Healthcare
France — Healthcare: Public Healthcare
Anyone stably and regularly residing in France for at least 3 months is entitled to public health insurance under PUMA (Protection Universelle Maladie), which replaced CMU in 2016. Registration is with the local CPAM (Caisse Primaire d'Assurance Maladie); the full process — from application to receiving a Carte Vitale — typically takes 3-9 months on top of the 3-month residency wait, so budget up to a year total from arrival. PUMA reimburses only around 70% of the base healthcare rate, leaving a gap typically covered by a mutuelle (see [[private-insurance]]). A significant 2026 change: holders of a long-stay visitor visa (VLS-TS visiteur — the common route for retirees, rentiers, and digital nomads) must now pay a mandatory annual healthcare contribution (estimated €300-€600) before accessing PUMA, under the 2026 Social Security Financing Law (LOI n° 2025-1403).
Key facts
- Eligibility: stable, regular residency in France for at least 3 months, regardless of nationality.
- Registration is with the local CPAM; total time to receive a Carte Vitale can be up to a year from arrival (3-month residency wait + 3-9 month processing).
- PUMA reimburses ~70% of the base rate for most care — a mutuelle is needed to cover the remainder.
- 2026 change: VLS-TS visiteur (long-stay visitor visa) holders must pay a new mandatory annual healthcare contribution (~€300-€600) before accessing PUMA, under LOI n° 2025-1403.
Steps
- Establish 3 months of stable, regular residency — Required before PUMA eligibility begins.
- Register with your local CPAM — Via ameli.fr or in person; submit required documents.
- If on a VLS-TS visiteur visa, pay the new annual contribution — Mandatory since the 2026 Social Security Financing Law, estimated €300-€600/year.
- Receive your Carte Vitale — Full enrolment can take 3-9 months after CPAM registration.
Costs
- VLS-TS visiteur annual healthcare contribution (2026+): estimated €300-€600/year
Timelines
- Residency wait before PUMA eligibility: 3 months
- CPAM registration to Carte Vitale: 3-9 months
Required documents
- Passport/ID
- Proof of stable residency (3+ months)
- Birth certificate (for some cases)
Common mistakes
- Not budgeting for the full ~1 year timeline from arrival to receiving a Carte Vitale.
- VLS-TS visiteur holders overlooking the new 2026 mandatory annual healthcare contribution before PUMA access is granted.