My First Trip to the ER in France

Last month, I went on a four-hour hike through the snow in Chambéry, France. I put on my oversized jacket, layered up in every way, and put on my best wool socks. Equipped with a pair of leather, wool-lined boots, I thought this was going to be a walk in the park (or the woods). What I didn’t account for was the snow melting as soon as it touched my boots and my feet sitting wet for hours in the cold. The next night I discovered a small open wound had appeared by my toenail. By the next morning it was undoubtedly infected.

Instead of immediately booking a doctor’s appointment, as I had just seen my doctor the day before the hike, I thought it would be fine if I tried to treat the wound myself. Given the title of this article, you can probably guess that wasn’t the best idea.

By day two I was miserable, by the end of the week, I was in severe pain. No number of Manuka honey presses, green clay masks, red-light sessions, or bleach baths was healing me. So by the time I finally came to my senses on Sunday night, I realized my only option was to go to the hospital to get immediate care, only four days before my international flight to go home for the holidays.

My French friends (pretty much family), advised I go early, so I arrived at the ER in my town at about 8:20am on Monday morning. There were 4 people waiting to be seen ahead of me. I approached the window to address the intake nurse. When she called me forward, I explained my injury. She took my carte vitale and told me she would return it after I was seen to complete payment. The carte vitale is the social healthcare card in France. It tracks healthcare visits and prescription fills, facilitating reimbursement when eligible. As a language assistant for the French public school system, I was provided one, first digitally, and eventually in card form once all my paperwork was processed. After I answered a handful of questions, I took a seat in a waiting chair.

I was called back after about 15 minutes, this time met by a male nurse and a female assistant. Both looked relieved when they realized that I spoke French. I explained my situation and when I showed them my foot, they were immediately compassionate. They gave me a wristband to be processed as a patient and told me the doctor would call me back shortly. I returned to the waiting room for about 30 minutes. Soon enough, I was called into another room. There, a friendly young doctor of about my age explained that she would be doing an immediate procedure to remove as much of the infection as possible and to cut back the side of my ingrown toenail.

I should probably preface this by saying that not only was this my first trip to the ER in France, but it was my first trip to the ER — ever. I took a deep breath and lay back on the operating table. We started with just local anesthesia, but the pain of the infection was quite intense, so another nurse was called in to give me laughing gas. Soon enough the procedure was over and I was able to sit up to receive my care instructions.

I received my paperwork documenting the procedure and prescriptions to fill at the pharmacy. The doctor spoke slowly and I asked for clarification for the one word that was outside of my vocabulary. Limping back to the intake nurse to see what the damage was, she asked if I had a mutuelle, an additional private healthcare insurance to complement the social system. I replied no. She looked disappointed by the news, so I braced myself for the worst. Then she said, “That’ll be 19.98 euros,” the equivalent of about twenty dollars. Cue my sigh of relief.

My prescriptions at the pharmacy came to another 30 euros, making my total expenditure about 50 euros. As an American, these numbers were simply astounding. I have never been so grateful for the French healthcare system.

I won’t fool you and say it was all blue skies and rainbows from there. The following days, the pain returned and I was put on an antibiotic that contained pork and gluten — both of which I am allergic to. Passing through Paris with my suitcase and post-op foot was also not the most fun I’ve ever had. By the time I made it back to the States, I visited a doctor and received another antibiotic for $150. I guess that’s the difference between French and American healthcare, about 200%.

My toe is fully on the mend and you can bet I’m watching my nails for any signs of ingrowth like a hawk. What a memory made! Though I’d be glad to have missed out on this experience altogether, I’m quite proud to have proven my French proficiency equal to the occasion. Have you ever gone to the ER or sought healthcare while in France? We’d love to hear about your experience. Cheers to firsts (and hopefully lasts)!

Photo taken by yours truly on the hike that started it all. Was the view worth it?

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doctor and nurse figurines in front of another on a hospital bed

How Healthcare for Expats in France Really Works

Posted by Molli Sébrier

We often get asked questions about healthcare for expats in France. This is especially true for our older audience — retirees hoping to move abroad, folks over 50 who decide to make a life for themselves in Paris or elsewhere — they want to make sure they’ll have coverage.

