Health insurance for Americans moving to France

You land with a French address, a French phone number, and no French health coverage.

The last one surprises most Americans, because France does have a public health system and you are about to live inside it. Just not yet. Coverage works as a sequence, not a switch: private insurance from day one, the French public system from around month three, and a mutuelle on top of it after that.

Getting the order right is most of the work.

This article describes how the system works rather than what to buy, and since amounts and rules change, check each figure at the source.

This article is brought to you by by Maxime Roseau, Co-Founder of EasyFranceNow

What happens to your Medicare when you cross the border

Medicare is a domestic program. It generally does not pay for care outside the United States, and the exceptions on Medicare's own page all turn on a foreign hospital being closer than an American one. None describe a retiree in Montpellier. Part D does not cover prescriptions bought abroad.

Your Medigap policy may carry a foreign travel emergency benefit, and the terms matter. Most Medigap plans pay 80 percent of billed charges for certain medically necessary emergency care abroad, after a 250 dollar yearly deductible, and only if the care begins during the first 60 days of a trip. The lifetime limit is 50,000 dollars. That is cover for a trip, not for a life.

Medicare Advantage plans are tied to a service area you are leaving.

That leaves the real decision: keep paying the Part B premium for coverage you cannot use, or drop it. Drop it, and if you return to the US later without a Special Enrollment Period, the late enrollment penalty adds 10 percent for each full 12-month period without Part B, for as long as you hold it. Neither choice is free.

Your other US coverage does not travel either

Under 65, the wall is the same shape. Employer plans are built around a US provider network. Marketplace coverage is not available once you leave: eligibility requires you to live in the United States, and the plans cover US providers. The rest applies to you identically.

Travel insurance is not residency insurance. It is priced for a trip with a return date, and consulates read it that way.

Your visa already requires you to solve this

The consulate makes you close the gap before you leave. A long-stay visitor visa file has to show your resources, your accommodation, medical cover in France, and a formal undertaking not to work. The certificate is checked in the file, so the policy must exist before your appointment.

Buy cover for the full authorized stay, not the first weeks. Hospitalization and medical repatriation are the lines consular staff check.

Once you arrive, you have three months to validate your VLS-TS (the long-stay visa that doubles as a residence permit) on the ANEF portal. Miss it and your stay stops being regular, which blocks the health insurance application. France Navigator puts the visa file, the insurance certificate and the arrival deadlines on one timeline.

Months 1 to 3: private insurance is the bridge

French public cover is based on residence, and residence has to be established before it counts. Until then you pay for your own care.

A bridge policy should cover hospitalization, medical repatriation and any chronic condition you have.

Leave the end date open, or cheap to extend. Three months is the earliest your French rights can open, not the day they do.

Month 3 onward: joining the French system

France's public cover runs on PUMa (protection universelle maladie), which sets two conditions. Your stay has to be regular, which for an American means a valid residence document. Your residence has to be stable: with no professional activity, you wait three months in France before your rights open, and stay open as long as you live there at least six months a year.

You apply by sending form S1106, the application to open health insurance rights, to your local CPAM (the health insurance office covering your department) with the listed documents. Expect a provisional social security number first, a permanent one later, then the carte Vitale (the card that lets doctors and pharmacies bill Assurance Maladie directly).

An incomplete file stretches the wait, and no official page promises a date. Until your rights are confirmed, pay in full, keep every feuille de soins (care statement) and receipt, then claim.

One more step changes your money: declare a medecin traitant, your registered primary doctor. It is a one-page form signed in the doctor's office, and it restores the normal reimbursement rate, 70 percent of the official tariff instead of the reduced one.

Get help signing up for CPAM.

What the French system actually pays, and what it does not

French reimbursement is a percentage of an official tariff, not of your bill. Take a sector 1 GP consultation, priced at 30 euros, roughly 34 dollars at mid-2026 rates. With a declared medecin traitant, Assurance Maladie pays 70 percent of the tariff and deducts a 2 euro flat participation, so 19 euros comes back and 11 euros stays with you. Without one, the same visit returns 8.40 euros.

Hospital stays add a daily charge Assurance Maladie does not reimburse: the forfait hospitalier, 23 euros a day in hospital or clinic and 17 euros a day in a psychiatric ward since 1 March 2026. A short list of situations exempts you from it, maternity from the fourth month and a work accident among them, but none of them describes a newly arrived retiree.

Then there are depassements d'honoraires, the fees sector 2 specialists charge above the tariff. The system reimburses on the tariff. The excess is yours.

What is left on each act is the ticket moderateur, which is why the next section exists. Worth watching: the social security financing law of 30 December 2025 creates a financial participation for PUMa members who meet three conditions at once, stable and regular residence in France, no professional activity, and no liability for CSG, CRDS and health insurance contributions under an international agreement. The amount waits on a decree that service-public.fr still listed as unpublished on 29 July 2026.

The mutuelle fills the rest

A mutuelle, or complementaire sante, is private top-up insurance that pays what Assurance Maladie does not: the ticket moderateur, the daily hospital charge, dental and optical work, and some or all of a specialist's excess fees.

Buy it once your CPAM rights are confirmed. It sits on top of public cover and does little alone.

Do not cancel your private expat policy the day you post the S1106. Cancel it when CPAM confirms in writing that your rights are open. The overlap costs one premium. The gap can cost a hospital stay.

Your timeline

About 90 days out: buy private cover for the full visa period and file the certificate with your application.

• Arrival week: settle your address, then validate the VLS-TS online within three months.

• Month 3: send form S1106 to your CPAM with proof of three months' residence.

• After confirmation: declare a médecin traitant, add a mutuelle, then cancel the private policy.

Before you go

Coverage arrives in three stages, and the calendar is what you control. The expensive mistake is not landing underinsured. It is cancelling private cover the week you file with CPAM, months before your rights open. Book the bridge policy first, then work back from your consular appointment. France Navigator maps those dates against your departure.

Maxime Roseau is a relocation adviser at EasyFranceNow, which guides Americans through moving to France and the paperwork that follows.