Healthcare choices can affect your experience abroad a lot as a French expatriate. You’ll need to pick between the Caisse des Français de l’Étranger (CFE) and private coverage. This decision needs careful thought, whether you’re already living overseas or planning to leave.
French citizens living abroad must think over several factors when choosing between CFE and standalone international health insurance. The CFE serves as a dedicated French social security body that provides global coverage to expatriates. It bases reimbursements on French rates, which often fall below actual medical costs in your host country. Basic illness and maternity coverage through CFE costs around €124 monthly (about €1,488 annually) for people aged 45 to 59.
Timing plays a crucial role with CFE. Your coverage starts right away without any waiting period if you sign up within three months of leaving France. The total expense of CFE plus supplementary coverage matches the cost of standalone international health insurance over a decade.
Seven key questions in this article will guide your decision between these options. These questions are a wonderful way to get clarity about your healthcare protection abroad and help you make the right choice for your specific needs.
1. Where Are You Living and How Expensive Is Healthcare There?
Your choice of location makes a big difference in what kind of international health insurance you’ll need as a French expat. Healthcare costs vary significantly across different regions of the world. Such variation makes where you live one of the key factors in choosing between CFE and private insurance options.
Cost of care in Europe vs Asia vs North America
The differences in medical service prices across different regions significantly influence the type of insurance you require. The United States stands out as the world’s most expensive healthcare market. Americans spend about €12,817 per person each year on healthcare. This is a big deal, as it means that U.S. spending is €3,530 more than any other wealthy nation. Americans pay almost twice what other similar countries spend (€7,054).
European healthcare systems provide you much better value for money. The World Health Organisation ranks France’s universal healthcare system as the best in the world. French state health insurance covers about 70% of medical costs, making it much cheaper than American healthcare.
Healthcare costs in Asia depend on which country you’re in and what quality you’re looking for. Many developing Asian countries have lower prices, but you might not get the same quality. High-end care in places like Singapore, Hong Kong, or Japan can cost almost as much as in North America.
The way you pay for healthcare also changes depending on where you are:
- French patients pay first but get 70-80% of their money back later
- Some countries don’t ask you to pay anything upfront
- U.S. patients often end up with big out-of-pocket expenses based on their insurance plan
CFE bases its paybacks on French healthcare rates. This can be tricky if you live somewhere pricier. Countries like the United States, Canada, Japan, Australia, and Hong Kong charge much more than French rates. So CFE coverage by itself might leave you with hefty bills to pay in these places.
How local healthcare systems affect your choice
The way healthcare works in your new country shapes what insurance you need and how you get care. European countries all have their own rules and benefits, even though they’re close to each other. To name just one example, see how France has 10% more general practitioners than the UK and more than twice the number of hospital beds.
Here’s what you need to think about when looking at insurance options:
- The mix of public and private healthcare
- Whether you need to pay upfront
- How easy it is to find specialists and facilities
- How long you’ll wait for procedures
- Whether you can get medical care in your language
France’s healthcare system is excellent, but other countries might do better in certain areas. Some places have better rural medical facilities, shorter waiting times, or more detailed specialist services. All the same, things we take for granted in France—like having a regular family doctor—might cost extra or not exist at all elsewhere.
Local insurance plans cost less than international health insurance. French local coverage runs between €20 and €100 monthly depending on your age and what’s covered. Private international policies can cost anywhere from €50 to over €300 monthly. Local plans usually have stricter limits on coverage and might not cover some treatments.
Different regions pay for healthcare in different ways. Wealthy countries usually cover more through public funding. In poorer and middle-income countries, people often pay more than half of their healthcare costs themselves.
The bottom line? Let your host country’s healthcare costs and system guide your choice between CFE and private international health insurance. If you’re heading to expensive places like North America or parts of Asia, CFE coverage alone probably won’t be enough. You’ll want to look into extra or standalone international insurance.
2. How Long Do You Plan to Stay Abroad?
Your health insurance needs depend on how long you plan to stay abroad. The time you spend in another country determines which plan works best and what coverage you can get.
Short-term vs long-term expat needs
People who stay abroad for 1–12 months usually require short-term international health coverage. These plans protect you temporarily without requiring a long-term commitment. People planning to live overseas for more than a year need long-term international health insurance designed specifically for expatriates.
