Healthcare in France - Full Cover for Expats, Breakdown of Costs & More

Healthcare in France
©iStock/Deejpilot

While known as purveyors of “la belle vie” (the good life), the French tend to have very healthy lifestyles, thanks in large part to one of the best healthcare systems in the world. Never ones to shun a glass of Pinot Noir or a creamy slice of Camembert cheese, it’s a wonder how they maintain such a high life expectancy.

Despite their meat- and cream-rich diet augmented by alcohol and cigarettes, the French have been living much longer in recent years. Life expectancy now averages 85.7 years for women and 79.5 for men. The number of people living over the age of 100 has doubled. Married people are found to live longer than non-married people, and people in the north of France die at a younger age.

The low cost of health insurance and the superb quality of care means that France consistently receives high scores in the healthcare category of International Living’s Annual Global Retirement Index.

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Who is eligible for the French national health system?

In 2016, France established a new national healthcare system, known as Protection Universelle Maladie (PUMA). This new system grants an automatic and continuous right to healthcare for those who legally reside in France in a “regular and stable manner.” This means that if you’ve lived in France for a minimum of three months and legally reside there at least six months a year, you are eligible to apply for public healthcare.

Previously, expats in France were generally eligible to apply for universal coverage only if they were legally employed in France and paid into the social security system, or if they legally resided in France for one to five years. During this period, expats were required to have private health insurance, which is significantly costlier than the French system. Thanks to this new law, expats might be able to get French healthcare coverage in less than a year, saving thousands of dollars.

If, however, you are not yet eligible to apply for French healthcare coverage, you must have private health insurance. One cost-effective option is to buy into a group plan. You’ll need to become a member of an association that offers this benefit. One is the Association of Americans Resident Overseas(AARO). Costs to join the association are €65 ($71.68) annually per individual and €85 ($93.73) for couples and families. The association offers a plan that is very popular with expats in France and throughout Europe, administered by MHS Intl., with annual premiums starting at €11,208 ($12,359) for comprehensive coverage for people aged between 50 and 59. For more details, and a full list of premiums, contact the Association of Americans Resident Overseas (AARO).

Visits to the Doctor in France

©iStock.com/anyaberkut
©iStock.com/anyaberkut

In France you can visit any doctor of your own choosing—a general practitioner or a specialist—in the private or public sector. The cost of a doctor’s visit in France depends on whether you elect to see a médecin non-conventionné—that is, a private doctor—or a médecin conventionné, a doctor who works within the French social security system. The sécurité sociale sets standard fees—currently €25 ($27), for a visit to a general practitioner and from €50 ($55) to see a specialist. Some médecin conventionné doctors observe the standard sécurité sociale rates, but many within the system set their own fees. Private doctors’ fees can be more than triple the state amounts. You will always be told exactly how much you will have to pay.

If you’re visiting the country and fall ill, you can ask the tourist office, a pharmacy, or your hotel to recommend a doctor.

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Hospital Treatment in France

The conditions for reimbursement for medical expenses vary from hospital to hospital. Unless it’s an emergency, you should check into the reimbursement conditions before you’re signed in for hospital treatment. For instance, your healthcare insurance policy may cover you for treatment only in a public hospital, not in a private clinic.

The French social security system covers treatment in public hospitals and clinics with conventionné status. You’ll be reimbursed 80% for treatment the first month and 100% thereafter. All surgical expenses are reimbursed 100%. Regardless of treatment and surgery costs, you’ll also be charged a non-reimbursable rate of €18 ($19.85) per day for bed occupancy; in a psychiatric hospital, you must pay €13.50 ($14.89) per day. However, at private clinics with non-conventionné status, you’ll be able to reclaim only about 10% of your medical expenses under the French social security system.

Should you develop a medical issue which requires long-term or life-time treatment, such as cancer or multiple sclerosis, all medication and hospitalization is free. For expats, this does not apply to pre-existing conditions, so you will be asked for your medical history.

Dentists

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France has a modern and sophisticated dental system. You will find dentists in practically every town of any size, all of whom are well trained. Basic dental care is efficient and by world standards very affordable, and you will find that most dentists speak some English. A basic check-up will cost €25 ($27), the same as a visit to the GP. If you need a basic filling, it will be an additional €18 ($19), but can be much more depending on the complexity of the procedure. An extraction will start from €35 ($38). When it comes to more sophisticated dental work, prices start to go up significantly, with a crown costing from €400 ($441). As with all healthcare in France, you will be given a precise quote for the work before you proceed, which is a legal requirement.

