Potential Changes to Medical Coverage in France

Changes to medical coverage for American retirees in France?

This weekend (Saturday, 8 November 2025) the French General Assembly voted in principle to impose a “minimal participation charge” (participation minimale) on US retirees residing in France under long-stay visas. What might this mean for you?

The current situation

French residents primarily contribute to the public health care system through the application of three combined social charges on income known as the CSG/CRDS/CASA. The total charge is applied at different rates. For those receiving their pensions, the current rates are 0%, 4.3%, 7.4% and 9.1%, depending on income level.

And some people are exempt. If your primary residence is not in France or you are covered under another nation’s health regime, you won’t pay or you will pay a reduced rate depending on the reciprocal arrangement the country (or NGO) where you employed has with France.

The US does have a social security agreement with France (see here). But the reciprocity of health care in that agreement is complicated, largely because of the US’s substandard health insurance systems. Nonetheless, the US-France income tax treaty essentially exempts US retiree income from both income taxes and social charges on that income when the US person is living full-time in France (income taxes are still owed in the US).

What this has meant in practice is that US tax residents in France who are receiving retirement income, whether social security benefits, pension income or retirement plan withdrawals, are not being charged for their participation in the French state health care scheme. So as a US retiree, your French health care costs have been limited to a very affordable, optional, top-up health care policy known as a mutuelle.

What will change?

It is too early to say exactly what sort of change will be enacted, or even if it will happen at all. At the moment, we only have a vote to propose a change with no details at all. But there are a few changes that could be proposed.

The French system could add a tax at the rates above to US social security benefits, to US pension benefits or to all three. It could instead use the CSM, a supplementary health contribution tax more commonly referred to as the PUMa taxe. This charge currently applies to anyone in France who reporting significant income from passive investments but is not paying the CSG/CRDS/CASA through retirement income or through active earnings. The General Assembly’s express mention of a “minimal” charge could suggest that this is a third option – maybe a reduced charge applied foreign retirees otherwise exempt from participation.

How would the change affect my finances?

If you are living in France on very limited income, any changes would be unlike to affect you. Health care participation is generally free for residents of limited means in France. If you have substantial income in retirement, you will likely see an increase in your tax bill in France. And this could become important to your financial plan going forward. It is worth noting, however, that the French charge is unlikely to exceed or even match the cost of medical care and long-term care for retirees in the US.