For many Americans, retiring in France is the dream. The slower pace of life, the world class healthcare system, the safety, and the rich cultural environment make it one of the most attractive retirement destinations in Europe. But there is a new development retirees need to understand. The French National Assembly is examining a proposal to introduce a minimum healthcare contribution for non EU retirees who live in France under long stay visitor visas. This group includes American retirees who access PUMA after three months of residency without paying into the system during their working lives. Under the current system, non-EU nationals, including US citizens, can access the public system after a short period of legal residence, often without a financial contribution.
While the details are still under review, it is clear that the French government wants to bring more fairness and sustainability to the system. A new proposal and new amendment to the social security budget have been introduced, requiring payment of a healthcare fee by foreign residents, and a sub amendment has been added to clarify the details of this contribution for non-EU nationals. If you are planning to retire in France or are already living there on U.S. income, now is the time to prepare.
This post explains the proposed change, who may be affected, what costs you might expect, and how to strengthen your financial planning for life in France. Americans planning to retire in France should understand the requirements for a residence permit and long stay visa, and seek professional advice to ensure compliance with the new healthcare fee rules.
Introduction to French Healthcare
The French healthcare system stands out as one of the most respected and accessible in the world, making France a top choice for American retirees seeking affordable healthcare and a high quality of life. For those planning to live in France, understanding how the French public healthcare system operates is essential. The system is built on the principle of universal access, allowing residents, including foreign retirees, to benefit from world class medical care, hospital services, and reimbursements through the Protection Universelle Maladie (PUMA) program.
For non-EU residents, such as Americans retiring in France, eligibility for public healthcare is typically granted after three months of stable residency. Many retirees living in France have enjoyed access to the French system, often without making social security contributions, especially if their income comes from sources like U.S. pensions or investment income that may not be subject to French income tax. This has made the prospect of free healthcare particularly attractive for Americans moving to France on a long stay visitor visa.
However, recent changes proposed by French lawmakers are set to reshape this landscape. The French National Assembly has approved an amendment that introduces a new healthcare contribution for non-EU retirees, including American retirees living in France. This mandatory contribution, which still requires Senate approval, is designed to ensure that all foreign retirees who access public healthcare also contribute financially to the sustainability of the system. The move addresses concerns about the social security budget and the fairness of allowing retirees to benefit from the French healthcare system without paying into it.
The exact amount of the annual contribution has yet to be determined and will be specified by a future decree, but it is expected to be lower than the current Cotisation Subsidiaire Maladie (CSM) tax that applies to some non-EU residents. This new healthcare contribution will apply to many retirees who previously paid little or nothing for public healthcare, particularly those with investment income or pensions not subject to French taxes.
For American retirees living in France, this change means it is more important than ever to plan ahead. Understanding the eligibility criteria for public healthcare, budgeting for the new contribution, and considering private health insurance to supplement public coverage are all crucial steps. While the new rules will not affect the quality or scope of medical care provided, they do require careful financial planning for those wishing to access public healthcare in France.
As the French healthcare system continues to evolve, the government is also looking to revise agreements with G20 countries, including the United States, to establish reciprocal arrangements for healthcare contributions. With broad support from the French National Assembly and ongoing discussions among French authorities, American retirees and other foreign nationals living in France should stay informed about these developments to ensure continued access to the world class healthcare system France is known for.
Why is France Considering a New Healthcare Contribution?
France’s healthcare system is consistently ranked among the best in the world. It offers universal access, high quality medical care, and regulated insurance costs. French citizens contribute through payroll taxes and social charges throughout their careers. EU citizens benefit from reciprocity agreements that balance contributions across borders. However, Americans do not. Under the current system, certain non-EU retirees, including Americans, can access public healthcare without making a financial contribution, as long as they meet specific residency and income requirements.
Under current rules, Americans who stay in France more than three months can access the PUMA system and pay only the standard social charges based on investment income. Many retirees do not pay anything at all if they rely on pension income that is exempt from French social charges under the U.S. France tax treaty. The new rules will require payment from those who previously accessed the system for free, marking a significant change from the previous arrangement.
The proposed contribution would ensure that non EU retirees who live full time in France help support the healthcare services they use. This change introduces a financial contribution for non-EU retirees, replacing the automatic or free access provided by the current system. It is not expected to be extremely high, and the intention is fairness rather than a major increase in revenue. But for individuals planning their long term retirement income strategy, it matters.
Who Would the New Contribution Affect?
While the exact criteria are still under discussion, the proposal is likely to apply to:
- Non EU nationals, including US citizens, who have obtained legal residence in France through a long stay visa or residence permit
- Individuals accessing PUMA
- Non EU citizens who have not contributed to French social security through employment
- Retirees with income sourced outside France
If you hold a carte de séjour visiteur, rely on U.S. Social Security, pensions, or IRA withdrawals, you may be part of the group expected to contribute. Foreign residents with legal residence status are the primary group targeted by the new rules.