Each option comes with features that match its intended purpose. Short-term plans typically offer:
- Daily rates for non-renewable coverage
- Protection that meets immediate needs
- Cost-effective solutions for brief stays
- Quick application with minimal paperwork
French citizens who work abroad temporarily, study internationally, or test life in a new country find short-term coverage adequate and affordable. Digital nomads benefit from these plans as they move through France’s various regions—from the Côte d’Azur to the vineyards of Bordeaux.
Long-term international health insurance gives you complete protection during extended expatriation. These plans include:
- Yearly renewable coverage that stays continuous
- Extended benefits with preventative care
- Management options for chronic conditions
- Coverage for cancer treatment
- Regular health screenings
The main difference shows up in how these plans deal with pre-existing conditions. Short-term policies usually exclude them, but long-term plans might cover them right away or after you wait for a specific period. Maternity benefits—which matter if you plan to start a family abroad—come only with long-term policies. Note that an 18-month waiting period applies if you buy coverage after pregnancy begins.
What it all means for CFE eligibility and private insurance flexibility
The timing of your CFE enrolment matters. You should enrol right after leaving the French Social Security system to avoid special conditions or waiting periods. If you wait more than three months, you face waiting periods—three months if you’re under 45 and six months if you’re 45 or older.
CFE membership starts on the first day of the month after your application. This gap shows why planning ahead matters, especially since you can only make simple state pension contributions through CFE while living abroad.
Private international insurance lets you make further adjustments. With long-term plans, each year, you can:
- Change your coverage level
- Update your family members
- Switch your geographical coverage area
- Add a voluntary excess to lower premiums
These changes must happen when your policy renews. Private insurance also lets you cancel as soon as you get your carte vitale in a national healthcare system. This helps you avoid paying for coverage you don’t need.
Starting with short-term coverage works well if you’re not sure how long you’ll stay abroad. Many expats use short-term insurance until they get long-term coverage from their employer or a private company. Some people mix CFE with extra private insurance to get complete protection that costs less over time.
French retirees moving abroad should know they can get state-run insurance only after living in their new country for three straight months. International health insurance fills this gap during the move.
3. Do You Have Any Pre-Existing Medical Conditions?
Pre-existing health conditions are a vital factor in choosing the right expatriate health insurance. Private international insurers and CFE handle these medical issues differently. This difference could determine which option best protects your specific health profile.
CFE’s acceptance of pre-existing conditions
The CFE gives French expatriates with existing health concerns a major advantage: it covers pre-existing conditions without asking for detailed medical questionnaires. This is one of the CFE’s best benefits compared to private international health insurance options.
Your CFE coverage protects you for:
- Current ongoing treatments
- Recently diagnosed conditions
- Past medical issues that might need future care
The CFE can offer this inclusive approach because it works as an extension of the French social security system, not as a profit-driven private insurer. The system follows the same principles of universal access, whatever your health status.
CFE coverage’s most valuable feature relates to total and permanent disability. If you develop such a condition, your coverage continues throughout your life without extra contributions. This gives peace of mind to people with chronic or degenerative conditions.
The CFE isn’t completely blind to health risks. Your pre-existing conditions might increase premiums in some cases. Specific exclusions might apply in rare cases. These limitations are nowhere near as restrictive as those from private insurers.
Remember that CFE coverage alone usually isn’t enough to protect you fully. Since reimbursements match French social security rates, you’ll probably need complementary insurance with your CFE coverage. This requirement becomes crucial in countries where healthcare costs more than in France.
Private insurance underwriting and exclusions
Private international health insurers handle pre-existing conditions very differently from the CFE. These companies use several underwriting methods:
- Full Medical Underwriting: You must complete a detailed medical questionnaire about your health history. Each insurer interprets this information differently; a condition that one company considers problematic may be acceptable to another. The insurer might:
- Accept you under standard terms
- Offer coverage with higher premiums
- Exclude specific conditions
- Decline coverage completely
- Moratorium Underwriting: Pre-existing conditions are excluded for a set period from when your coverage starts. This method often skips medical questionnaires, which makes applying easier. You might get coverage for previously excluded conditions after the waiting period ends.
- Medical History Disregarded (MHD): Corporate international health plans often use this approach, where most pre-existing conditions don’t affect underwriting. MHD usually covers acute conditions rather than chronic ones. These plans cost more because they offer broader coverage.
