The 70% Rule and Its Limits
The baseline is well-known: for a standard GP consultation, the state — through the Assurance Maladie, France's public health insurance — reimburses 70% of the official fee, while the remaining 30%, called the ticket modérateur, stays with you. On a €30 visit, that means €21 back and a €9 gap to cover. A mutuelle, the private top-up insurance carried by around 96% of the population, typically absorbs most or all of that remainder.
That 70/30 split, though, is not universal. It slides considerably depending on what you're receiving. Hospital stays are reimbursed at 80% of the approved tariff. Certain serious or long-term conditions — classified as affections de longue durée, or ALD — attract 100% reimbursement for related treatment. Maternity care from the sixth month of pregnancy through twelve days postpartum is also fully covered. The rate is a signal the state sends about what it considers medically essential.
The Flat Fees and the Uncovered Gap
Below the percentages sit several fixed deductions that apply regardless of your situation. A small franchise médicale is subtracted from reimbursements for prescription items, paramedical acts and ambulance or other transport claims (up to an annual ceiling). A separate €0.50 charge applies per medication box in a prescription. These amounts are small but automatic — they exist to discourage unnecessary use, not to fund the system in any meaningful way.
More significant are the costs that sit outside the reimbursement structure entirely. Dentistry, optical care and hearing aids have traditionally been the largest gaps, though a reform called 100% Santé, rolled out from 2019 to 2021, created zero-cost baskets for glasses, hearing aids and basic dental work. Outside those baskets, charges can still be steep. Private-room supplements in hospital, balance-billing by certain specialists (dépassements d'honoraires), and most psychological care beyond a limited number of reimbursed sessions all sit in territory the state touches lightly or not at all.
What emerges is less a uniform guarantee than a layered architecture: high coverage for frequent, standard care; full cover for serious illness; partial cover for hospital stays; and a set of domains where the system historically underinvested. Knowing which tier your care falls into is the first step to knowing what your bill will actually look like.