This change does not affect tourists or short term visitors. It focuses entirely on long term French residents who are legally resident in France.
What Could the New Healthcare Contribution Cost?
The government has not released a confirmed amount. The new healthcare fee will require payment from retirees who wish to access public healthcare. However, several scenarios have been mentioned in the debate. These include:
- A minimum annual financial contribution based on income level
- A formula similar to the existing PUMA contribution
- A capped percentage of passive income
- A flat healthcare fee for non EU retirees
While estimates vary, the direction is clear: retirees who previously paid nothing may now be required to make a financial contribution or pay a healthcare fee moving forward.
Even if the amount is relatively small, it is important to consider how it interacts with your U.S. retirement income, exchange rate fluctuations, and long term budgeting.
How to Prepare for Healthcare Costs in Retirement
Healthcare is one of the biggest financial concerns for Americans retiring abroad. Americans planning to retire in France should consider how their worldwide income and professional activity status may affect their eligibility for health care and the new contribution. The new rules make thoughtful planning even more essential. Here are key steps to take.
1. Understand how your U.S. income will be taxed
Many Americans wonder “How are American retirees taxed in France?” or “Will France tax my U.S. Social Security?” Under the U.S. France tax treaty, U.S. Social Security is taxed only in the United States. IRA or pension withdrawals may also receive favorable treatment, but this depends on your specific situation. US citizens living in France may be subject to taxation on their worldwide income, so it is important to seek professional advice to avoid double taxation. This is why personalized planning is vital.
2. Review your private health insurance
Even with PUMA, many retirees choose private top up insurance. Ensure your plan covers long term residency rather than travel only. Compare premiums in France with costs in the U.S. to understand the true value of moving your care to Europe.
3. Build healthcare contributions into your budget
Retirees often underestimate medical expenses. Whether you rely on private cover, PUMA, or both, prepare for potential annual contributions and inflation. With recent changes in France’s healthcare system, retirees should budget for the new healthcare fee and financial contribution, as the new rules will require payment before accessing public healthcare.
4. Plan for long term care
France offers high quality elder care, but it is rarely inexpensive. Questions like “Who pays for elderly care in France?” or “Can I use Medicare in France?” come up often. Medicare cannot be used abroad. This means you should plan for private options or long term care coverage.
5. Work with a cross border financial adviser
American retirees face unique challenges. From managing U.S. taxable accounts to respecting French reporting rules, even a small mistake can be costly. A regulated cross border adviser can help you evaluate healthcare costs, taxes, Social Security benefits, and investment planning in one coordinated strategy. They can also assist with issues related to worldwide income and professional activity in France, ensuring compliance with both tax and residency requirements.
Will France Tax My U.S. Social Security?
This is one of the most common questions from Americans considering retirement in France. Under the bilateral tax treaty, U.S. Social Security benefits remain taxable only in the United States. France does not tax Social Security. However, US citizens living in France must report their worldwide income and should be aware of both US and French tax obligations.
However, other income such as IRA withdrawals, 401k rollovers, and pension distributions may be treated differently. The treaty is complex, and planning early is the best way to optimize your outcome.
FAQs – New Healthcare Contribution for American Retirees in France
Can Americans get free healthcare in France?
Not exactly. Americans can access the French public system after three months of legal residence, but PUMA is not completely free. A new healthcare fee and financial contribution will apply to non-EU residents, including Americans, who wish to join the public system. The exact amount of this contribution has yet to be determined.
Is France cheaper for healthcare than the USA?
Yes. Even with a future healthcare fee or financial contribution, healthcare in France is significantly more affordable than in the United States.
Do pensioners pay for healthcare in France?
EU pensioners often benefit from agreements that transfer costs between countries. U.S. retirees do not. This is why a new healthcare fee and financial contribution is being proposed for non-EU retirees accessing the public system.
Can I use Medicare in France?
No. Medicare does not cover medical treatment outside the United States.
How long do you have to live in France to get healthcare?
You can apply for PUMA after three months of stable legal residence, typically proven by a long stay visa or residence permit.
Is private health insurance worth it for retirees?
Many retirees choose a private plan to supplement PUMA coverage for a more complete solution.
Do I need legal residence to access the French public system?
Yes. To be eligible for the French public system, you must have legal residence in France, which generally means holding a long stay visa or a residence permit. This documentation is required to access public healthcare and other social benefits.
Speak With a Cross Border Adviser
If you are an American retiree in France or planning a move soon, now is the perfect moment to review your financial strategy. Americans planning to retire in France should seek advice on managing worldwide income and any ongoing professional activity to ensure compliance with new healthcare contribution rules. A new healthcare contribution may be introduced, and planning ahead will make the transition smooth and predictable. Harrison Brook specializes in helping U.S. persons living abroad manage pensions, Social Security, investments, healthcare planning, and long term retirement income.
Speak with an adviser today and build a retirement strategy that is secure, tax efficient, and fully adapted to life in France.
