Last verified: October 2026 — Sources: ameli.fr, Service-Public.fr, complementaire-sante-solidaire.gouv.fr
The French healthcare system works on two levels: the Sécurité sociale (mandatory, managed by the CPAM) reimburses roughly 70 % of medical costs, and a mutuelle (supplementary health insurance) covers most of the remainder. For people on low incomes, the Complémentaire santé solidaire (CSS) provides full coverage, free or for less than €1 per day. This guide explains every piece of the system and how to access it.
Sécurité sociale and PUMA: universal coverage
Since 2016, Protection Universelle Maladie (PUMA) guarantees that anyone legally and stably residing in France is entitled to basic health coverage under the Assurance Maladie. It is not a separate scheme — it is the framework that ensures access to the general system.
Who can register?
- EU/EEA/Swiss citizens: free movement with an ID card or passport. If you are employed, registration is immediate. Without employment, rights open after 3 months of stable residence (at least 6 months per year in France).
- Non-EU nationals: a valid residence permit or long-stay visa is required. With a job, registration is immediate. Without one, the 3-month waiting period applies.
- International students: direct registration via etudiant-etranger.ameli.fr, with no 3-month wait.
What is the CPAM?
The CPAM (Caisse Primaire d’Assurance Maladie) is the local office that manages your file within the Sécurité sociale. It is your point of contact for:
- Registering for health coverage (affiliation).
- Obtaining your social security number and your Carte Vitale.
- Receiving your healthcare reimbursements.
- Declaring your médecin traitant (designated GP).
What does the Sécurité sociale cover and how much does it reimburse?
The Sécurité sociale reimburses a percentage of the tarif conventionné (official set rate) for each medical procedure. The unreimbursed share is called the ticket modérateur and is your responsibility (or your mutuelle’s).
Example: GP visit (sector 1 doctor)
Since December 2024, a consultation with a sector 1 GP costs €30:
| Item | Amount |
|---|---|
| Consultation fee | €30 |
| Sécurité sociale reimbursement (70 %) | €21 |
| Flat-rate co-payment (participation forfaitaire) | €2 |
| Ticket modérateur (your share) | €9 |
| Total out-of-pocket without mutuelle | €11 |
The €2 flat-rate co-payment (in effect since May 2024) is deducted from every consultation and is not reimbursable. Without a declared médecin traitant, the reimbursement rate drops to 30 %.
Key reimbursement rates
| Type of care | Sécu reimbursement |
|---|---|
| GP consultation (sector 1) | 70 % |
| Specialist consultation (sector 1, with referral) | 70 % |
| Essential medications | 65 % |
| Lab tests and analyses | 60 % |
| Hospitalisation | 80 % |
| Dental prostheses (100 % Santé) | 100 % |
| Glasses (100 % Santé) | 100 % |
| Hearing aids (100 % Santé) | 100 % |
The 100 % Santé (zero out-of-pocket) scheme guarantees full coverage of a selected range of glasses, dental prostheses and hearing aids.
The mutuelle: supplementary health insurance
A mutuelle (or complémentaire santé) covers what the Sécurité sociale does not reimburse: the ticket modérateur, specialist surcharges from sector 2 doctors, and a portion of dental, optical and hospital costs.
Is it compulsory?
- For employees: yes. Since 2016 (ANI law), every employer must offer a company health plan and fund at least 50 % of the premium. Enrolment is compulsory, except in specific exemption cases (already covered by a spouse’s plan, fixed-term contract under 3 months with proof, etc.).
- For self-employed, job-seekers and others: not mandatory, but strongly recommended. Without a mutuelle, you pay 30 % of every consultation, all specialist surcharges and a large share of dental/optical costs outside the 100 % Santé scheme.
How much does an individual mutuelle cost?
Prices vary by age, coverage level and provider. Prices depend on age, benefits and insurer. Request several up-to-date quotes before choosing a plan. Always compare several quotes before signing up.
Complémentaire santé solidaire (CSS): coverage for low-income residents
The CSS replaced the former CMU-C and ACS in November 2019. It is a Sécurité sociale scheme that provides full coverage (equivalent to a good mutuelle) for people on modest incomes.
Two options
- Free CSS: if your income is below the first threshold.
- CSS with contribution: if your income exceeds the first threshold but stays below the second. You pay a small monthly premium based on your age.
Income thresholds 2026 (mainland France, 1 April 2026 – 31 March 2027)
| Household size | Free CSS (up to) | CSS with contribution (up to) |
|---|---|---|
| 1 person | €10,421/year | €14,069/year |
| 2 people | €15,632/year | €21,103/year |
| 3 people | €18,758/year | €25,324/year |
| 4 people | €21,885/year | €29,544/year |
| Each additional person | +€4,169 | +€5,628 |
Income is assessed over the 12 months preceding the second-to-last month before the application.
Monthly contribution by age (CSS with contribution, mainland France)
| Age on 1 January | Monthly contribution per person |
|---|---|
| 29 or under | €8 |
| 30–49 | €14 |
| 50–59 | €21 |
| 60–69 | €25 |
| 70+ | €30 |
What does the CSS cover?
- Consultations, lab tests and hospitalisation: no ticket modérateur.
- Daily hospital charge (forfait hospitalier): fully covered.
- Glasses, dental prostheses and hearing aids: covered at 100 % (100 % Santé).
- Third-party payment (tiers payant): you pay nothing upfront in most cases.
How to apply
- Log in to your ameli.fr account → “Mes démarches” → “Complémentaire santé solidaire”.
- Alternatively, download form S3711 and send it to your local CPAM.
- Attach proof of income for the required 12-month period.
- The CPAM normally responds within about 2 months.
- If approved, you will receive a rights certificate. The CSS is renewable every year.
Summary: which coverage for your situation?
| Situation | Sécurité sociale | Recommended supplementary |
|---|---|---|
| Employee in France | Automatic registration | Company mutuelle (compulsory) |
| Self-employed / micro-entrepreneur | Registered at sign-up | Individual mutuelle or CSS if eligible |
| International student | Via etudiant-etranger.ameli.fr | CSS (most students qualify) or student mutuelle |
| New EU arrival without a job | After 3 months of residence | Individual mutuelle or CSS |
| New non-EU arrival with a visa | After visa validation (ANEF) | Individual mutuelle or CSS |
| Low-income resident (any status) | Yes, via PUMA | Free or low-cost CSS |
Frequently asked questions
What is the difference between Sécurité sociale, Assurance Maladie and CPAM?
The Sécurité sociale is France’s national social protection system. The Assurance Maladie is the health branch of that system. The CPAM is the local office that manages your file and reimbursements within the Assurance Maladie.
Did the CSS replace the CMU-C?
Yes. Since November 2019, the Complémentaire santé solidaire (CSS) has replaced both the CMU-C (free) and the ACS (subsidised). The CMU-C no longer exists as a standalone programme.
Can I get Sécurité sociale without working?
Yes, thanks to PUMA. If you live in France stably and legally (at least 6 months per year) and hold a valid residence permit (or are an EU citizen), you are entitled to health coverage. Without employment, rights open 3 months after your arrival.
Related guides
- How to apply for the Carte Vitale
- How to get your social security number
- How to read a French payslip
- Gross vs net salary in France
- Your first 30 days in France
Official sources
- ameli.fr — Assurance Maladie
- Service-Public.fr — PUMA
- complementaire-sante-solidaire.gouv.fr
- etudiant-etranger.ameli.fr — International students
Figures, thresholds and reimbursement rates may change. Always check the official sources for the most current information applicable to your situation.