Carte Vitale and PUMa: how Americans in France get into the public health system

If you live in France legally and stably, you can join the public health system, though people who don't work there usually wait three months first.

The short version

• PUMa (protection universelle maladie) covers anyone who lives or works in France in a stable and regular way. Workers are covered as soon as their file is accepted; people who don't work qualify after three months in France [1].
• Apply to your CPAM (the local health insurance office) with form S1106a, "Demander l'ouverture des droits à l'Assurance maladie" (Cerfa 15763*02) [2].
• The carte Vitale is free. Once you're registered, order it through your ameli account and expect about two weeks [3].
• The carte Vitale app has been live nationwide since November 2025, but keep the plastic card on you [3].
• Public insurance doesn't cover everything. A GP visit at EUR 30 is reimbursed at 70% minus a EUR 2 charge if you've declared a médecin traitant [5]. A mutuelle covers much of the rest.

USD conversions use the Federal Reserve H.10 rate of October 30, 2026 (EUR 1 = USD 1.1163).

How French health coverage works

Coming from the States, the French system feels upside down. There's no network, no deductible to hit and no surprise bill from an out-of-network anesthesiologist. Instead there are three layers:

The public system pays a percentage of an official rate (the tarif de convention). Doctors in secteur 1 charge that rate. Doctors in secteur 2 can charge more, and the extra (dépassement d'honoraires) is on you or your mutuelle [5]. In central Paris, many specialists are secteur 2, so ask before you book.

Who qualifies for PUMa

You need both of these [1]:

1. Regular residence: for Americans, a valid residence permit or equivalent document, such as a validated VLS-TS.
2. Stable residence: - If you work in France, you're affiliated right away once your application is accepted. - If you don't work (retirees, spouses, people on a visitor visa), your rights open after three months in France, and you keep them as long as you live in France at least six months a year.

Adults get their own coverage and don't need to be attached to a spouse. Kids are covered as dependants of a parent, can ask for their own coverage from 16, and stop being dependants in the year they turn 18 [1].

A heads-up for visitor visa holders

The visitor visa requires private health insurance for your first year, and the three-month wait is the reason. Don't cancel that policy the day you hit three months: CPAM processing can take a while, and you want overlap.

There's also a new wrinkle. The 2026 social security financing law creates a contribution for some PUMa members who live in France, don't work and don't owe French social charges on their income under an international agreement. The amount is set by a decree that hadn't been published when Service-Public last updated its page [1]. Retirees living on US pensions should keep an eye on this one. The older cotisation subsidiaire maladie (CSM) on investment income can also apply to people with little work income. A US expat tax preparer can check your situation.

Not signing up isn't really an option either: deliberately refusing to join can be punished with up to six months in prison and a fine of up to EUR 15,000 (about USD 16,745) [1]. In practice, that's aimed at people who dodge the system on purpose.

Applying to the CPAM in Paris

Paris has one CPAM for the city (the CPAM de Paris). Here's the routine:

1. Wait until you qualify. Employees can apply right away; others after three months.
2. Fill in form S1106a (Cerfa 15763*02), "Demander l'ouverture des droits à l'Assurance maladie" [2].
3. Gather your documents: ID, your residence permit or validated visa, proof of address in Paris, proof of when you arrived (if you don't work), your bank details (a French RIB) and a birth certificate. The CPAM will tell you which supporting documents it wants for your case; foreign documents usually need a French translation.
4. Send it to the CPAM de Paris by mail or through your account once you have one [2].
5. Get your social security number. You may first get a provisional number. Your permanent one (the NIR) comes once your identity is checked.
6. Create your ameli account on ameli.fr with that number. It's where you'll download certificates, track reimbursements and order your card.

Expect to wait weeks, sometimes months. Keep copies of everything and note the date you sent it.

The carte Vitale and the app

The carte Vitale is a free, chip-based green card that identifies you to the health system [3]. Show it at the doctor's office or pharmacy and the paperwork goes straight to the CPAM. You're usually reimbursed within a week, with nothing to mail [3].

Ordering the card

• Online: through your ameli account or the ameli app, in about two weeks [3].
• By mail: about three weeks [3].
• Cost: free. Only repeated replacements cost money: EUR 5 (about USD 5.60) from the fourth physical card in a calendar year [3].

The carte Vitale app

Since November 2025, the app version of the card has been rolled out nationwide, on the App Store and Google Play [3]. To use it, you need an ameli account, you must be over 16, and your health fund has to be in a department where the app is active [3].

You can activate it two ways [3]:

• With France Identité, if you hold the electronic French ID card. That's not an option for most Americans.
• By video, with your social security number and ID. You film your document and your face.

Not every doctor and pharmacy can read the app yet, so Service-Public recommends always carrying the physical card [3].

Picking a médecin traitant

This part matters for your wallet. Declare a médecin traitant (primary care doctor) and you're inside the parcours de soins coordonnés, the coordinated care pathway [4]. Skip it and you're reimbursed less.

Service-Public last checked those fee figures in December 2024, so confirm the current rate with your doctor. Some other things to know [4][5]:

• The doctor has to agree to be your médecin traitant. In Paris, finding one taking new patients can take some hunting.
• The doctor declares it online with your carte Vitale. No form needed.
• You can change any time by declaring a new one.
• Direct access is fine for gynecologists, ophthalmologists, and psychiatrists for people aged 16 to 25, which are still reimbursed normally.

Those small fixed charges add up. On October 1, 2026, the yearly caps on the EUR 2 participation forfaitaire and on the EUR 1 per box franchise for medicine each rose from EUR 50 to EUR 70 (about USD 78), so the combined maximum is EUR 140 a year [7].

Choosing a mutuelle

The mutuelle fills the gap between what the public system pays and what you're billed. It's what pays for most of the 30% on a GP visit, part of the secteur 2 fees, and much of your glasses and dental work.

• Employees: your employer must offer a group plan and pay at least half [6]. Usually you're automatically enrolled.
• Everyone else: you buy your own. Compare plans by what they pay above the official rate (often shown as 100%, 150%, 200% of the base rate), and by optical and dental coverage.
• Low income? The complémentaire santé solidaire (C2S) is free or low-cost coverage based on income. Service-Public has a simulator [8].

Get your carte Vitale first. Many mutuelles link to it so reimbursements flow automatically.

What about Medicare?

Medicare generally doesn't pay for care outside the US. If you're 65 or close to it, look at the Part B late-enrollment penalty before you drop it. Also note the US–France totalization agreement covers social security contributions, not health care: workers exempted from French contributions under it don't get French health benefits [9].

Doctor recommendations, especially English-speaking GPs taking new patients, are some of the most traded tips in our community group for Americans in France.

Sources

1. Service-Public: protection universelle maladie (PUMa) (in French)
2. Service-Public: Demander l'ouverture des droits à l'Assurance maladie, form S1106a (in French)
3. Service-Public: carte Vitale (in French)
4. Service-Public: médecin traitant and the parcours de soins coordonnés (in French)
5. Service-Public: doctors' fees, conventionné or not (in French)
6. Service-Public: company health plans (mutuelle santé) (in French)
7. Service-Public: annual caps on medical deductibles rise on October 1, 2026 (in French)
8. Service-Public: complémentaire santé solidaire (in French)
9. SSA: Totalization agreement with France

Keep reading

• Healthcare in Paris
• Titre de séjour and the OFII for Americans in France
• Banking in France as an American
• Medicare when you live abroad