InsuoraHow does French health insurance work?
France operates a two-tier health insurance system. Everyone residing in France is covered by the Assurance Maladie obligatoire (mandatory public health insurance, part of the Sécurité Sociale), which reimburses a defined share of medical costs at official rates. The patient's remaining share — the ticket modérateur — is typically paid by a supplemental private insurance called a mutuelle (or complémentaire santé).
About 95% of French residents have a mutuelle. For private-sector employees, employers are legally required to offer one and pay at least half the premium. For everyone else — the self-employed, retirees, students — it is optional but strongly advisable given the gaps in public coverage.
What Assurance Maladie covers (and what it doesn't)
- Covered at 70%: GP consultations (sector 1 doctors), most specialist visits, lab tests, X-rays.
- Covered at 80%: hospitalisation (surgery, overnight stays).
- Covered at 65%: most prescription drugs on the general list.
- Covered at 30% or 15%: drugs of lower medical service rating.
- Not reimbursed by Assurance Maladie: specialist overcharges (dépassements d'honoraires from sector 2/3 doctors), dental prosthetics beyond the 100% Santé basket, premium optical frames, hearing aids above the basket, most alternative medicine.
The mutuelle covers the patient's remaining share — and often goes further to cover dépassements, better dental, and extras depending on the tier.
The three coverage tiers explained
- Base (entry-level)
- Covers only the ticket modérateur — the mandatory copay. No significant dental, optical, or specialist overcharge coverage. Suitable for young, healthy people who want basic protection and plan to use only sector 1 doctors.
- Confort (mid-range, most common)
- The most popular tier. Adds a private/semi-private hospital room, better dental reimbursement (including all 100% Santé basket items plus some beyond), optical allowance (typically €150–200 per pair of glasses every 2 years), and a paramedical allowance (osteopathy, etc.). Covers a share of sector 2 dépassements. Suitable for most families.
- Haut de gamme / Premium
- Maximum coverage: high reimbursement of specialist overcharges, adult orthodontics, implants, premium hearing aids, extended paramedical, and travel coverage. Suited to those who frequently use private specialists or have high dental needs.
The 100% Santé reform
The 100% Santé reform (rolled out 2019–2021) is one of the most significant changes to French healthcare in decades. It guarantees a zero remaining charge option in three categories:
- Dental: A basket of crowns, dentures, and bridges at government-set prices — fully reimbursed by Assurance Maladie + any mutuelle. More complex or aesthetic treatments remain with a remaining charge.
- Optical: A range of frames and lenses at capped prices — fully covered for most wearers who haven't changed prescriptions recently.
- Hearing aids: Class I devices (standard digital hearing aids) — fully reimbursed. Patients can choose Class II (more advanced) for an additional charge.
Any mutuelle — even the cheapest base tier — now covers the 100% Santé basket. The reform primarily benefits people who previously avoided treatment due to cost.
Sector 1, 2, 3 doctors
French doctors are classified into three sectors based on their right to charge above the official rate:
- Sector 1: Charges only the official tariff (e.g. €30 for a GP consultation). Fully reimbursed by Assurance Maladie at 70%, with the mutuelle covering the remaining 30%. No extra cost to the patient with a good mutuelle.
- Sector 2: Can charge above the official rate (dépassements d'honoraires). Assurance Maladie reimburses only the official rate; the overcharge is partially covered by higher-tier mutuelles, partially left to the patient.
- Sector 3: No agreed pricing at all. Very high out-of-pocket cost regardless of insurance. Rare but exists among some specialists.
About half of all specialists in France practice in sector 2. If you live in a major city and often need specialists, a confort or premium mutuelle significantly reduces your out-of-pocket costs.
The CSS — free or subsidised coverage for low incomes
The Complémentaire Santé Solidaire (CSS), introduced in 2019 to replace CMU-C and ACS, provides:
- Free CSS for single adults earning under ~€8,815/year net — the state pays the full premium of the mutuelle.
- Subsidised CSS for incomes up to ~€11,900/year — the contribution is a few euros per month.
- Thresholds rise for couples and families.
- Apply at ameli.fr, your CPAM, or through a social worker.
Frequently asked questions
- Is this calculator free?
- Yes — completely free, no account needed. It runs in your browser and nothing you type is saved.
- Do I have to give personal information?
- No. The calculator uses broad categories only — no name, social security number, or address is required.
- I'm an expat moving to France. When am I covered by Assurance Maladie?
- EU/EEA/Swiss citizens can use their European Health Insurance Card (EHIC) during the first months. Non-EU expats must register with the CPAM within 3 months of arrival. Once registered (typically after 3 months), you receive full Assurance Maladie coverage. A mutuelle can be taken out at any time and is especially important while you're not yet in the public system.
- I'm self-employed. Is my mutuelle tax-deductible?
- Yes, under the Loi Madelin (1994), self-employed workers (travailleurs non-salariés — TNS) can deduct mutuelle contributions from their taxable business income, within annual limits. The deductible amount depends on your income and the type of contract. Consult an accountant to maximise the benefit.
- Can I switch mutuelles easily?
- Yes. Under the Loi Hamon (2015), you can cancel any individual mutuelle contract at any time after the first year, without fees or penalties. Your new insurer typically handles the cancellation. For employer group mutuelles, you can only leave when your employment ends (with portability rights for up to 12 months after leaving).
- What are franchise médicale and participation forfaitaire?
- These are small fixed amounts deducted from your reimbursements that mutuelles are legally prohibited from covering. Franchise médicale: €0.50 per drug box, €0.50 per medical transport act (max €50/year). Participation forfaitaire: €1 per medical consultation (max €50/year). These are small but real costs — budget up to €100/year.