- Continued Personal Medical Exclusions (CPME): You can transfer your current policy terms when changing insurers, keeping coverage for conditions included in your previous policy.
Private insurers find it most challenging to provide coverage for the following:
- Progressive conditions needing long treatments
- Recent illnesses with uncertain recovery times
- Chronic conditions needing ongoing care
Private international health insurance rarely covers pre-existing conditions outside group plans or social security systems. This basic limitation exists because insurance covers uncertain risks—not certainties like existing medical conditions.
French expatriates with serious health concerns often find combining CFE with supplementary insurance works best. If private insurers turn down your application, your international health advisor can help find companies offering partial exclusions that work well with CFE coverage.
4. Will You Return to France in the Future?
Your health insurance decisions as an expatriate should account for your eventual return to France. These choices impact both your immediate coverage needs and long-term healthcare security, whatever time you decide to return.
Reintegration into French social security via CFE
French nationals coming back home after living abroad face a big challenge – they typically wait three months before national system coverage kicks in. Having proper health insurance during this transition becomes vital to avoid hefty medical bills.
The CFE gives you a significant advantage by creating a continuous connection to the French social security system. This organisation specifically extends French social security to expatriates, and your CFE membership keeps you linked to the national system while you are abroad. Your future reintegration becomes easier in several ways:
CFE members don’t start from scratch when they ask for healthcare coverage upon returning to France. You keep your status within the system instead of dealing with complex paperwork as a new applicant. This makes the process much smoother.
CFE participation helps you avoid the three-month coverage gap that returning expatriates usually face. The standard waiting period can put you at financial risk, so keeping your CFE coverage until national health insurance activates protects you during this sensitive transition.
The CFE also builds your French retirement benefits if you plan a career with international moves. Signing up for the CFE’s pension component lets you keep accumulating benefits toward your French retirement while working abroad. This benefit becomes especially valuable if you switch between international assignments and time in France throughout your career.
Portability of international health insurance for French expats
Health insurance portability – knowing how to keep coverage under the same terms when moving internationally – matters a lot for French citizens who move around globally. Portable insurance plans offer these key advantages:
- Continuous coverage without gaps: Regular plans often leave you uncovered during moves, which might lead to big out-of-pocket expenses for unexpected medical needs.
- No waiting period: This plan honours the waiting period you’ve completed, so benefits like dental coverage remain available right after you move.
- Continuous pre-existing condition coverage: Portable plans keep covering conditions that developed during your policy period, unlike new coverage applications that require medical underwriting.
Portable insurance does have its limits. Insurance companies might restrict portability to lower-risk countries and exclude regions with political instability or conflict. Many insurers also won’t offer portability for U.S. plans because healthcare costs there are nowhere near those of other countries.
Your premiums will change based on where you live. To name just one example, moving from Vietnam to Hong Kong – where healthcare ranks among the world’s most expensive – usually means higher premiums at renewal because care costs more in your new location.
You have two main options for portable coverage: check if your employer’s plan includes portability or buy an individual international health insurance policy designed for expatriate mobility. Either way, picking a plan with strong portability features gives you flexibility for your future plans to return to France or move elsewhere.
5. What Level of Coverage and Reimbursement Do You Expect?
Your health insurance’s reimbursement structure will determine how much money you get back after medical expenses. This is a vital factor to think over when choosing international health coverage options. Understand the basic distinctions between CFE and private insurance reimbursement models to accurately estimate your out-of-pocket expenses.
CFE reimbursement based on French rates
CFE reimburses medical expenses based on standard French social security rates, whatever country you get treatment in. This creates a big problem for expatriates in countries where healthcare costs more than in France. For simple medical care like doctor visits, CFE pays back only 70% of expenses. The standard French tariff caps at €26.50, which means you’ll get a maximum of €18.55 per visit.
The gap grows even wider with hospital care. CFE splits countries into zones based on local healthcare costs. The reimbursement percentages drop as costs rise:
- Zone 1 (e.g., Cambodia, Togo): Up to 67% reimbursement
- Zone 5 (e.g., USA, Hong Kong): As low as 19% reimbursement
To cite an instance, see what happens with a €12,000 hospital stay in Hong Kong. CFE would give back about €2,280 (19%), and you’d need to pay €9,720. For specialised treatments like cancer chemotherapy in the United States, CFE covers nowhere near enough – just 20% of actual costs.