It’s no surprise that Americans are concerned about this as our healthcare system is one of the most complicated, expensive, and challenging ones in the world (I said what I said). For many, healthcare is one of the biggest unknowns when moving to France.

The good news is that France consistently ranks among the best in the world for quality and accessibility of care. I have had nothing but good experiences with healthcare in France (okay, maybe I’ll admit the one dentist I saw wasn’t the best), and I found it easy to navigate once I got the hang of it.

We’ve already written about our experiences with osteopaths and chiropractors, how to get a numéro provisoire to get your carte vitale and sign up for a mutuelle, and the differences between the CSS and top-up insurance, but I wanted to create a deep dive to hopefully help quell some of your worries.

While the system may seem intimidating at first, healthcare for expats in France is surprisingly affordable and reliable once you understand how it works.

The Basics of French Healthcare

France operates on a universal healthcare system called the PUMA (Protection Universelle Maladie). This means that every legal resident — yes, including legal expats — is entitled to coverage. When you go to the doctor or a hospital, the state pays a percentage of your medical costs and you’re responsible for the rest.

The golden ticket to benefiting from this system is the carte vitale. This small green health insurance card is tied to your French social security number, and when you hand it over at the end of appointments or at pharmacies your reimbursement is processed automatically.

Once you arrive, securing this card is one of the first big steps toward fully integrating into life in France.

Who’s Eligible and When

Generally anyone with legal residence in France can access the system. Non-EU expats (like Americans) typically have to wait three months after their arrival before they can apply.

Students, salaried workers, and retirees each have slightly different processes:

Students are often enrolled through their university (this is how I first obtained mine way back when!).
Employees are usually registered by their employer.
Self-employed expats and folks on the visitor visa (including retirees) need to apply directly through their local CPAM (Caisse Primaire d’Assurance Maladie). We have a full article on this process!

While you wait for approval, we typically suggest you stick to the private health insurance you were required to have for your visa application. Cigna Global has great options for expats, as does AXA.

What’s Covered and What Isn’t

One of the best surprises about healthcare for expats in France in my opinion is just how much is included. Doctor’s visits, specialist appointments, hospital stays, prescriptions, and maternity care all fall under the state system. Most GP visits cost around 25 €, and the government reimburses about 70% of that (color me surprised at my first appointment when I only owed 7.50 €!). Hospital stays are reimbursed at 80%, and chronic conditions are covered 100%.

The biggest gap is in dental care, eye care (including glasses and contact lenses), and certain specialists. I personally found the cost to be nominal coming from the US, but after some encouragement from my mother-in-law, who was choquée that I didn’t have top-up insurance to cover it, I did end up signing up for a mutuelle to help cover the costs (more on that later).

One thing to note if you’re still waiting on your carte vitale — save your receipts. You’ll be required to pay up front, but as soon as you receive your card, you can submit your feuilles de soins for reimbursement later. And yes, I can confirm they actually do reimburse you.

The Role of the Mutuelle

A mutuelle is France’s version of supplemental private insurance, or “top-up” insurance. You can think of it as the add-on that fills any gaps left by the state. A typical mutuelle covers the remaining 30% of GP visits, plus higher percentages of dental and eye care.

Don’t let the word “private” fool you, it’s still very affordable especially coming from the US. You can expect to pay anywhere from 30 € to 100 € per month, depending on the coverage you choose. I wear glasses and contact lenses so I decided to get a plan somewhere in the middle and paid around 45 € per month. Most, if not all, of my appointments were covered and my glasses and lenses were very inexpensive.

For any of our salarié readers, if you’re employed in France your company is legally required to provide a mutuelle, and it’s usually one with very good coverage. Freelancers, students, visitors, and retirees need to shop around for themselves. I like Harmonie Mutuelle myself.

Tips for Using the System

Once you’re set up with your carte vitale and mutuelle (if you choose), daily life within the French healthcare system is very straightforward:

Finding a doctor: USE DOCTOLIB. It’s the easiest way for expats to find a doctor, especially if you haven’t made French friends yet who can recommend one. You can even set filters for providers who speak English. If you’re in the Paris area, I loved my team at Ipso.
Appointments: Remember to bring your carte vitale so you are reimbursed automatically. Otherwise, save your receipts to submit later.
Pharmacies: You’ll also need your carte vitale to pick up prescriptions. Another thing to mention: don’t be afraid to ask your pharmacist for advice on medications. I’ve found that they are incredibly helpful and knowledgeable and they served as an invaluable resource for me.
Emergencies: Don’t call 911 and expect to receive help. Instead, dial 15 for the SAMU (medical emergency line that can connect you to ambulances).

