Americans Could Soon Be Charged For Healthcare Access in France

For years, Americans who made the move to France on long-stay visas have enjoyed one of the country’s best perks: access to its world-class healthcare system. But that may be about to change.

French MPs have now backed a new amendment that would make healthcare contributions mandatory for non-EU residents living in France on a long-stay “visitor” visa, a move aimed largely at American retirees.

The amendment, approved on Saturday as part of the draft 2026 social security budget, still needs to pass through the Senate before becoming law. If it’s finalized, it will mean that retirees living in France but not working there will have to pay a minimum annual fee to access public healthcare.

How Has Healthcare Access in France Changed for Americans?

Under the current system, non-EU residents who’ve lived in France for at least three months can apply for coverage through PUMA (Protection Universelle Maladie). Once approved, they gain access to the same public healthcare benefits as French citizens, often contributing little or nothing to the cost of these benefits.

Under the new amendment to the 2026 social security budget, foreigners living in France on a “visitor” visa, including many Americans, will soon be required to pay a mandatory healthcare charge.

The approved amendment will change that. It introduces a minimum annual fee for healthcare access, with the exact amount to be defined in a forthcoming decree. The measure still requires Senate approval before it becomes law, but with broad support in parliament, it’s likely to move forward.

Who Will Be Affected

If you’re a non-EU retiree living in France, including Americans, Canadians, Australians, and Brits who arrived after Brexit, this could affect you.

Currently, many retirees on long-stay visitor visas can join the public healthcare system after three months. The new plan would likely remove that immediate access and instead require payment before joining.

Those who work or run a business in France already pay social security contributions, so they’re unlikely to be impacted. However, retirees living solely on pensions or investment income might soon face additional costs to maintain coverage.

How Much Could It Cost?

The amendment doesn’t yet specify the amount of the annual healthcare charge. The government has stated that the amount will be specified in a future decree once the final law is approved.

For now, the change means that non-EU retirees on “visitor” visas will no longer have automatic, low-cost access to the French healthcare system after three months. Instead, they’ll need to pay a set fee to join, regardless of income.

While it’s too early to determine the exact amount, the shift marks a clear move toward requiring a financial contribution from anyone benefiting from France’s healthcare system.

Understanding the CSM Charge

Each November, some residents in France receive an unexpected bill from URSSAF, known as the Cotisation Subsidiaire Maladie (CSM). It’s separate from income tax and often comes as a surprise, especially to foreign retirees who thought their healthcare contributions were already covered.

The CSM is a type of social charge linked to healthcare funding. It’s not based on how often you visit the doctor or even whether you’re actively registered in the French healthcare system. Instead, it applies to those who live in France but aren’t paying into the system through regular employment.

In simple terms, if you’re not working and your main income comes from investments or property, you might find this charge on your doorstep once a year. Most people who work in France, run a business, or receive French or EU pensions are automatically exempt. The same applies to those claiming disability or unemployment benefits, as well as dependents of individuals in these groups.

To be liable for the charge, two conditions generally need to be met:

• You earn less than 20 percent of the annual social security ceiling from professional activity in France (for 2024, that’s under €9,273)
• You earn more than 50 percent of the same ceiling from global investment income or assets (over €23,184).

Investment income includes profits from property rentals, capital gains, shares, and non-professional business activity. It usually doesn’t cover pensions, as these are considered earned retirement income rather than returns from capital.

What It Means for American Retirees

This is where things get murky. Unlike retirees from EU countries or the UK, Americans don’t benefit from a reciprocal healthcare agreement with France. There’s no S1 form that allows the US government to reimburse healthcare costs abroad, because the US doesn’t have a state-funded healthcare system like Europe does.

That leaves American retirees in a somewhat ambiguous position. Some individuals may technically meet the criteria to pay the CSM, especially if they rely on income from investments or rental properties rather than pensions. However, in practice, the way French authorities apply the rule has varied.

Private pension plans add another layer of complexity. Depending on how they’re classified, these may or may not count as “professional income,” which determines whether you owe the charge.

For Americans planning to settle in France, it’s important to budget for the possibility of the CSM and to seek local tax advice early on. Even if you’re not billed right away, staying compliant with French regulations can prevent costly surprises later.

Why France Is Making the Change

France’s healthcare system is one of the best in the world, but it’s also expensive to maintain. With rising costs, an aging population, and increasing demand, the government is tightening the rules to protect resources for those who contribute to the system.

Officials have also pointed out that some foreigners arrive with pre-existing conditions and quickly access subsidized care after just a short stay. The reform aims to strike a balance between fairness and sustainability, ensuring the system remains viable for all.

The new amendment forms part of a broader social security reform aimed at ensuring that everyone who benefits from the system contributes to its funding.

Lawmakers behind the proposal say it targets retirees who have chosen to live in France but don’t pay into the French system through work or taxation. The government sees this as a matter of fairness, protecting the sustainability of public healthcare for residents who actively contribute.

What You Can Do

If you’re an American considering a move to France, this is the time to plan ahead. Before applying for your visa, make sure you have private health insurance that meets French requirements for the first year.

For those already living in France, keep an eye on official announcements from the Ministry of Health and Service-Public.fr. If the reform passes, you’ll likely need to submit updated paperwork or proof of income to continue receiving coverage.

It may also be worth consulting a specialist visa advisor or French accountant who understands expat taxation and can help you navigate any new contributions.

The Bottom Line

France remains one of the best countries in the world for healthcare, even with these new changes on the horizon. The amendment requiring non-EU retirees to pay a healthcare fee has cleared one major hurdle in parliament but still awaits Senate approval before becoming law.

If it goes ahead, Americans living in France on long-stay “visitor” visas will need to budget for an annual healthcare charge as part of their living expenses. Still, even with this new requirement, France’s healthcare system continues to offer exceptional value compared to private insurance in the US. For many retirees, it’s a cost well worth paying for the peace of mind it provides.