Navigating the French Healthcare System: A Guide for Non-EU Citizens and Retirees


[Sponsored article] If you’re a non-EU citizen moving to France, it’s essential to understand how to join the French healthcare system, also known as “sécurité sociale” (literally “social security”), through an entity called CPAM. This article focuses on the perspective of non-workers or retirees who need to apply to CPAM through PUMA (Protection Universelle Maladie). Fab French Insurance explains everything you need to know on the subject.

What is PUMA?

Implemented in 2016, PUMA ensures medical coverage for all legal residents in France, regardless of their employment status. This means you can access healthcare services even if you’re not actively working.

How to Enroll in French “Sécurité Sociale”

After three months of legal residence in France, individuals must enroll in the French “Sécurité Sociale”, according to the Code of Social Security (CSS). However, there are exceptions. For instance, expatriate workers sent by U.S. employers may be ineligible for up to five years. Additionaly, British pensioners can apply through the S1 program, which provides healthcare coverage under specific post-Brexit agreements.

Is French Social Security Free?

While French social security offers extensive coverage, there might be some costs involved. The contribution level for PUMA depends on a resident’s income. Some individuals covered by PUMA may be subject to the CSM (“cotisation subsidiaire maladie”), an annual healthcare cost contribution.

Exemptions from CSM include:

  • Individuals with modest incomes (less than 50% of the PASS, which is €46,368 in 2024, or €3,864 net per month)
  • Married or PACSed partners with a low combined income (under 1 x PASS)
  • Minors
  • Recipients of French or EU retirement, invalidity, or unemployment pensions, including British retirees

For those not meeting these criteria, the CSM typically amounts to around 6.5% of worldwide passive income over a certain threshold. Note that while passive income earned in the U.S. is exempt from French income tax under the U.S.-France tax treaty, it is still subject to the CSM.

How much CSM should I expect to pay?

Here’s a straightforward way to estimate your CSM contribution:

If your income exceeds 0.5 times the PASS (€23,184 in 2024), you may need to pay the CSM.

For example, a single person earning €50,000 would calculate their CSM as follows: €50,000 – €23,184 = €26,816 * 6.5% = €1,743.

For a couple earning the same amount: €50,000 – (€23,184 x 2) = €3,632 * 6.5% = €236.08.

With a child, the additional “PASS allowance” would exempt you from the CSM.

How to apply for “La Sécu” (La Sécurité Sociale)

Registering for the French social security system requires a form called a Cerfa, in this case it’s the Cerfa n° 15763*02 title “demande d’ouverture de droits“, which you must file with CPAM. The process takes about 6-7 months on average, depending on your location in France and how busy CPAM is. Once approved, you’ll receive an “attestation de droits” enabling you to apply for a Carte Vitale and top it up with a particular kind of health insurance called a “Mutuelle”.

What is a Mutuelle?

A Mutuelle is supplementary health insurance that covers the portion of healthcare expenses not covered by Social Security. Even French natives opt for a Mutuelle to minimize out-of-pocket costs, especially for services from private dentists or opticians.

For non-EU citizens residing permanently in France, having a Mutuelle is mandatory. This insurance often covers the full cost of services, although luxury items may not be fully covered. Despite a minor 2€ deductible applied to every claim, French residents enjoy excellent medical care without excessive bills, allowing you to enjoy other aspects of life in France.

To obtain a quote for the cost of a top-up health insurance plan, go to the following link. For further advice on your insurance, contact Fab French Insurance.

Sponsored articles do not belong to the editorial team at Frenchly. They are provided or written at the request of the advertiser, who determines the content. 

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