Long-Stay Visa and Insurance for Americans

The most expensive item in an American family’s budget may be health insurance. Many Americans have no understanding of the true cost of their insurance because it’s included in their employment package. Folks simply don’t think about how much their employer may be reducing their salaries when factoring in insurance costs.

Before I retired, my employer paid for my health insurance but I had to pay to insure my wife. The cost, taken out of my every paycheck, came to about $6,000 annually. And even with insurance, there were co-pays and other out of pocket expenses. We were reasonably healthy (and still are, knock wood), but we each take a few common prescription medications - for blood pressure and cholesterol and the like, nothing exotic or costly. Even so, with regular visits to the doctor, periodic lab work, the drugs, and the occasional illness or injury, we normally spent an additional several thousand dollars annually in the States over and above the cost of the insurance.

The French do not recognize the American public health insurance plan for retired seniors known as Medicare. There is no reciprocal agreement between our governments. This becomes a problem for Americans when applying for a long-stay visa leading to a permanent residency in France. We must demonstrate that we won’t be a burden on the French social system and therefore, before the French embassy or consulate that covers our particular region of the United States will approve our visa request, we must demonstrate among other things that we have a certain level of health insurance. Coverage must equal at least 30,000 euros without a deductible and must include repatriation. A coverage letter (and not just an insurance card) must be presented at the time of application in the US naming the insured(s), length of coverage, amount of coverage, and so on.

Rules change periodically. I am not a professional in the field. This post simply reflects my personal experiences. Research for yourself. Ask questions.

You can buy two types of health insurance to meet the requirements for a long-stay visa. Full coverage health insurance, similar to that which most folks have in the States, or travel insurance.

A number of internationally recognized companies offer full service health insurance for expat Americans in France. AXA, Cigna, Bupa, and BC/BS are well known companies offering plans to Americans but there are a raft of others. Their plans are structured similar to the way that plans are structured in the States with different levels of coverage, different deductibles and co-pays, and different riders and optional benefits. Health status will be questioned and certain pre-existing conditions and prescriptions may be excluded. Coverage may exclude the USA/North America or be world-wide. There may be age limitations. Evaluating plans is not simple stuff…not quite rocket science but not easily understood at first glance. Apples to oranges to pecans in many cases.

Travel insurance from companies like UnitedHealthcare Global and Seven Corners is simple by comparison. You don’t pay very much money and you don’t get very much coverage. Because it’s travel insurance, lost luggage and trip interruption may be covered. But you are moving to France, not spending two weeks on a barge on the Loire, so that’s not a very big deal. What can be a big deal is that pre-existing conditions are almost never covered. Your everyday meds are not covered. Regular checkups are not covered. Fall down the stairs and break your leg? Covered. Get caught in the rain and contract pneumonia? Covered. But for most folks who are not accident prone and who have the good sense to stay inside when it’s raining, travel insurance will seldom come into play. You’ll be paying full retail for your healthcare without much of a backstop.

The cost differential between full-service insurance and travel insurance is significant. For one year of coverage, a couple that we know who are just past retirement age has recently been quoted $3,000 for travel insurance for their first year in France, $25,000 for full-service. Not a typo. $25,000 for two people for health insurance for one year. After the sticker shock wears off, how do you make your choice?

Here’s how we helped our friends choose.

  1. We took a list of their prescription meds to our local pharmacy in France and asked for the cost of a one month’s supply of all of the meds on the list. At full retail without insurance, the extensive list came to about $200 per month - $2,400 per year.

  2. I recently had a minor surgical procedure in France. Nothing life threatening but I had an MRI, spent one night in the hospital, had lab work done, had to pay a surgeon and an anesthesiologist, had an EKG and other tests, and had a follow-up visit with the surgeon for a minor in-office procedure without anesthesia. Total at retail? Under $3,000.

  3. If I’m not mistaken, at the first of the year the full price for a simple visit to a general practitioner to have prescriptions renewed and a quick checkup will rise to about $27.50. Visits to specialists run from about $100 to $150. As an example, a recent series of visits to a podiatrist for my wife to be fitted for shoe inserts cost us about $115. That amount fully included the cost of the inserts plus an initial visit to measure for the them, a second visit to fit them, a third visit to check on an area of chafing, and a fourth visit to fit some extra padding.