The one caveat about the French healthcare system that I feel called to share is that not all French doctors are well-trained in bedside manner. I do believe this is changing as more time goes on, but like many things, don’t expect to receive the same exact experience as you would in the US.

The care is just as good, don’t get me wrong, but you likely won’t be coddled in the same way you would in America. Honestly, this is good advice to heed when it comes to adjusting to life in France as a whole (just saying).

Healthcare for expats in France may seem intimidating at first glance, but once you take care of the necessary paperwork, it will quickly become one of the more reassuring aspects of life there. With universal coverage, reasonable costs, and a mutuelle to handle all of the extras, feel confident that if something happens, you’ll be well cared for.

Photo by Annie Spratt on Unsplash

How to Get a Mutuelle in France

Posted by Molli Sébrier

When I first decided to start my life in France after years of being an au pair and a student, I started to hear talk of something called a mutuelle. I had already been enjoying the benefits of seriously discounted health care for years at this point, and I often relished the fact that my monthly prescriptions were only a few euros instead of upwards of $40 per month back in the states.

You may be thinking, “Huh? But I thought going to the doctor was free in France and so was all medicine.” Health care is much, much less expensive here than in the United States, but as they say, nothing in life is free.

Why You Should Get a Mutuelle in France

If you’re a permanent resident of France, you’re eligible to receive government-provided health insurance within the first three months of being here. It works like a co-payment system, and much of your medical costs are reimbursed up front by the standard, public health insurance. For example, if you go to the doctor and you’re uninsured, you’ll pay around 25 € (still a steal, if you ask me). If you sign up for public health insurance, you’ll pay around seven euros. If you get a mutuelle (some call it “top-up” coverage in English) in France, you’ll pay nothing.

Having that extra coverage ensures that you don’t pay anything at the doctor’s office and most prescriptions are covered too. If you have to stay overnight at the hospital, depending on the plan that you choose, you won’t have to pay for that either.

If you wear glasses or contacts or enjoy having clean teeth, you’ll want to sign up for one as well. I wear both glasses and contacts (and like keeping my pearly whites, well, white) and so my mutuelle is a lifesaver. I went from paying hundreds of dollars every year for my eyes to paying nothing.

I haven’t even begun to mention all of the other perks you could be enjoying if you sign up for your own mutuelle. Specialists such as dermatologists, chiropractors, and osteopaths are also covered (again, depending on your plan). Furthermore, you can sign up no matter your medical history and without fear that a preexisting condition will make the monthly free skyrocket. Oh, and if you’re pregnant or plan to be, a mutuelle is also really helpful.

Shout out to my French mother-in-law for pushing me to finally sign up. I think for me, seven euros to go to the doctor just seemed so sweet that I couldn’t imagine paying even less. My American mentality prevented me from signing up for a mutuelle for several years when in reality I could have started benefitting from one all the way back in 2012.

How to Know Which Plan to Choose

Not all mutuelles are created equal, but neither are everyone’s health care needs. Stephen, for example, almost never goes to the doctor, so a mutuelle for him would be a waste of money. Furthermore, if you don’t have terrible eyesight as I do, you don’t need a plan that will help you save on glasses and contacts.

When you begin shopping around for a plan, you’ll notice that coverage is determined in percentages. I recommend opting for coverage that is over 100%. Start with at least 150%. And if you have problems with your teeth or need to visit the eye doctor, consider going up to 175-200% coverage. I know that asking for over 100% coverage may sound a bit much, but some doctors charge more than the standard fee set out by the government. You’re going to want that extra coverage just in case you find yourself at a specialist (like the dentist, ophthalmologist, or chiropractor) that naturally charges more than your primary care physician.

