France — Healthcare for retirees

This page is for general information only. It is not medical advice.

What this page covers

How retirees get healthcare in France. What public cover is. When you need private insurance. How EU cards and EU pensions work. What waiting periods mean. What to do if you are from the USA.

Public vs private (simple)

Public health-cost cover in France runs through Assurance Maladie (health insurance) under Protection universelle maladie (PUMa) — universal sickness protection. Local desks are CPAM (or MSA for agricultural workers).

Since 2016, anyone who works or lives stably and regularly in France can open personal, continuous cover of health expenses — subject to French rates, patient shares, and affiliation rules.

Private complementary cover is often called a mutuelle. Many people keep one because public cover does not pay 100%.

A card is not full cover. A numéro de sécurité sociale (social-security number) and Carte Vitale are tools once rights are open. They do not mean every visa holder is covered from day one, or that care is free. You still typically pay the ticket modérateur (patient share), franchises, and the hospital daily fee (forfait journalier).

How affiliation opens:

• Workers / self-employed: immediate PUMa — no waiting period (sans délai de carence).
• Inactive with stable regular residence (foreigners: with a titre de séjour / residence title): generally 3 months before residence-based PUMa rights open.
• EU/EEA/Swiss (and UK-coordination) pensioners: register portable document S1 with CPAM — contributions usually stay with the pension-paying state.

There is no Spain-style flat monthly convenio especial table. France’s path for inactive residents is residence-based PUMa, plus possible cotisation subsidiaire maladie (CSM) (a possible sickness contribution based on resources) and a 2026 LFSS financial participation whose euro amount is pending decree (see Things to double-check).

If you are from the EU/EEA/Switzerland

Short visits — EHIC / CEAM / GHIC

EHIC means European Health Insurance Card (French: CEAM). The UK version is GHIC.

Show EHIC (or a Provisional Replacement Certificate) to conventionné providers (providers linked to the public system). You often pay upfront and reclaim at CPAM of stay or at home. Typical reimbursements run around ~70% non-hospital / ~80% hospital of official social-security tariffs; medicines at graduated rates; you still owe ticket modérateur + franchises. The daily hospital fee is generally not reimbursed under French social security. Planned care needs S2, not EHIC. Emergency: 112.

Settling as a pensioner — S1 → CPAM

1. Request S1 (“Registering for health care cover”) from the pension-paying state’s competent institution (UK: NHS Overseas Healthcare Services).
2. Register with CPAM of your French residence without paying new French contributions for that coordination path.
3. Typical dossier: S1 + form S1106 (Demande d’ouverture de droits à l’Assurance Maladie) + birth certificate with filiation (parents named) + passport/ID + proof of address + French RIB (bank details). Affiliation is generally by post/agency, not fully online.
4. Each accompanying family member needs their own S1.
5. For temporary stays elsewhere, request EHIC from the pension-paying competent institution — not from French CPAM as if France were competent.

No contribution-month wait once S1 is registered; administrative delays possible.

Workers and non-active without S1

• Workers: immediate affiliation via French activity.
• Non-active without S1: free-movement stays over three months need resources + sickness insurance; EHIC is not a residence document. After 3 months stable regular residence, apply for residence-based PUMa at CPAM. Until then: private insurance. You may face CSM and/or the future LFSS 2026 participation if inactive and conditions are met. Keep the residence criterion (≥ 6 months/year in France) thereafter.

If you are from outside the EU

Paths to public cover:

1. Work in France → immediate PUMa via employer / self-employed affiliation.
2. Residence-based PUMa after ≥3 months stable regular residence with a valid titre de séjour / long-stay visa treated as a residence document → apply at CPAM (S1106 + supporting docs). Affiliation may be free or subject to CSM depending on resources.
3. Bilateral social-security conventions (including the United States for some worker contexts) may change which state’s rules apply for workers — they do not give US retirees an S1-style portable public cover from the US.
4. AME is a separate scheme for certain irregular residents — not the VLS-TS / retiree pathway.

Waiting periods: workers — none; inactive residence-based PUMa — 3 months uninterrupted residence before rights open.

If you are from the USA

• Medicare does not cover routine care in France.
• U.S.–France SSA totalization coordinates Social Security coverage/benefits. SSA is clear: a worker exempted from French social-security taxes under the Agreement cannot receive free health care under the French system and must arrange private health insurance.
• No US-issued S1 for French public care.
• Typical VLS-TS visiteur / long-stay path: comprehensive private insurance for the visa → validate stay / carte de séjour → keep private cover through the 3-month wait → CPAM application for PUMa if eligible → expect ticket modérateur; consider a mutuelle; monitor CSM and the LFSS 2026 decree for inactive non-contributors.

Simple enrollment checklist

EU / EEA / Swiss (and UK S1-eligible)

• Pathway: worker / S1 pensioner / non-active (3-month then PUMa).
• If S1: obtain abroad → send to CPAM with S1106 + birth certificate with filiation + ID + address + RIB.
• If worker: affiliate via employer / URSSAF → rights without wait.
• If non-active without S1: private insurance for residence file + first 3 months → CPAM.
• Do not rely on EHIC for settlement; request EHIC from the competent (pension-paying) state when S1-based.
• Optional mutuelle for ticket modérateur.

Non-EU (incl. USA)

• Meet consulate insurance wording for VLS-TS / residence.
• Enter; validate stay; keep private policy through month 3.
• If working: immediate PUMa track.
• If inactive: after 3 months, file CPAM (S1106 + titre de séjour + birth certificate with filiation + ID + address + RIB).
• Budget for ticket modérateur + possible CSM / future LFSS participation.
• Do not expect US–France totalization to open free Assurance Maladie for retirees.

Things to double-check

1. LFSS 2026 financial participation — LOI 2025-1403 creates a participation for inactive PUMa beneficiaries who reside stably/regularly, have no professional activity, and are not liable for CSG/CRDS/sickness contribution under an international convention. A decree setting the amount and modalities is awaited (service-public verified 13 May 2026). Do not invent a euro figure. Until the decree, existing page information remains the live guidance.
2. CSM thresholds change with PASS — verify current Urssaf figures yearly; CSM is distinct from the LFSS 2026 participation.
3. VLS-TS visiteur interaction with the future participation — likely target population for inactive non-contributors; confirm when the decree issues.
4. Birth certificate with filiation often required for affiliation — plan translations/apostilles.
5. Consular insurance wording varies by post — confirm the current checklist.

References

• Emergency: 112 · ameli phone (France): 3646