In the end, our friends agreed that there was no reason to pay $25,000 when the cost of care is so reasonable here. If a new illness was discovered during their initial year, not a pre-existing condition, the travel insurance would cover them. Otherwise, it seemed that saving over $20,000 would more than provide a buffer for the actual cost of care that they were likely to incur that travel insurance would not cover.

So our friends bought travel insurance from a reputable company and will apply for residency as soon as they arrive. Once granted residency, they will apply for their cartes vitale. But that’s a story for another day.

I repeat, rules change periodically. I am not a professional in the field. This post simply reflects my personal experiences. Research for yourself. Ask questions.

Check out how we dealt with the move across the Pond on the Moving page of my blog: www.southfranceamerican.com.


All good advice Ira

We came from Australia over 3 years ago and took out full cover insurance through ASFE - Mondassur and were paying around €6500 per annum for a couple in their 60’s. Full re-imbursement for everything (90% for GP and doctors) but it also covered pre-existing conditions both for medical treatment and prescription medications. Worked well for us and certainly not €25,000. See the link below


After January this year, there were changes in the French system and we applied for our Carte Vitales under the PUMA Scheme. These were delivered in around 3 weeks and now working in full for all events.The only requirement now is that you can clearly demonstrate that you are permanently based here and have been here for a minimum of 3 months…the dreaded utilities facture/receipt is called for again. No requirements for French or EU citizenship.

As I understand it, we will be charges a cotisation at the rate of around 8% of our taxable income (less the first €9,600 which is exempt) The first bill for this does not come for around 12-18 months and can be charged quarterly. Our calculations is that it will still be a lot lower than the €6,500 charged for our insurance, but of course that may depend upon your taxable income.

Good luck

I believe that the 12 month delay before the first payment will be a once only bonus for those people who applied soon after PUMA was introduced.

Thanks for the kind words. I just did the quick online quote from Mondassur as an American couple, 66 years of age, arriving in France in March, 2017. Was quoted over 12,000 euros for a full year for two. Healthcare is a real mine field.

I suspect that you may be correct David. Normal payment to be put in place soon, but I feel good in that we contribute to the system that we are using. Still a lot better than private health insurance, even after allowing for addition of a mutuelle.

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Ira, did you use Mondassur or ASFE. Try the link below…it may give you a different result although they refer to 18-65 years of age, they will still cover over 65’s but may need to provide a special quote.


One thing is certain and that is the fact that private health insurance is not cheap. Perhaps you could consider either travel insurance or self cover for the first 3 months and then apply for you Carte Vitale through PUMA, but you should do some research first to make sure it will work for you.

Good luck

For Americans, the French system is a revelation. Even if taxes were increased to the point of fully funding real costs, it would be less expensive than the American crazy quilt system and our experience has been that the quality of care is at least comparable if not better.

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Graham, I used the link that you provided previously. Actually, this is all about my in-laws. Americans need a full year of insurance when applying for a long-stay visa and can’t self-insure regardless of situation. At least, that option has never been on the table for us or anyone we know and you know how happy the French are to approve something not on the books. Anyway, we used travel insurance when we came over, it was relatively inexpensive, it worked for us, and that’s what we’ve recommended that our in-laws do.


My husband and I are both retired Americans. We moved here in June/2016. We were required to show proof of health insurance coverage for one year, but we only needed to pay the first installment (3 months) in advance, as that is how our health insurance premiums are paid (quarterly).

We went with AARO and pay about $9k in premiums (for 2 people) due to age and pre-existing conditions. I didn’t want to go with travel insurance, as I thought that was only for vacations and not moving and living in another country. Maybe I am wrong?

I need to inquire into using the French National Health Care System to find out if we are allowed to and what the costs would be. I guess I am a bit confused because if I am not paying (and have never paid) into their social security system, then why I would I be able to use their heath care system?

Thanks for sharing,


Ira…sorry I did not recall that I had included the link in my first response…must be getting old.

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Hi Nancy,

As I continually repeat, I’m not a professional. But here’s how I see it as an American expat who has done some homework and assisted others.