You’ll be charged a monthly fee in order to benefit from your mutuelle. The cost is nominal, especially when compared to the ever-climbing costs of private health insurance in the US. For example, my mutuelle is one step above the “basic” plan, and I pay around 30 € per month. There are several different providers to choose from:

Harmonie (my preference!)
Allianz
APRIL
Axa

Once you sign up, you’ll receive your mutuelle card. It’s not a plasticized card like your carte vitale (the card you use to benefit from the standard public health care), but rather a small piece of paper you’ll have to be careful not to lose.

My advice? Take your time when comparing plans, ask your French friends for advice, and don’t get too hung up on finding “expat” specific plans. If you are a resident of France, you have all of the rights of a French person. These so-called expat-specific plans tend to be much more expensive for no real reason that I can see. And, if you don’t earn a lot of money, you could be eligible for a state-run mutuelle program called the CSS, so, if you can, don’t forget to look into that option, either.

There are plenty of mutuelle comparison sites that can help you decide as well. This one by Le Comparateur Assurance (The Insurance Comparer — a great resource for comparing any type of insurance in France) is my favorite. However, I will say this again, your French friends will be your best asset here. They’ve had this type of insurance their whole lives and are the best place to start for some advice!

Photo by National Cancer Institute on Unsplash

Molli offers private consultation services which range from help with visas and adjusting to life abroad to Paris travel itineraries. Fill out the contact form to learn more.

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Osteo & Chiro in France

Posted by Stephen Heiner

“We’re not covered by the French insurance system.”

I was only slightly surprised when my osteopath said this to me at the end of our visit. As someone who has spent most of his life outside of a single-payer healthcare system, and has confessed that he only goes to the doctor occasionally, I expect to always pay a little something when I have medical needs in France.

Part of my lower spine had been troubling me for several weeks and my exercise regimen wasn’t helping it to heal — but stopping exercise, even for just a couple weeks, was not an option I was willing to consider. In a past life, upon feeling this way, I would have immediately gone to my chiropractor in the US. Those visits were covered by my US insurance at the time. But I never had insurance in a post-Obamacare America. I left the US in 2013, before the changes to the insurance system began, and as such, have no idea whether chiropractic care is still covered in the way it might have been back then. But whatever might be the policies of the US insurance companies, it seemed that chiropractors really didn’t have a presence in France in general, and in Paris in particular, and so I made an appointment with “the next best thing,” an osteopath.

What’s the Difference?

The osteopath who saw me took a few minutes to quickly parse the two disciplines. “It’s a vast oversimplification, but you might say that chiros are more exclusively spinally focused, whereas in addition to the spine we are concerned with respiratory and digestive issues. We also won’t see our patients as frequently.” She went on to tell me that the founder of chiropractic was actually a student of the founder of osteopathy for a short 6 weeks. However divergent their paths are now, both disciplines are a reaction to “traditional” treatments of the time in which they were invented, at the end of the 1800s.

In the end, because of my travel schedule last month, I double-dipped. The osteopath I saw in Paris made some helpful adjustments just 2 days before a trip I made stateside, and while I was in America I had 4 adjustments over a 2 week period with a chiropractor, including some time on a traction table. On all these visits on both sides of the Atlantic I paid cash (70 € for my French visit, and $50 USD for each of my American visits), as I have no US insurance, and as I said, French insurance does not cover osteopathy. But, some mutuelle plans do. Would I finally be motivated to get one of those “top-up” plans that the French are so attached to? Not yet. But seeing both the osteo and chiro helped tremendously, and my back feels a lot better now. I also managed to learn more about a field I didn’t know about and what the French system will pay for. So, the pain was worth it, if only to remind me to be grateful that I live in a country in which I can easily see a doctor when I have a problem, and not pay an exorbitant amount to do so.

TAIP is 100% reader-supported through tipping. If you want to leave us a tip of any amount it would be highly appreciated. These tips help support our efforts to keep TAIP an ad-free environment. Just as at a cafe, the tips are split evenly among the team.

Getting My French Carte Vitale and Going to the Doctor…Finally

Posted by Stephen Heiner

It felt futile. I knew the French didn’t operate this way, but I was feeling worn out and was reverting to American habits. I was writing, in French, on a post-it note, the following message:

“I am very happy to send another yet another check to cover my health insurance charges, but I still have not received my Carte Vitale.”

