Understanding French healthcare and the mutuelle

France covers its residents through the Assurance Maladie, the state health system. The rule is called PUMa: anyone living in France legally and stably for at least three months can register, whether or not they work. If you are employed here, affiliation starts with the job.

Registration goes through your local CPAM office. Expect to provide a passport, proof of address, a birth certificate (often with a certified translation) and, where relevant, proof of employment or income. You receive a social security number first, then the carte Vitale, the green card that doctors and pharmacies scan to trigger reimbursement.

British state pensioners are a particular case. With an S1 form issued in the UK, the NHS funds your French healthcare, but you still register the form with the CPAM and use the French system like any other resident.

The process takes months in practice. Keep your EHIC, GHIC or private cover running until your number arrives, and keep every paper feuille de soins: care received after your rights open can be claimed back later.

Once registered, declare a médecin traitant, the GP who coordinates your care. The declaration is a one-page form signed at the surgery, or filed online by the doctor.

This matters financially. France runs a coordinated care pathway: you see your GP first and get referred to specialists when needed, and the standard rates apply. Consult a specialist directly without a referral, or skip declaring a GP altogether, and the state's share on consultations drops from 70% to 30% of the tariff. A few specialities remain in direct access, including gynaecology, ophthalmology and dental care.

A practical warning for the Var and the wider Côte d'Azur: many GPs are full and turn away new patients. Start looking as soon as you arrive. If you cannot find one, tell your CPAM; a mediation procedure exists for patients without a doctor.

The percentages you read about apply to official tariffs agreed with the state, not to whatever a doctor charges. A standard GP consultation has a set tariff, currently €30. The Assurance Maladie reimburses 70% of it, then deducts a €2 flat contribution, so roughly €19 comes back and €11 stays with you.

Elsewhere the rates vary. Hospital stays are covered at 80% as a rule, but the €20 daily hospital charge (the forfait journalier) is never reimbursed by the state. Medicines come back at 100%, 65%, 30% or 15% depending on the product. Doctors in "secteur 2" may bill above the official tariff, and that excess is yours whatever the percentage says.

Dental prostheses, glasses and hearing aids are where the gap widens most. The state's base tariffs sit far below real prices, so the unreimbursed share can run to hundreds of euros.

The mutuelle is a complementary policy that picks up what the Assurance Maladie leaves unpaid: the ticket modérateur (the 30% on a standard consultation), the daily hospital charge and, depending on the level of cover, part or all of the excess fees billed by secteur 2 doctors. Good contracts also open the "100% Santé" baskets: selected glasses, dental prostheses and hearing aids with no out-of-pocket cost at all.

One point expats often miss: a mutuelle only works if you are registered with the French system. It complements French reimbursements, it does not replace them, and it pays nothing for someone who is not affiliated.

Employees normally join a group contract: since 2016 every private employer must offer one and pay at least half the premium. Retirees, self-employed workers and non-working residents take out an individual contract, and this is where comparing pays, because the price of identical guarantees varies widely between insurers.

ASSUDIRE compares around thirty insurers for health insurance in France. The advice is free and the team works in English.

Along this stretch of coast, plenty of households live in France and commute to Monaco. Their health cover follows the job: employees in the Principality are affiliated to the Caisses Sociales de Monaco, not to the French Assurance Maladie, with Monaco's own tariffs and reimbursement rules.

You can still be treated in France, but a standard French mutuelle is built around French reimbursement rates and will not always fit. Frontier workers need a complementary policy designed to sit on top of the Monegasque system. It is a specific market, and worth a proper review rather than a copy of a colleague's contract.

We handle these cases from Port Fréjus. Book an appointment and bring your pay slip and current cover; we will tell you plainly whether it fits.

If France is only your holiday base, the picture is simpler. A second-home owner who remains resident in the UK, Italy or elsewhere is not registered with the Assurance Maladie, so a mutuelle has nothing to complement. It is simply not the right product for you.

For a stay, carry your EHIC (EU residents) or GHIC (UK residents). Both give access to necessary state healthcare during a visit, on the same cost basis as a local patient. They do not cover everything: private clinic fees and repatriation sit outside, which is what travel insurance is for.

What your French property does need is cover of its own. See our pages on home insurance in France and mobile home insurance for owners on the Var's campsites.

For anything specific to your situation, call +33 4 89 78 15 49 or write to info@assudire.fr. We answer within two working hours, in English or Italian, and the first conversation costs nothing.