Carte Vitale and mutuelle: how Brits get into French healthcare

France will look after you very well, but unlike the NHS it rarely pays the whole bill. The state covers most of it; a top-up policy called a mutuelle covers the rest.

The short version

• If you live in France and aren't working, you can apply to join the state system, PUMa (Protection Universelle Maladie), once you've lived there for at least three months [1].
• UK State Pensioners can instead use an S1, which means the NHS pays for their French state healthcare. You register it at your local CPAM office [1].
• Once you have a French social security number you can get a carte Vitale, the green health card. The FCDO warns it can take six months or longer to arrive [1].
• Declare a médecin traitant (your regular GP). A €30 GP visit pays back €19 if you're in the system with a declared GP, but only €8.40 if you're not [3].
• A mutuelle pays most or all of what the state doesn't. Employees usually get one through work.

Pound conversions use the Bank of England spot rate of 5 November 2026 (£1 = EUR 1.20).

How French healthcare differs from back home

The biggest surprise for Brits is that you usually pay first and get money back afterwards. Doctors, pharmacies and labs are paid at the time. The Assurance Maladie (French state health insurance, run locally by your CPAM, the caisse primaire d'assurance maladie) then reimburses a set percentage of an official tariff. The bit it doesn't pay is called the ticket modérateur, and that's what a mutuelle is for.

With a carte Vitale in your wallet, most of this happens automatically. Your GP or pharmacist swipes the card, the claim goes straight to the CPAM, and the refund lands in your French bank account within days. Without one you post paper forms, which is a proper faff.

Route 1: PUMa, for residents of working age

PUMa is the way into the system for anyone who lives in France "stably and regularly" (de manière stable et régulière). If you work in France, you're covered through your job from the start. If you don't work, cover is based on residence, and you can apply once you've lived in France for at least three months [1][2].

To apply you'll need:

1. Proof of identity and right to live in France. For Brits that means your passport plus your residence card, either the Withdrawal Agreement card or the card you got with your visa [2]. Our guide to the carte de séjour covers which one you hold.
2. Proof of address and of three months' residence, such as a lease and utility bills.
3. A birth certificate, often with an official translation. Ask your CPAM what it accepts.
4. Your French bank details (RIB) for refunds.

You send the application to the CPAM for where you live. In Paris that's the CPAM de Paris. Expect a temporary number first, then a permanent one. Ameli says you must keep showing that you live in France for at least six months of each 12, and that if the Assurance Maladie asks for documents you have 30 days to send them or your rights can be closed [2].

There's one sting for early retirees who don't use an S1. Residents covered by PUMa with little earned income but significant investment or rental income can be asked to pay a yearly health contribution, the cotisation subsidiaire maladie. It's worked out on your capital income above a threshold and collected by URSSAF. The rules change from time to time, so check your own position with URSSAF or a tax adviser who knows both countries.

Route 2: the S1, for UK State Pensioners

If you get a UK State Pension and live in France, the UK may pay for your French state healthcare. You ask the NHS Overseas Healthcare Services for an S1 form, then register it with your local CPAM. You get a temporary social security number, then an attestation of your rights, and after that you can apply for your carte Vitale [1].

A few points worth knowing:

• The S1 covers what a French resident gets from the state, not more. You still pay the ticket modérateur, so most S1 holders take out a mutuelle too.
• Your family may be covered on your S1 if they don't work and don't have their own pension.
• Coming home? If the NHS funds your healthcare through an S1 and you move back to the UK, contact the NHS Overseas Healthcare Team to cancel it [4].
• Working in France cancels it out. If you start working in France, French contributions normally take over.

Our living-abroad guide to the NHS when you live abroad explains how the S1 works across the EU.

Getting your carte Vitale

Once you have a permanent social security number, you apply for your carte Vitale on your ameli account or by form, with an ID photo. The FCDO says it can take six months or longer [1]. In the meantime, ask your CPAM for an attestation de droits (certificate of rights) and show it at appointments. Keep every receipt and feuille de soins (paper claim form) so you can claim back.

Set up your online ameli account as soon as you have your number. It's where you see refunds, download certificates, update your RIB and, increasingly, use the app version of the card. Children usually appear on a parent's account.

Your médecin traitant: the GP behind full refunds

Every adult in the system should declare a médecin traitant, a named GP who coordinates your care. You don't register with a practice as you would back home; you ask a doctor if they'll take you on, and they declare it online.

It matters for your wallet. The Assurance Maladie's 2026 figures for a sector 1 GP (one who charges the official tariff) show the difference [3]:

That €19 is 70% of the €30 tariff minus a €2 flat contribution that's never refunded [3]. Outside the system a further €10.60 is knocked off, leaving you €8.40 [3]. These are the tariffs in force from 1 January 2026; France tinkers with reimbursement rates often, so check ameli before you rely on the exact numbers.

Doctors are either sector 1 (official tariff), sector 2 (free to charge more) or in OPTAM (an agreement that caps their extras). In smart parts of western Paris, sector 2 is common. Ask before you book, or use the ameli directory, which shows each doctor's sector and fees.

Finding a médecin traitant in Paris can take a few calls; some doctors aren't taking new patients. Ask neighbours and colleagues, or try a centre de santé (a health centre). Fancy a recommendation from someone who's already been through it? Ask in our community group for Brits in France.

The mutuelle: your top-up policy

A mutuelle (or complémentaire santé) pays some or all of what the state doesn't: mainly the ticket modérateur and, depending on the policy, extras above the official tariff. The €2 flat contribution stays with you. It matters most for:

• Dentistry and glasses, where state refunds are low on anything beyond the basics.
• Hospital stays, where there's a daily hospital charge and private-room costs.
• Specialists who charge above the tariff.

If you're employed, your employer will normally offer a group mutuelle and pay part of the cost. Check what it covers and whether your partner and children can join.

If you're self-employed, retired or on an S1, you buy your own. Compare a few on:

1. The level of cover, usually shown as a percentage of the official tariff (100%, 200% and so on). "200%" means it pays up to twice the tariff, including the state's share.
2. Waiting periods before some benefits start, especially for dental work and glasses.
3. Age-related pricing. Premiums often rise sharply for retirees.
4. Whether it uses tiers payant, so you don't pay up front at the pharmacy.

People on low incomes may qualify for the complémentaire santé solidaire, a free or cheap state top-up. Ask your CPAM.

There's also the 100% Santé basket, a range of glasses, hearing aids and dental work that's free once your mutuelle and the state have paid, if your mutuelle is a standard "responsible" contract. Ask your optician or dentist for the 100% Santé option.

Long-term illness (ALD)

If you have a serious long-term condition on the official list, such as diabetes or some cancers, your doctor can apply for affection de longue durée (ALD) status. Treatment for that condition is then refunded at 100% of the tariff. It doesn't cover unrelated care or extra fees, so you still want a mutuelle.

Sources

1. GOV.UK (FCDO): Healthcare in France (updated 25 July 2022)
2. Ameli: La protection universelle maladie
3. Ameli: Consultations en métropole, vos remboursements (2 October 2026)
4. GOV.UK (FCDO): Living in France (updated 2 October 2026)

Keep reading

• Healthcare in Paris
• The carte de séjour: Withdrawal Agreement cards vs new arrivals
• French admin for Brits: CAF, impots.gouv and the RIB
• The NHS when you live abroad (and the S1 for pensioners in the EU)