You can be reimbursed by the government for dental work, but this only applies to basic procedures and not cosmetic dentistry. As with the doctor, you pay the dentist directly after the consultation, so make sure you have enough cash.

Charges can be dramatically different from dentist to dentist. There are additional charges if you require treatment on a public holiday or on a weekend, as well as extra charges for emergency dental treatment. Nonetheless, the prices are generally low compared to those in the U.S.

It is worth considering supplementary dental insurance if you think you may need care in the coming years.

In France, First-Rate Healthcare Costs Me $9 Per Doctor’s Visit

©iStock/Armando Oliveira
©iStock/Armando Oliveira

By Tuula Rampont

As an expat who has lived in the south of France for the last 12 years, I thought I’d developed a pretty effective toolbox of “fix-its” for every situation.

Car problems? A scruffy but kindhearted mechanic has been my go-to guy for the last nine years. Recommended by an ex-neighbor, he’s never steered me wrong…pun intended.

Plumber? Same. Doctor? Many moons ago I’d combed through a list of potential candidates and relied heavily on what the French call bouche à oreille—literally “mouth to your ear,” or word-of-mouth, recommendations. I had a wonderful general practitioner who enjoyed trying out a few English phrases he’d mastered, and who dreamed about doing a motorhome tour of U.S. national parks in his retirement.

I’d even become quite adept at making appointments over the phone—a skill not to be underestimated when attempting to master the French language. Trying to get receptionists to spell my first name, Tuula, had been a sharp learning curve.

“Il y a un double U, pas un double V!” (There’s a double U, not a W!) Tuula and Twla had become two confused patients in the waiting room. So, I’d become “Maria” over the phone, at least until we met in-person.

Small tricks of the trade that you pick up over the years. Like knowing which supermarkets sold hard-shell tacos (only one in my town), or how to grow your own jalapeno peppers in the backyard, or which train to avoid taking (the RER) to Nice because it meant stopping at every town along the French Riviera.

I felt like I had a pretty good hold on all things expat in France, until I had a startling revelation one chilly December morning at our local Lidl supermarket. For all of my careful planning, and boots-on-the-ground know-how, it seemed I’d overlooked a key point of the French lifestyle—I hadn’t been taking full advantage of the healthcare system.

And that was about to become painfully apparent.

An Easy-to-Use, Expat-Friendly System

Back at the supermarket, a gentle throbbing, nothing invasive or extraordinary, but continuous, had started in one of my back molars.

Th-thump…th-thump…th-thump.

I closed my eyes for a second, and tried to silently will it away. Perhaps I’d slept wrong, put too much pressure on that side of my mouth, or was simply just tired. Putting back a handful of lemons, and heading for the exit, I knew that was all just wishful thinking.

There was a sizable toothache brewing in my head, reaching around to my temples, and I had no one to blame but myself. I honestly couldn’t remember the last time I’d been to the dentist.Prescription drugs are covered up to 100% of cost.Well, actually, I could. It was at a dentist back in Ventura, California circa 2004—for a cracked tooth, root canal, and eventual crown. Even the memory of it made me shudder. Not for the work itself, which passed in low-pain ease, but for the number of lines I’d written in my checkbook when it came to paying the bill.

I had a good job and good insurance at the time, but that dental (mis)adventure had cost me well over $2,000. It wasn’t the first time I’d had a hefty bill after a spin in the chair, and, while my dentist back home was a very kind and gentle man, I’d avoided seeing him as much as possible. I just didn’t have the extra funds for it.

Fast-forward to France many years later, and it was with a mixture of panic and regret that I realized I was still living very much in my American mindset—cutting corners on my healthcare for fear of the cost.

While my French colleagues and friends scheduled routine check-ups and exams, seemingly every month or so, and went straight to the doctor at any hint of an ailment, I went, on average, once a year for a routine exam.

A general check-up around June and an eye exam around springtime were my two yearly appointments. I’d visited the doctor once for a bad case of the seasonal flu, other years I’d rode it out at home. A sprained ankle took me to the emergency room a few years ago, and I did two stints of physical therapy—15 sessions in total. All of them were paid for under the system, and I could have renewed for more sessions with Hugo, my excellent physical therapist, who included strength training and deep tissue massages into his regime twice a week.

But I hadn’t wanted to take advantage of the system. And now I was starting to realize that there was a pretty big gap between taking advantage and simply being proactive with my healthcare. The French had been doing it all their lives.

I called a local dentist who was gracious enough to squeeze me in for an emergency appointment that same Monday morning. Prescription for antibiotics in hand, he slid me two pain pills as I left his office for a pharmacy around the corner.

“Here, take these now and go get the prescription filled. I’ll see you in a week for the root canal.”