Private insurance: actual cost reimbursement and higher limits
Private international health insurance pays based on actual expenses instead of preset rates. This is a big deal, as it means that you get better financial protection in countries with high medical costs.
Private plans come with much higher coverage limits. Some even offer unlimited annual and lifetime coverage. Many policies cover up to 100% of medical expenses. This helps especially when you have markets where healthcare costs are sky-high compared to French rates, like in the United States, Canada, Japan, Australia, and Hong Kong.
Private insurance companies let you pick exactly how much protection you need through tiered coverage options. These range from simple hospital-only plans to complete packages that cover outpatient care, medications, imaging, dental services, and alternative therapies.
Cashless hospital access and global coverage
One of the best things about private international health insurance is direct billing with hospitals worldwide. Most private plans handle payments directly with healthcare providers, so you won’t need to pay upfront for hospital stays. This takes away the stress of finding large sums during medical emergencies.
CFE usually wants you to pay first and claim later. However, some CFE strategic collaborations offer direct settlement for hospital stays and easier claims through a single reimbursement channel.
Private insurers handle claims quickly. The top providers pay back over 80% of eligible claims within 48 hours if you give them all the information they need. They also have giant networks of healthcare providers globally – one company has access to 40,000 hospitals worldwide.
Even with CFE coverage, you’ll likely need supplementary insurance. These extra plans fill the gap between what CFE pays and actual expenses. Many insurers have agreements with CFE to make getting your money back easier. These arrangements mean you only need to fill out one claim form and get one combined payment.
6. What Is Your Budget and Are You Willing to Combine Plans?
Money plays a decisive role in choosing health insurance options during your expat experience. You need to strike the right balance between detailed coverage and cost by evaluating various plans.
CFE + supplementary insurance vs standalone private plan
French expatriates face two main choices: they can combine CFE with supplementary insurance or choose a standalone private international health plan. Each option comes with its own financial implications.
The combined approach uses CFE as base coverage. It follows the French social security model and covers about 70% of standard French medical costs. You then add a supplementary plan (mutuelle) to handle the remaining 30% and any expenses above French rates.
Standalone private international health insurance works outside the French system. These policies offer more detailed coverage. They often pay up to 100% of actual medical expenses instead of limiting reimbursements to French rates. Your premium costs depend on the coverage level you pick. Simple plans only cover emergencies and hospital visits. More detailed packages include preventative care, routine check-ups, and prescription medications.
Cost comparison over 5–10 years
Your total spending over the course of 5–10 years depends on several key factors.
The cost of the CFE and supplementary insurance ranges from €20 to €100 per month, depending on factors such as your age, health, and level of coverage. A 60-year-old pays about €110 monthly for a mutuelle policy. A family with two parents and one child pays around €134 monthly.
Standalone private international health insurance starts at higher rates – €50 to €300 monthly. A simple plan for a 60-year-old costs €102.50 monthly. Premium coverage might reach €243.51.
Your location affects these costs. Countries like the United States, Switzerland, or Singapore have expensive healthcare systems that lead to higher premiums. U.S. health insurance for resident expats ranges from €190.84 to €954.21 monthly.
Age is a vital cost factor. Most plans group ages into five- or ten-year brackets. Premiums rise after age 50. Medical history also shapes pricing through medical underwriting. Pre-existing conditions can increase premiums.
Administrative complexity of dual coverage
The paperwork involved with dual coverage deserves attention beyond just costs.
France’s two-tier system of public and private insurance creates complexity and expense. This extends to expat coverage when you combine CFE with supplementary insurance.
Note that filing claims with multiple insurers takes extra paperwork and time. You might need to send original invoices to different parties and direct different reimbursement systems without simplified processing.
Some partnerships between CFE and supplementary providers now make the process easier. These arrangements let you submit one claim form and get combined reimbursement in a single payment. Companies like MSH International offer integrated management. Both CFE and supplementary reimbursement requests go through one online platform for faster processing.
Some supplementary plans also offer cashless direct billing with hospitals. This removes the need for upfront payment during emergencies. The simpler administration might justify paying slightly more in premiums.
Your final choice depends on balancing your coverage needs, budget limits, and paperwork preferences. A careful review of immediate costs and long-term financial effects helps you pick insurance that meets your expat healthcare needs.
