The Mutuelle: Top-Up Health Insurance in France

A mutuelle pays what Assurance Maladie leaves

A mutuelle (complémentaire santé) is supplemental insurance. It covers some or all of the part of your medical costs that Assurance Maladie (Sécurité sociale) does not reimburse through your Carte Vitale. It sits on top of the public system; it does not replace it. How you join that system, through PUMa, is explained in our overview of French healthcare.

The base reimbursement depends on the type of 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 recognized long-term condition (ALD). That leaves a ticket modérateur of roughly 20–30% for routine care, plus any dépassements d’honoraires, the fees above the official rate that secteur 2 specialists may charge. About 95% of French residents hold a mutuelle.

A mutuelle is not legally required for most residents. It is legally mandatory only for salaried employees, whose employer must offer one. For retirees, the self-employed and remote workers living on foreign income it is optional but strongly advised: without one you pay the co-pay, the dépassements and dental, optical and hearing costs outside the 100% Santé basket entirely yourself.

What a mutuelle covers

The exact cover depends on the plan and its tier. With the Carte Vitale and a mutuelle together, your out-of-pocket share is often 0–5%, depending on the tier, though very high tiers are needed to fully cover dental, optical and above-tariff specialist fees. The items a mutuelle can pay include:

• The ticket modérateur, the co-pay left after Assurance Maladie, usually 20–30%
• Dépassements d’honoraires, specialist fees above the official rate
• Better dental and vision cover, including glasses, dental prosthetics and hearing aids beyond the basic no-cost 100% Santé basket
• The forfait journalier hospitalier, the daily hospital fee base Sécurité sociale does not cover, which rose from €20 to €23 a day (€17 in psychiatric units) on 1 March 2026; a mutuelle typically reimburses it
• The forfait patient urgences of €23, charged for an emergency-room visit that does not lead to admission; most mutuelles reimburse it in full
• Private hospital rooms and comfort amenities
• Pharmacy co-pays and some non-reimbursed medications
• Alternative medicine such as osteopathy and acupuncture, depending on the plan
• Overseas emergency cover, and on some plans telemedicine and mental-health support

What no mutuelle is allowed to pay

By law, no mutuelle, even a top-tier one, can reimburse two small fixed charges. They are designed to always come out of your pocket, whatever your plan.

Per-visit chargeparticipation forfaitaire

€2 per consultation or exam

Per-item chargefranchise médicale

€1 per box of medication, €1 per paramedical act and €4 per ambulance transport

Pathway penaltymajoration du ticket modérateur

the extra charge for not going through your declared referring doctor first (the parcours de soins coordonnés) is never covered by any complémentaire

What a mutuelle costs in 2026

Premiums vary a great deal by age, region and tier, so the figures below are approximate 2026 ranges, not quotes. Barometers put the overall market average at around €135–160 a month per person in 2026, with annual increases of about 4–6% common.

Individual

roughly €45–135 a month on average: students and under-25s often €35–60, a typical working adult €70–125, and people aged 60 and over frequently €130–220 or more

Couple

roughly €150–260 a month

Family

two adults and children, roughly €180–350 a month

International plans

expat-focused plans with worldwide cover often cost more than standard French mutuelles: some budget expat top-up products start under €30 a month, while premium global plans can exceed €400

Salaried employees get an employer mutuelle

Since the 2016 ANI law (Code de la Sécurité sociale, article L.911-7), private-sector employers must offer a mutuelle d’entreprise to salaried staff and pay at least 50% of the premium, whatever the size of the company or your seniority.

You can opt out of your employer’s plan only under specific conditions, through a dispense d’adhésion. If you are already covered as a dependent on a spouse’s employer plan, or hold another qualifying individual contract, you can usually request one by giving proof of that existing cover.

Choosing a mutuelle

A mutuelle comes after you are in the public system. Private or international insurance covers the first months and is required for the long-stay visa; the mutuelle is usually set up once you receive your Carte Vitale or activate its digital version, around months 3–6.

When you compare plans, start with where you expect to spend. The tier matters most for dental, optical, hearing and specialists who charge above the official rate, because those are the costs the base rate covers least. Check how each plan treats the 100% Santé basket and what it pays beyond it, whether it covers alternative medicine, and whether it includes overseas emergency cover, telemedicine or mental-health support.

The main kinds of provider are these:

• Large mainstream French mutuelles such as MGEN, Harmonie Mutuelle and MAAF, and insurers such as Allianz, AXA and Assurance Banque Populaire
• Providers offering service in English, such as April International, and Alan, a digital-first insurer with an app and English support
• International and expat plans such as Henner and Cigna Global, with worldwide cover at higher prices
• Long-stay travel insurance such as Chapka, which serves the visa application stage rather than acting as a classic French mutuelle
• Comparison and broker platforms such as Ma Nouvelle Mutuelle, which are not insurers themselves