Phew, I’d really dodged a bullet there. A week later all would be back to normal.

Only that, after the week was up, and the root canal finished, the pain came back. Turned out I was one of an unlucky 20% or so with a failed treatment. The hunt was on for a specialist, or else the tooth would have to come out.

Well, there’s nothing like feeling as if a small freight train is rumbling around your head to get you motivated. I took the day off work and drove to one of the most prestigious teaching hospitals in the country—the workplace of France’s top COVID expert who had been a regular fixture on TV talk shows at the height of the pandemic.

Their dental clinic in Marseille, around a 40-minute drive from home, took walk-in patients at all hours of the day.

I’d doubled-down and hedged my bets the night before, scoring a 9 a.m. appointment at a private dental office just down the street from the hospital. At this point, I wanted to get a second opinion, and I couldn’t believe how easy it had been to find one.

A few years back, a service called Doctolib (see: Doctolib.fr) launched across the country. Type in your location, and the type of health service desired, and you got a list of doctors, dentists, and therapists with their next available appointments listed on the screen before you. You could even select your preferred language.

I put in my preference for English and an Outlook-like calendar opened with a list of available timeslots. I immediately received a confirmation email for my dental appointment the next day.

It was an expat godsend! No need for “Maria” to ever make an appearance again.

The dental clinic in Marseille led me on a path to a specialist who, incredibly, was a two-minute walk from my place of work in the center of Toulon. A young Spanish dentist, trained in Madrid, who spoke perfect English.

Another root canal, and two replacement crowns later, I’d made up for a lot of lost time and shed a lot of the fears I’d had in the U.S. Total cost for all treatments came to around $670, with my top-up insurance.

Since that time, I’ve become fast friends with Doctolib, and have scheduled a slew of check-ups that every French person turning the corner on 50 has already booked in. Like them, I’ll be unashamedly taking advantage of their wonderful healthcare system, anytime and anywhere.

Top-Notch Healthcare, Anytime And Anywhere

France operates under a universal healthcare system in which everyone is entitled to receive medical services. There are no age restrictions, pre-existing condition limitations, or networks to join. You can see any doctor, anywhere, at basically any time they are available. Expats, in possession of a long-stay visa (issued for 12-months and then renewable), are eligible to enroll in the healthcare system after three months of living in the country. France must be your primary residence for six months of the year.

The French pay a small portion of their earnings in social security contributions (around 8%, with additional deductions available) to pay for healthcare benefits. For expats, the pot gets a little—or a lot— sweeter, depending on your situation.

As the U.S. holds a tax treaty with France, Americans cannot be double-taxed on income already paid to Uncle Sam. Therefore, U.S. Social Security benefits and pensions are not taxable by the French government, and do not enter into your healthcare payment calculations.

In the French system, rich, middle-class, low-income, unemployed, and retired folks all have the same access to medical services. Some are paying more, considerably more, and others are paying considerably less. Employers, who are heavily taxed, make up the difference.

It doesn’t mean that your healthcare will be entirely free of charge. You’ll pay 8% of your income that the French government is allowed to tax (after an additional standard allowance of around $11,000 per person). As a ballpark figure, an individual who has income to declare to the French government of $30,000 will pay around $1,520 a year in healthcare.

You are then entitled to a 70% to 100% reimbursement on medical services—which are already incredibly low-cost. Top-up insurance (rates start at around $55 a month) covers the rest.

In plain language, a person not enrolled in French healthcare pays $29 (€25) for a doctor’s visit. Once registered in the system, that fee is $9—a 70% reduction. Specialist visits are $17 once enrolled, with the 70% off marker.

Hospital stays cost $112 (€100) a day, and are covered at 80% for the first month (meaning that you pay $22 a day), and at 100% for any additional length of time (meaning that you pay nothing).

Prescription drugs, already affordable compared to U.S. price tags, are covered up to 100%. One of my current medications costs $5.25 (€4.70), off the system.

These costs are fixed by the government, and whether you visit a top clinic in Paris, or your village practitioner down the street, a doctor’s visit will always be $9. These fees, as well as specialist visits, hospital stays, and exams like MRIs, have not increased since I arrived in 2010.

Another incredible feature of the French healthcare system is that treatments for long-term illnesses are 100% covered. Designated une affection longue durée (ALD), or chronic illness, a patient’s general practitioner submits a form to the healthcare service to initiate a treatment plan. A list of ALDs is available on the national healthcare website (see: Ameli.fr) and cardiovascular disease, cancers, diabetes type 1 and 2, Parkinson’s disease, and Alzheimer’s figure among the illnesses eligible for 100% treatment coverage.