7. Do You Need Family or Maternity Coverage?
Family planning and possible pregnancies need special attention when you choose international health insurance as a French expatriate. Your coverage choices will affect your financial security and healthcare access for everyone in your family.
CFE family plans and maternity benefits
CFE designs its plans with families in mind and includes maternity benefits in its standard packages. This family-focused approach makes it a great choice for many expatriate households.
CFE coverage protects your dependents—including spouses, partners, and children under 20 years old—if they don’t have another compulsory social security plan. This protection works whatever their location in France or abroad, which helps families with members living in different places.
Pregnant women get full coverage under CFE. The plan pays back medical expenses for declared pregnancies and all required examinations. Official guidelines provide a 16-week allowance. All mandatory prenatal examinations, birth preparation classes, and extra laboratory tests come with 100% coverage. Medical expenses between the sixth month of pregnancy and twelve days after birth receive full coverage, whatever their connection to the pregnancy.
Private insurance options for dependants and childbirth
Private international health insurers usually offer better maternity benefits with specific conditions. You should know about the 18-month waiting period before maternity benefits start. This means you need coverage long before pregnancy to use these benefits.
Family-friendly health plans from private insurers come with benefits like child home nursing, hearing exams, and vaccinations. Multiple child discounts make coverage more affordable as your family expands.
Premium maternity packages through private insurers can pay up to €15,300 for routine pregnancy and childbirth care. These plans include pre- and postnatal support and cover pregnancy-related medical conditions such as ectopic pregnancies, retained placenta, and postpartum haemorrhages.
Premium private plans are a wonderful way to get extra benefits like remote midwife support, antenatal and postnatal consultations, and newborn checks. Many providers also ensure COVID-19 treatment coverage for all insured family members.
High-quality private healthcare costs vary widely—from €5,000 to €30,000 for normal pregnancies and deliveries. Complications can push these costs to €50,000-€100,000, which shows why adequate coverage matters so much.
Comparison Table
| Feature | CFE | Private International Insurance |
| Simple Monthly Cost | €124 (ages 45-59) | €50-€300+ |
| Reimbursement Basis | French social security rates (70% of French rates) | Actual medical expenses (up to 100%) |
| Pre-existing Conditions | Covered without medical questionnaires | Usually excluded or requires medical underwriting |
| Waiting Period | None if joined within 3 months of leaving France; 3-6 months otherwise | Varies by plan; 18 months for maternity |
| Hospital Payment Method | Typically requires upfront payment | Direct billing available |
| Maternity Coverage | Included in standard package: 100% coverage for mandatory examinations | Premium packages up to €15,300; requires 18-month waiting period |
| Geographic Coverage Limitations | Reimbursement varies by zone (19-67% depending on country) | Worldwide coverage with higher premiums for expensive regions |
| Family Coverage | Automatic coverage for dependents under 20 | Available with potential multi-child discounts |
| Return to France Integration | Uninterrupted reintegration into French social security | No special provisions mentioned |
| Claims Processing | Traditional reimbursement system | 80% of eligible claims processed within 48 hours |
Conclusion
The best health insurance choice for French expatriates depends on your unique situation. There is no universally applicable solution. This piece explores seven vital factors that affect your decision between CFE and private international health insurance. Your host country’s healthcare costs matter a lot, especially if you live in expensive markets like the United States or Hong Kong. CFE reimbursements based on French rates might leave big gaps in these places. The length of your stay abroad shapes both coverage options and eligibility rules. Pre-existing conditions make CFE’s acceptance policy valuable.
Plans to return to France should be on your mind since CFE membership creates an effortless path back into the French social security system. The coverage level you want – from simple protection to detailed care – guides your choice. Your budget for monthly premiums over time plays a key role too. Family planning needs are vital, especially when you have maternity benefits and dependent coverage to think about.
You might find that mixing CFE with supplementary insurance gives you the right balance of detailed coverage and easy administration. A standalone private international health plan could work better if you want higher reimbursement rates and direct billing options. The smart move is to really analyse your personal situations and needs before making a decision. Reach out to us to review your case and find the best health coverage strategy for your life abroad.
Your choice of health insurance protects your well-being and financial security as you build your life in a new country. Good coverage lets you enjoy your international experience without worrying about healthcare costs.
