Three things, often confused
France has universal healthcare, and as a legal resident you can access the public system alongside French nationals. But three separate things get muddled together, and they do different jobs.
- PUMA — the entitlement. Available to anyone residing in France in a stable and regular manner for at least 3 months
- Carte Vitale — the card that makes reimbursement automatic
- Mutuelle — private supplemental insurance covering what the base rate does not
What the base rate actually pays
The Carte Vitale reimburses the regulated base rate (tarif de convention), typically 70% for a GP consultation within the declared care pathway. The 2026 base rate for a GP visit is €30, so the reimbursed portion is about €21.
Dental prosthetics, glasses, hearing aids, daily hospital charges and any practitioner billing above the regulated rate are only partly covered, or not covered at all, by the base rate alone. This is why a mutuelle is normal rather than a luxury.
What a mutuelle actually covers
The base reimbursement depends on the care: typically 70% of the official rate for a GP or specialist visit, 80% for hospital care, and up to 100% for maternity or a recognised long-term condition (ALD). What is left is the ticket modérateur — roughly 20–30% on routine care — plus any dépassements d’honoraires charged by secteur 2 specialists above the official rate.
- The co-pay, and specialist fees above the official rate
- Dental, vision and hearing beyond the basic 100% Santé basket
- Private hospital rooms, and the daily hospital charge (forfait journalier, about €20/day)
- Pharmacy co-pays and medicines the state does not reimburse
- Often osteopathy, acupuncture, telemedicine and overseas emergencies — this varies by plan
Two charges no mutuelle may reimburse, by law: the participation forfaitaire on each consultation, and the franchise médicale on medicines, ambulances and paramedical acts. Together they are capped at €50 a year and are designed to always come out of pocket. Nor will any plan cover the penalty for bypassing your declared referring doctor.
What it costs
- Individual: €40–170 a month — younger adults at the low end, those over 60 frequently more
- Couple: €90–260 a month
- Family: €150–350 a month
- International or expat-focused plans generally run higher, reflecting worldwide cover
If you take a salaried job, this changes: since the 2016 ANI law private-sector employers must offer a mutuelle d’entreprise and pay at least 50% of the premium. Already covered on a spouse’s employer plan? You can usually request a dispense d’adhésion rather than hold two.
Your visa insurance is separate
A long-stay visa requires private health insurance covering your whole stay. That is a visa requirement, satisfied before you arrive, and it is not the same thing as PUMA.
PUMA eligibility follows residency. The two do not overlap the way people expect, so plan to carry private cover into your first months in France.