French Healthcare access and social payments

Hi All,
I have been reading as much as I can find, and think i will eventually have to create a massive flow chart to navigate and understand systems Francais,
(Although Brexit may have a hand in upsetting the apple cart, we can only go on what we have).
I don’t mind all sorts of comments, because it can often trigger other questions i need to find answers for.

I have questions for different areas, so need to split them up…although they do relate/ have dependency from one to another.
To my point(s)
When i reach UK retirement age and pension AND decide to reside permanently in France.

  1. Because i will have attained retirement age, how do I join the French Healthcare system, via the CPAM office ?

  2. How do i prove residency ?

  3. As a retiree, do I have to pay contributions to receive all healthcare ? or also some form of insurance.

many thanks

At present, but as you say everything could be different after Brexit:

  1. If you are in receipt of a UK old age pension, you ask DWP in the UK for a form S1. You then take this form S1 to CPAM with the other documents they need, eg birth certificate etc.

  2. A tenancy agreement, electricity bills… it’s not usually a problem because once you live here, you automatically seem to accumulate the paperwork you need.

  3. If you have an S1, that entitles you to the health cover provided by the French state system with no extra cost (because the UK is refunding France). However, French state healthcare only covers approx 70 per cent of most healthcare costs. You can if you wish take out insurance to cover some or all of the remaining 30 per cent. If you don’t you’ll have to pay all of that 30% out of your own pocket. Most people take out insurance. There is a wide range of policies available, from inexpensive hospital-only cover to policies with higher premiums that will cover opticians, dentists, private consultants’ fees, etc.

Hope this helps clarify a bit.

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Thanks Anna, yes it does help. Having read so much lately, the info hasn’t percolated to a level and stopped . … item 3 was an interesting one for me due to the more vagueness of info i had found to date…
Be interesting to find the costs of policies for the additional %'s … thank you.

I suggest you look through this thread

and particularly the bits that explain what a “100%” policy means - ie that it is capped at 100% of the state-approved tarif for the procedure. But in fact many healthcare providers charge more than the state-approved tarif. Therefore if you have a policy that gives “100%” cover, you would still have to pay any difference between state-approved cost and the actual cost. A policy giving 150% cover, for example, would give higher cover because it is capped at 150% of the state-approved tarif.

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Actually thanks for the reminder… I did read somewhere about the 100% thing, and your explanation clarifies that well… and is also a very salient point to think on.

It’s worth adding though that if you have a serious illness (I have cancer) the state will cover 100% of your costs.

Correct Geof but only related to treatment and (most but not all) drugs for that specific illness (ALD).


So true Simon… even with ALD…the piggy bank can empty quite quickly if there is not a good Mutuelle in place…

One of the things NOT paid in full by the State… is the prescribed medication needed to combat the side-effects of the Affection Longue Durée (ALD) medications which fill our bathroom cabinet !

Of course, it makes sense when you accept that the side-effects are not considered to be life-threatening … (but they are b***** awful., just the same)

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Merci for tout les “inputs” :slight_smile: I think the moral of the story, is to have a good Mutuelle in place, whatever your situation - retired, working, inactive, whichever… and have it professionally reviewed annually.

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Spot on @Stella ! And nicely put :wink: !

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I have read all sorts of posts on this topic and with every post I become more confused. I am well used to international travel and dealing with the ins and outs of the various UK systems, but I am totally lost when it comes to understanding EXACTLY what I must do to get myself into the French health care system.

I am 59, suffering from advanced cancer (although stable at the moment), living with my partner who is 50 between Pomas and Carcassonne. I am not working but could do some consultancy work in my area of expertise. We went to the CPAM office in Carcassonne to find out what was required and was handed a sheet saying that we needed to get an S1 form form the UK. I later found out that this was not available until State retirement age. I am currently drawing my occupational pension which is sufficient to live off though not massive.

What I desperately need is a blow-by-blow listof what I need to do, i.e. “(1) Do This, (2) Do That etc” - a sort of Guide for Dummies tailored for my circumstances.

Can anyone help please? I’d rather not do these things by text, much preferring to speak to people, but any help will be gratefully received.


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I think the simplest would be to go back to CPAM and explain that your status at present is “inactif”. They will then explain what documents you need to provide, as an economically inactif person below retirement age. It sounds as if last time you spoke to them they were confused over your status and thought you were “retired” ie in receipt of a state pension, so they gave you a list of the documents that a “retired” person has to provide. Hope this helps.


Hi , and thanks all so far.

A bit of a hypothetical one, but reality could strike…with respect to residency before retirement age,

IF, I registered as a Micro Entrepeneur ( to run a small business ); does this automatically qualify one into the Healthcare system ?

