What this means for your policy
France is the one where the gap is legislated, not accidental. There is no nomad visa, so you come in as a visitor, and the visitor visa obliges you to hold private health insurance for the full stay and not to work in France. PUMa does not open for three months if you are not employed, and you then need to be resident at least six months a year to keep it. The 2026 Social Security Financing Law also created an annual healthcare contribution for stably resident, non-working PUMa beneficiaries. The law is on the books, but the implementing decree setting the amount had still not been published as of mid-2026, so nobody can honestly tell you the price yet. Treat any figure you see quoted as a guess.
Do not treat PUMa as the finish line. Even a fully covered French resident gets roughly 70 percent back, which is why almost everyone buys a mutuelle. So the sequence is: a compliant private policy to get the visa and to cover the first three months and beyond, then a decision about whether to sit on private cover permanently or move to PUMa plus a mutuelle once you qualify. If you ski, buy the mountain-rescue and off-piste extension explicitly. A helicopter off a Savoie glacier arrives as a commune invoice, not a health-service one, and no ordinary medical policy pays it.
Before you buy, check these four things
- Does it pay the hospital, or you? A reimbursement plan means you front the money. Where hospitals in France expect payment before treatment, that difference is the whole policy.
- Is evacuation actually included, and up to what limit? It is the one bill that can exceed a year of income, and it is the benefit people cut first.
- Does the term cover your permit? A 90-day travel policy expires inside a one-year visa, and an immigration officer comparing the dates will see it.
- Have you declared everything? A condition you left off is grounds to challenge a claim years later, even one unrelated to it.
What care costs in France
These are the bills expat insurance exists to stand between you and. Read them before you decide how much cover is enough, because the number that looks generous in the abstract rarely does next to a real invoice.
| GP consultation (public Sector-1 tariff) | 30 euros ($32 USD) |
|---|---|
| Specialist consultation (public tariff) | 40 to 60 euros (~$45–70) depending on speciality |
| Emergency department visit, not admitted (forfait patient urgences) | 23 euros ($25 USD) |
| Hospital day charge (forfait journalier) | 23 euros (~$25) per day, and this one is not reimbursed by Assurance Maladie |
| Private clinic or Paris international hospital | substantially more than the public tariffs above |
These are the public reference rates, which are the amounts an uninsured foreigner pays upfront and only recovers if a private insurer reimburses them. Sector-2 doctors add supplements (dépassements) on top, and private or international hospitals in Paris, such as the American Hospital of Paris, charge well above the reference rates. The cheap headline numbers are real once you are in the public system, but a serious private admission is a different order of cost.
Healthcare system & visa context for FranceThe cost of going uninsured in France
Insurance is abstract until you put a number on the thing it prevents. Pick a scenario and see what it costs in France with nobody paying on your behalf.
Interactive
Verified pricesWhat would it cost in France without insurance?
You pay, out of pocket
$3,000–$15,000
A surgery and multi-day admission; ICU pushes higher.
Bars to scale. A flight home is in another league.
That is the bill you carry alone. Insurance exists for exactly this.
See what cover costsTypical private-care estimates for illustration, not a quote. Actual bills vary by hospital, city and severity.
Expat insurance in France: FAQ
In most cases France expects long-stay residents and visa applicants to show proof of health coverage. The specific bar (carrier, sum insured, residency-vs-travel cover) depends on your visa class; the France guide covers the country's current visa-and-residency stance.
Premiums vary by age, plan and deductible far more than by country; the underwriting risk is priced, not the postal code. The France guide breaks down local treatment costs so you can see what your insurance protects you from, then run a real quote for your own number.
It depends on your situation: how long you're staying, your visa class, your age and health, and whether you want cashless treatment or are fine with reimbursement. Rather than push one plan, we match you against the options that actually fit a stay in France: answer a few honest questions and see only what's relevant.
15 (SAMU, the medical emergency line) or 112 (EU-wide). Also 18 for the pompiers and 114 by SMS for deaf and hard-of-hearing callers.. Worth saving before you need it. Note that reaching an ambulance and being covered for what happens next are different problems, and in many countries the second one is yours to solve.
Paris is the exception, not the rule. The American Hospital of Paris runs a 24/7 medical-surgical unit staffed by bilingual emergency physicians, and the Hôpital Franco-Britannique is the other established option. Outside Paris and a handful of large cities, assume the consultation is in French. This matters more than people expect: describing a symptom precisely is part of being diagnosed correctly, and it is the main practical reason foreigners end up in the private system even where the public one is good.
In France, a private GP visit runs €30 for a sector-1 GP (the fixed national tariff). Sector-2 doctors set their own fees and commonly charge more; the Sécu still only reimburses against the €30 base. and an emergency room visit €23 forfait patient urgences for any emergency visit not followed by admission (arrêté of 27 February 2026, up from €19.61). If you are admitted, the forfait journalier hospitalier is €23 per day. Uninsured foreigners are billed the full cost of care on top.. Those are the routine numbers and they are survivable. The reason to insure is not the GP visit, it is the admission that follows a bad day, which is where the figures stop being survivable.
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