I knew as I sealed the envelope that some French functionary processing my cheque would see this note, laugh scornfully, then peel it off and place it delicately into the circular file.

So you can imagine my surprise when, one week later, I received a letter in the mail letting me know the only thing missing to process my Carte Vitale was a photo and my signature, after I had verified some information they had on me. It is one of those times I was quite happy to be wrong.

This was the only part of my paperwork processing that had gone sideways as I left visitor status and transitioned into my profession libérale life. But, since I’m not a frequenter of doctors anyway, it simply remained a slight irritation. When four months had passed without any sign of my Carte Vitale, I made a copy of my translated birth certificate, as well as a copy of the original, and sent it to RSI with a pleasant cover letter. No reply. Another four months passed. That’s when the wry (but polite) post-it note was written, which just goes to show you that every now and then an unexpected tactic might just work.

* * *

The visit to the doctor felt like an interstitial in an Inspector Clousseau skit. I had crowdsourced a good doctor from my Paris network, one who had a decent command of English, though I made the appointment in French. I made the mistake of not asking how to find the place (surely an address is good enough?) and when I walked into the vestibule of the apartment building that was the address for my doctor, I searched in vain for signage that would indicate my desired destination.

Not quite willing to admit defeat yet, I decided to climb the stairs (surely the doors will be marked?). But by the time I reached the 3rd floor (American 4th) I realized that this was a fool’s way to figure things out.

Humbled, I turned around and went all the way back down the stairs. Thankfully, on the ground floor, a resident was having her door locksmithed and I asked if she knew where the “medecin” was (on a side note, “doctor” is one of those words in French that doesn’t change ending whether you put a “le” or “la” in front of it). She responded insouciantly (as if she gets this all the time) that “all the doctors are on the fifth floor.”

Bingo.

I took the elevator up to the fifth floor, found her office, and checked in, roughly ten minutes after my original appointment time. Ten minutes after that, I heard a gentle, “Monsieur Heiner, S.V.P” from the hallway and went in.

Her room was cheery and welcoming and full of books. I felt like I was in a comfy study, not a doctor’s office. She took out a clean sheet of paper, wrote my name down at the top, drew a straight and clean black line under it, then looked up at me, smiled, and asked how she could help me.

“Puis-je parle avec vous en anglais?” I queried. She smiled down her glasses at me. “Yes, of course.” “I just don’t have the vocabulary to speak well about my health in French.” She nodded.

Ten minutes later she was asking for my Carte Vitale and 40 €. The carte goes into a card reader just like a chip-and-pin card, but with no pin. “Cash or cheque?” she asked. “Oh, you don’t take bank card?” “Non,” she gave the slightest of pouts and shook her head. “Is this the case for all medical appointments?” I asked. “Non, it is a choice,” she said. I had just enough cash on me: “You cleaned me out,” I laughed.

On the way out she handed me a form which designated her as my “medecin traitant” which in American parlance is “primary care physician.” Getting this form to La Ram/RSI would make sure I got properly reimbursed.

I was off to the lab after that for some testing and I thought I had understood her directions about how to get there (it was in the same structure, just down a different hallway) and seven minutes and a few dead ends later I was in front of the receptionist at the lab. Twenty minutes and roughly ten glasses of water later, I was prepared for my lab work. When it came time to draw my blood, the nurse gazed at all the vials which had been set aside for me (around 11) and asked if there was a reason I needed all the tests. I responded in French that I hadn’t been to a general doctor for 2-3 years and I figured why not check on everything? We both laughed.

I went back to the waiting room and five minutes later the receptionist called me. A swipe of my Carte Vitale and 80€ on my bank card later, and I was done. I went home, dropped the form for my new “medecin traitant” in the mail, and went back to my day.

Two weeks later, to the day, an envelope arrived in my mailbox. I had completely forgotten that I had some money coming back. There was a check for 15 € against the 40 € I had paid for the visit, as if even 40 € was “too much” (as an aside here I’ve mentioned in the past that you can acquire a “mutuelle” policy that tops up even this copay so you are 100% reimbursed all the time, but I don’t go to the doctor enough to add that extra cost to my budget).

My first encounter with the French medical system: easy, painless, friendly, efficient, and inexpensive. Against the roughly 700 € a year I pay to cover my national health insurance, not too bad.