Yes, you can use travel insurance to fulfill your long-stay visa requirements. We did. And you can tell that it’s routine because the travel insurance companies know exactly what you mean when you say,“I need a letter to satisfy the requirements for a French long-stay visa.” The agent for the travel insurance company that we used said,“No worries. We write those all of the time.” And their letter was accepted by the French embassy in DC without question.

Once you become a legal French resident - not a visitor on a visa - you are entitled to the benefits of the French system. Entitled under law. As soon as we were told that we had passed the interview for our titre de sejour - our temporary carte de sejour - we made application to the healthcare system. Different people who have arrived at different times and under different circumstances tell different stories about how long it took to be approved (that’s why we recommend hiring a professional) and how much it cost (you pay a percentage of your worldwide income minus a ‘standard deduction’ but there have been ‘holidays’ and other adjustments). But if you jump through the hoops, you get your carte vitale and receive all of the benefits. In fact, you will be compensated for any benefits that you would have received between the time your application was received and the time that it was approved. In our case, that amounted to several hundred euros in our regular prescriptions and doctor appointments.

So go for it if you plan on residing permanently in France. Consult a professional, by all means. But I believe that it is a rarity for the cost/benefit of being insured privately to outweigh being on the French system, especially for retirees on fixed incomes.


Nancy as I understand the system now is that as long as you are permanent residents and can verify that you have been here for over 3 months you can apply under PUMA regardless of where you have come from.

Once accepted you will need to pay your dues to the system on a quarterly basis. The charge as I understand it is determined on the taxable income recorded in your French Tax Return (less the first €9,600 which is exempt) and charged at 8%.This will be charged quarterly by URSAFF. See the links below


Hi Ira,

Thanks for the info! We are legal French residents as we have our titre de sejour. I have no idea about the difference between a titre de sejour and a carte de sejour. And how a titre de sejour changes to a carte de sejour.

I will definitely need to hire a professional. We have a tax person, maybe she can assist with this. But if not, do you have a person you can recommend? Bi-lingual is needed! :wink:

I really would never be able to say if I am residing in France permanently. But we have decided to stay for a 2nd year. And I suspect that is how we will mosey along. Making decisions on a yearly basis.

But as long as we are here – if we are doing everything legally, filing taxes, etc and the law allows us to use their health care system, I see no reason not to, especially if it is cheaper than the private system.

Thanks for sharing your thoughts. It is very appreciated.



Thanks Graham!! That’s very helpful information!! I will sure read that article.

If you know of any experts, please let me know. I have a lot to learn!

Joyeuses fêtes!

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I do not really know any experts but we simply applied with the appropriate form and documentation:

  • Photocopy of your Passport
  • Utilities Bill no older than 3 months
  • Name of Treating Doctor
  • Photocopy of your Carte Sejour
  • Photocopy of your Birth Certificate

Send in the forms and wait for the Carte Vitale to be issued

You may wish to talk to someone to determine what the cost will be to you.

See the link below and if you cannot read french, you will need to translate it (Google translate doesn’t do a bad job…not perfect but OK)


Good luck

Thanks again, Graham!

The reason that I always suggest a professional is that you can never be certain that one office will require the same documentation as another. A birth certificate with a seal and an official translation was not enough for me because I didn’t have a long form certificate, a certificate with the names of both parents. Fortunately, my sister in the US lived only a few miles from the issuing office and was able to get me a copy fairly quickly.

Totally agree, Ira. Working with a hired professional, we’ve decided to first do a comparison of several companies and PUMA. This way, we will be more assured of which is the best path for us to take given our situation (income, length of planned stay, out of country travel, etc).

Bonne et heureuse année!

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I negotiated expat health coverage for an american woman aged 75 with MSH International, the company is extremely efficient and the price was only €179 per month. Not all dentist and eye glass coverage was included but health care was. She works as AE and this picks up everything in excess of the CPAM.

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Once we had received our carte de sejour, we went with AXA for what would be called catastrophic insurance - just hospital stay coverage. Less than 100 euros monthly and covered the removal of a kidney stone 100%. Then moved to Pacific through our bank, also less than 100, and it covers all very much as you suggest. We’re 68, by the way.