France has one of the better-funded public health systems in the world, but navigating it as a newcomer takes time. The paperwork is real, the terminology is specific, and the way care is structured is different from most other countries. This guide covers the practical steps.

The two layers you need to know

French healthcare runs on two levels.

The first is Sécurité Sociale (often called “la sécu”) — the state health insurance system. It reimburses a portion of most medical costs. Not all of them. Typically 70% of a GP visit, 80% of hospital stays, 65% of most prescriptions.

The second is a mutuelle — a private top-up insurance that covers most or all of what the state doesn’t. Most people who live in France have both. Without a mutuelle, you pay the remaining 30% yourself. Dental and optical care in particular are poorly covered by the state alone.

If you’re employed in France, your employer is legally required to contribute to a mutuelle for you. If you’re self-employed or retired, you buy one independently. Prices vary considerably — compare a few providers before choosing.

Getting into the system: CPAM and Ameli

To access state healthcare, you register with your local CPAM (Caisse Primaire d’Assurance Maladie). Your CPAM is determined by where you live. In the Alpes-Maritimes (Nice, Cannes, Antibes, etc.), it’s the CPAM 06.

Registration happens through Ameli (ameli.fr), the online platform. You’ll create an account and upload supporting documents: proof of identity, proof of address, and proof of legal residence in France (titre de séjour or, for EU nationals, proof of registration). Once approved, you’ll receive your numéro de sécurité sociale — a 13-digit number that becomes your medical ID for life.

Processing takes time. Several weeks is normal; a few months isn’t unusual. In the meantime, keep any receipts for medical expenses — you can claim reimbursement retroactively once you’re registered.

The Carte Vitale

Once your Sécurité Sociale number is confirmed, you apply for a Carte Vitale — a green card with a chip that stores your entitlements. You present it at every medical appointment and pharmacy. It allows the provider to bill the state directly, so reimbursements happen automatically rather than requiring you to submit claims manually.

The card takes a few weeks to arrive after your number is confirmed. Until it does, you can use a paper attestation from Ameli as a substitute.

Choosing a médecin traitant

France uses a gatekeeping system. For non-emergency care, you’re expected to have a médecin traitant (a registered GP). You declare this choice through your Ameli account, and from that point, your GP is the first point of contact for most things.

Seeing a specialist without a referral from your médecin traitant is allowed, but reimbursement rates are lower. The system is designed to route care through your GP first.

Finding a GP who is taking new patients, speaks English, and is in your area takes effort. The shortage of available doctors (what the French call “déserts médicaux”) affects parts of the Alpes-Maritimes, particularly inland areas. Nice and Cannes have better availability. Ask neighbours or other expats for recommendations before searching cold.

Secteur 1, 2 and 3: what the tiers mean

French doctors are classified into three sectors based on how they set their fees.

Secteur 1 doctors charge the standard rate set by the state (called the tarif conventionnel). Reimbursement is straightforward and predictable.

Secteur 2 doctors can charge above the standard rate, within limits. The extra (called dépassement d’honoraires) is only partially covered by your mutuelle, or not at all depending on your policy.

Secteur 3 doctors are not covered by Sécurité Sociale at all. You pay the full fee yourself.

When you’re choosing a doctor or specialist, it’s worth checking which sector they’re in, especially for anything that will involve multiple appointments.

Pharmacies

French pharmacies are well-stocked and pharmacists are trained to a high level. For minor ailments, going directly to a pharmacist is efficient. They can advise on over-the-counter options and, for some conditions, prescribe certain medications directly.

With a valid prescription, most medications are reimbursed at the pharmacy immediately once you present your Carte Vitale. You pay any non-reimbursed portion at the counter.

Emergencies and urgent care

For genuine emergencies, call 15 (SAMU, the medical emergency service) or 112 (the European emergency number). Both dispatch ambulances and can connect you to the right level of care. The SAMU dispatcher will assess the call and decide whether to send a doctor, an ambulance, or advise you to get yourself to hospital.

For urgent but non-life-threatening situations, SOS Médecins is a network of on-call doctors who do home visits. It operates evenings, weekends, and public holidays. You call them directly; the appointment is billed to your Carte Vitale. It’s a useful option that many newcomers don’t know about.

Hospital A&E (called urgences) is available without an appointment, but waiting times can be long for non-critical cases. If your situation isn’t genuinely urgent, SOS Médecins or a pharmacy visit is usually faster.

Dental and optical

Both are covered only partially by Sécurité Sociale. A standard dental check-up is partly reimbursed; anything more involved (crowns, implants, orthodontics) involves significant out-of-pocket costs unless your mutuelle specifically covers it.

Optical care is similar. Annual eye tests and basic glasses frames and lenses are reimbursed at low rates. If you wear glasses or contact lenses, check your mutuelle’s optical allowance carefully when choosing a policy.

Since 2019, a reform called the 100% Santé scheme has made certain dental, optical, and hearing products available with zero out-of-pocket cost if you choose items within the regulated range. It’s worth asking providers what falls under this scheme.

Arriving from the UK

UK nationals arriving in France after Brexit are not automatically enrolled in Sécurité Sociale. You need to register as described above. Until you receive your Sécurité Sociale number, a UK GHIC (Global Health Insurance Card) provides access to state healthcare at local rates in France, but it isn’t a substitute for full registration if you’re living there.

If you’re working in France, your employer registration triggers automatic enrolment. If you’re not working, registration is done through CPAM directly as a resident.

Getting help with the process

The registration paperwork, especially the initial CPAM application, is easier with help. Some mutuelle providers offer bilingual support. Several expat forums maintain up-to-date guides on current processing times and document requirements for the Alpes-Maritimes specifically.

A bilingual GP is the most useful person to have in your corner once you’re registered. They can explain the system as you go, refer you appropriately, and handle the paperwork on the clinical side.