French healthcare from the UK: Sécu, carte Vitale & mutuelle (vs the NHS)
France isn’t the NHS: you often pay first and get reimbursed (~70%), and a top-up (mutuelle) covers the rest. Here’s how to register and how the system really works.
You’re moving to France from the UK and you’re used to the NHS — you want to understand how French healthcare works, how to register, and what a mutuelle is.
- France isn’t free-at-point-of-use like the NHS: you usually pay the doctor, then the Sécurité sociale reimburses a large share (70% of the official base rate).
- The often-quoted "3-month wait" for PUMa only applies if you arrive with NO job: start work (employed or self-employed) and you’re affiliated immediately through your employer’s declaration — no wait at all for most movers.
- A standard secteur 1 GP visit costs €30: the Sécu refunds €19 of that (70% minus a flat €2 charge that no mutuelle covers) — the remaining €9 "ticket modérateur" is what a mutuelle is actually for.
- Watch for "secteur 2" doctors: they can charge above the €30 base, but your reimbursement stays calculated on that base regardless — the extra is only covered if your mutuelle explicitly includes dépassements d’honoraires.
- Declaring a médecin traitant (your registered GP) keeps you in the parcours de soins and reimbursed at the best rate.
NHS vs Sécu: the culture shock
Coming from the UK, the biggest surprise isn’t quality — French healthcare is excellent — it’s the mechanics. There’s no single free-at-point-of-use NHS. Instead you usually pay the doctor, then the Sécurité sociale reimburses a large share (often around 70%), and a mutuelle tops up the rest. Once set up with a carte Vitale, much of this is automatic — but the “advance the money, get it back” logic catches newcomers off guard.
Registering: PUMa & the carte Vitale
You register through PUMa (protection universelle maladie). The often-repeated "3-month wait" is only half the story: it applies specifically to people who arrive with no professional activity at all. If you arrive with a job — employed or self-employed, which describes most people moving for work — your employer's declaration affiliates you almost immediately, no waiting period. Either way, you receive a social security number and a carte Vitale, the green card that automates reimbursements at the pharmacy and doctor. Keep proof of residence and your documents ready — the process rewards a complete file.
What a visit really costs — and gets back
Concretely: a standard secteur 1 GP consultation costs €30. The Sécu reimburses 70% of that base rate (€21), minus a flat €2 "participation forfaitaire" deducted from every reimbursement no matter what — so you actually get back €19. The remaining €9 (the ticket modérateur) is precisely what a mutuelle exists to cover; the €2 forfait never comes back, mutuelle or not. Bottom line, out of your pocket: €11 without a mutuelle, €2 with one.
Watch for secteur 2 doctors, common among specialists: they can charge above the €30 base (a dépassement d'honoraires) entirely at their discretion, but the Sécu's reimbursement stays pinned to the same €30 base regardless of what you actually paid. The gap is only covered if your mutuelle plan explicitly includes dépassement cover — worth checking the small print before you pick a specialist, not after the bill.
Why a mutuelle is (almost) essential
The Sécu rarely covers 100%. The remainder — the ticket modérateur, plus dental and optical where state cover is limited — is where a mutuelle (private top-up) comes in. Most residents have one, often through their employer (frequently part-funded). Compare cover for what you actually use before choosing — and specifically check its stance on dépassements d'honoraires if you expect to see secteur 2 specialists.
Médecin traitant & the parcours de soins
Declare a médecin traitant (your registered GP). Staying within this parcours de soins keeps you reimbursed at the best rate; going outside it (seeing specialists directly, in most cases) reduces reimbursement. It’s the French equivalent of being registered with a practice — but with a financial logic attached.
Your plan — a preview, not the full checklist
The principle: understand it’s pay-then-reimburse, register via PUMa for your carte Vitale, get a mutuelle, and declare a médecin traitant. The full, dated sequence — with the gap-bridging before you’re covered — is what Veia turns into your roadmap, with reminders.
FAQ
Is French healthcare free like the NHS?
No. You usually pay upfront and the Sécurité sociale reimburses a large share (often around 70%). The remainder is covered by a mutuelle (private top-up). The system is excellent, but the “pay then get reimbursed” logic surprises people from the UK.
How do I register?
Through PUMa (protection universelle maladie). If you arrive with a job (employed or self-employed), your employer’s declaration affiliates you almost immediately — the "3-month wait" people mention only applies if you arrive with no professional activity at all. Either way you get a social security number and a carte Vitale, which automates reimbursements.
Do I really need a mutuelle?
In practice, yes for most people: it covers the ticket modérateur (roughly €9 of a standard €30 GP visit) plus things like dental and optical where state cover is thin. Many employers provide one, often part-funded. Short visits before you’re registered may rely on a GHIC (the UK’s post-Brexit EHIC replacement, still valid in 2026) for necessary care.
What does a GP visit actually cost, and get reimbursed?
A standard secteur 1 consultation is €30. The Sécu reimburses 70% of that base (€21), minus a flat €2 "participation forfaitaire" that’s deducted from every reimbursement regardless of mutuelle — so you get back €19, leaving a €9 "ticket modérateur" for your mutuelle to cover, plus that non-refundable €2 — so €11 out of pocket without a mutuelle, €2 with one.
What’s the difference between secteur 1 and secteur 2 doctors?
Secteur 1 doctors charge exactly the conventionné (agreed) base rate — €30 for a GP. Secteur 2 doctors can charge more (dépassements d’honoraires) at their own discretion, but the Sécu reimbursement is still calculated on the same €30 base regardless of what you actually paid. The excess is only covered if your mutuelle plan explicitly includes dépassement cover — worth checking before you pick a specialist.