If this is the case, do you still get a Carte Vitale ? ( green card) to prove you are a member.

… would anyone know the mechanism ( steps) to do this , thank you.

If you register as a micro entrepreneur, you will automatically receive an attestation de droits for healthcare, and in due course, a carte vitale (I would describe it as more yellow than green, and the carte vitale doesn’t actually prove anything - it’s your attestation, with dates etc on it, that confirms your entitlement).
However, if your earnings from the micro are below a certain level, you’ll still be assessed for cotisations on the rest of your income, in exactly the same way as you would if you hadn’t registered a micro entreprise (this is a new system that will operate for the first time this year so remains to be seen exactly how it works, but on paper that seems to be the theory). So unless you are anticipating earning above the “floor”, registering as a micro isn’t actually going to gain you anything in terms of healthcare as compared to applying for healthcare via the “inactif resident” route, it just means you’ll pay a bit more. So basically, you need to register a business if you want to run a business, but since the rules changed it no longer makes sense to register a business primarily as a cheap route to healthcare if you don’t particularly want to run a business, that loophole seems to have been closed.

There’s a table explaining how the cotisation maladie subsidiaire is calculated here:

  • don’t forget that your earnings = your turnover minus the abattement forfaitaire, eg for prof lib your income is 66% of turnover.

A point of unimportant order Anna (!) - the relatively new photo cards are mostly green. You’re absolutely right though - having the card doesn’t prove anything - it’s simply an automated payment tool.

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Yes you’re right :grin: I just looked and was surprised how green it is, cos in my mind’s eye it’s yellow, very odd… of course you’re also right that it’s a point of unimportant order.

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Thanks Anna,

and just as i was getting my head around the other method !!

Using the examples in your link…i am presuming “property income” is eg gite / bnb rental ?“professional income” is anything else ?

So the ceiling seems to be 9,807 euros…

Pretty sure i wont be making that much in rentals… which leaves my other income which is a Forces pension ( not state retirement pension)… which would be very close to it, and combined take it over .

So am taking that i would just pay a straight 8% of my combined earning ? ??

Basically it is the difference between earned versus unearned income - earned income, ie from employment or self employment, will have had cotisations charged on it as a matter of course, whereas unearned income won’t.

If all your income is “unearned” you pay 8% of total worldwide revenue minus 9,807 euros or whatever the figure is. So if you earn marginally over that figure, you will pay next to nothing in cotisations.
It’s not even clear to me whether or not your Forces pension would be subject to cotisations or not. I think it says that pension income is exempt but nobody seems to know whether that means all pension income or what.
However, if you’re planning to have rental income from France, then I have a feeling that if it’s your main source of income you are obliged to register it as a business activity and pay cotisations on it as per for earned/professional income. There are several people on the forum who have gîtes/bnbs, so hopefully they’ll know chapter and verse on that, or if not, the tax office will tell you.

You might also want to check whether or not you would pay CSG on your Forces pension income. If you do, I think that is around 8% starting from the first euro, and Macron is talking about increasing it. (CSG is nothing to do with healthcare really, but while you’re doing the sums you might as well do this one at the same time.)

Thank you very much for your input Anna; it seems to be very difficult for some reason to co-relate this new PUMA system ( as in your link)… where it charges the membership fee (cotisation)…but still has the old system payments when you go to business types…
You cannot obviously pay both, you have to fit into a niche somewhere…or they haven’t thought it through, or website have not been updated.

Maybe what you were quoting is for people who are employed, not those who have their own businesses ??
But then if they were employed , it would be taken at source ?

Surely if what is quoted within the link… they would have to take the social payments element out of everything else … what am i missing , thanks

I don’t understand what’s confusing you, sorry.

Basically, your route to PUMA (healthcare) depends on your status - employed, “indépendant” retired or inactif. So you need to be clear on your status, and the rest will then fall into place.

Everybody has to pay a fair level of cotisations (=contributions) unless they fall into one of the exemption categories, e.g. having very little money, being a pensioner or whatever. If you’re employed or self employed you pay cotisations on your earnings. If your earnings are high enough and therefore the level of cotisations you pay is high enough, you don’t pay any “cotisations subsidiaires”.

If you’re inactif and therefore don’t pay any cotisations on earned income, you pay “cotisations subsidiaires” on your unearned income instead.

If you have a very low earned income, you obviously pay some cotisations on that, but not your fair whack. So in that case, if you have significant unearned income you will be liable for “cotisations subsidiaires” on that, to bring your cotisations up to a realistic level.

Hope that helps, I don’t know how else to explain it. The details are quite complex but the overall principle is quite simple, I think. Maybe CPAM will be explain it better.

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