Health cover is one of the most poorly anticipated issues before moving abroad. Many expats discover too late that they have lost their French social security entitlements, that the CFE does not cover everything, or that international private insurance becomes very expensive past a certain age. This guide lays out the three main options available in 2026, with real figures and a clear strategy by profile.

What happens to your French social security rights when you leave

The gradual loss of CPAM entitlements

Contrary to popular belief, your French social security rights do not stop on the day you leave. They are maintained for a transitional period of 6 months after the end of your professional activity in France or your departure, provided you were previously affiliated. This period can extend to 12 months in certain situations depending on your contribution history.

After this period, if you do nothing, you lose your French health coverage. Reimbursements for care received in France are still possible if you return temporarily, but only during the rights period. After that, you are outside the system.

The rules are detailed on ameli.fr and the CLEISS (Centre des Liaisons Européennes et Internationales de Sécurité Sociale), which is the reference for bilateral agreements between France and host countries.

The EU/EEA special case

If you settle in an EU/EEA country and work there (as an employee or self-employed), you contribute to the local system and gain access to the host country’s healthcare. The European Health Insurance Card (EHIC) remains useful for temporary stays in other EU countries, but does not replace coverage in your country of residence.

The CFE: what it actually is

Principle and how it works

The Caisse des Français de l’Étranger (CFE) is a voluntary social security scheme for French nationals living outside France. It allows you to remain affiliated to a regime modelled on the French general scheme, regardless of your country of residence.

The CFE covers three risks: health-maternity, workplace accidents, and retirement. The health-maternity contribution is the most commonly taken out by expats.

Real cost of CFE health contributions

Contributions are calculated based on an income bracket (1 to 10). Indicative 2026 figures:

  • Bracket 1 (income < €6,500/year): approximately €90-100/quarter
  • Bracket 3 (income €13,000-19,500/year): approximately €200-230/quarter
  • Bracket 5 (income €26,000-36,000/year): approximately €400-450/quarter
  • Bracket 7 (income > €52,000/year): approximately €700-800/quarter

These amounts are indexed to declared income and revised annually. Check the exact rates at cfe.fr.

The main limitation of the CFE

Reimbursement is based on French social security rates, which are often well below the actual costs abroad. Example: a GP consultation in France is priced at around €26.50, reimbursed at 70% (roughly €18.50). The same consultation at a private clinic in Dubai or Bangkok costs €80-150.

In practice, with the CFE alone, you remain very exposed to significant costs (hospitalisation, specialists, surgery). The CFE is designed to work alongside a complementary health policy tailored to expats, which covers the remaining charges and removes the reimbursement ceiling.

Who the CFE genuinely suits

The CFE makes sense if you have strong ties to the French system (planning to return, wanting to maintain French pension rights via the optional retirement contribution), or if you have a family with children and want a structured baseline safety net. It is less relevant for a 30-year-old digital nomad with no near-term plan to return.

International private insurance

Who it is for and why

International private health insurance is the most flexible solution and often the most appropriate for active expats. It covers you in (virtually) any country in the world, with no link to the French regime or the local system of your country of residence.

Practical advantages:

  • Worldwide geographic coverage (with or without the United States depending on the plan)
  • High annual limits (€1 to 5 million depending on the contract)
  • Medical evacuation included in almost all contracts
  • Reimbursement of actual costs incurred, not based on French social security rates
  • No link to the local scheme or length of residence

The main providers

Established international insurers active in this market in 2026:

  • Cigna Global: US-based insurer with worldwide presence, flexible plans, good reputation for fast reimbursement. Plans from ~€1,200-1,500/year for a 30-year-old adult excluding the US zone.
  • Allianz Care: Allianz’s expat division, strong presence in Europe and Asia, modular plans.
  • April International: historic French expat specialist, widely known among French expats and wealth managers.
  • Foyer Global Health: Luxembourg-based insurer, competitive pricing, good coverage across Europe and Asia.

Real price ranges by age (2026, excluding USA zone)

ProfileBasic coverageComprehensive coverage
Age 25-35€900-1,500/year€1,800-2,500/year
Age 35-45€1,400-2,200/year€2,500-3,800/year
Age 45-55€2,200-3,500/year€4,000-6,000/year
Age 55-65€3,500-6,000/year€6,000-10,000+/year

Including the USA zone (where care is extremely expensive) typically increases the premium by 30 to 60%. Many insurers offer a “rest of world excluding USA/Canada” plan at a significantly lower price.

Local healthcare systems

When joining the local system is enough

Depending on your country of residence, the local system can be a serious option, sometimes the best one.

In the EU/EEA: if you are employed or self-employed and affiliated locally, you benefit from the host country’s social protection. In Portugal or Spain, the public health system (Portugal’s SNS and Spain’s SES respectively) is accessible to residents with a residence permit. Quality is generally acceptable, although waiting times in the public system can be long. Many expats opt for a low-cost local supplementary policy (€150-250/year in Spain via Sanitas or Adeslas, for example).

In Thailand: private healthcare in major cities is excellent quality and remarkably affordable. A specialist consultation at a private hospital (Bumrungrad in Bangkok, Samitivej, BNH) runs around €30-60. One night hospitalisation with care: €300-800. Many expats in Thailand choose a local Thai insurance policy (€300-700/year for an adult under 45) rather than an international one, and pay routine care directly out of pocket.

In Dubai: health insurance is legally mandatory for all residents. Employers must provide it for employees. For the self-employed and free zone workers, a locally approved private insurance (DHA or HAAD approved depending on the emirate) is required to renew the visa. Basic plans start at AED 700-1,500/year (approximately €180-400) through insurers such as Daman or AXA Gulf. Expats in Dubai therefore have no real choice: insurance is built into the visa logistics.

Three-way comparison

Criterion CFE International private insurance Local system
Geographic coverage Worldwide (reimbursement on French rates) Worldwide (depending on plan) Country of residence only
Indicative annual cost €400-3,200 (by income) €900-10,000 (by age) €0-700 (by country)
Medical evacuation Not included (add-on) Yes, included Not included
Reimbursement of actual costs No (French rate basis) Yes Partial (depends on system)
Ideal for Expat with strong France ties, families Nomads, seniors, multi-country Stable EU resident or affordable country

Pitfalls to know about

Pitfall 1: pre-existing conditions

Almost all international private insurers exclude pre-existing conditions at the time of underwriting, or cover them with a surcharge and a waiting period. If you have diabetes, a chronic condition, or a cardiovascular history, check precisely what is covered before signing. Some insurers apply a very detailed medical questionnaire.

Pitfall 2: insufficient annual limits

An entry-level plan may cap reimbursements at €250,000 or €500,000 per year. That is plenty in most situations, but not for a serious illness or cancer treated in an expensive country. Aim for a limit of at least €1 million to have real peace of mind.

Pitfall 3: waiting periods

Many contracts apply a waiting period of 3 to 6 months for certain types of care (maternity cover in particular, often 10 to 12 months). Do not count on immediate coverage for planned procedures the day after you sign up.

Pitfall 4: the United States zone

Medical care in the United States is among the most expensive in the world. Insurers typically offer two pricing levels: with or without US coverage. If you do not plan to live or travel there frequently, excluding this zone can reduce the premium by 30 to 60%. But if you spend time there (for clients, family), the exclusion can become a very costly trap.

Pitfall 5: confusing travel insurance with expat insurance

Travel insurance covers short stays (usually up to 90 days). Expat insurance is designed for long-term residence. The two are not interchangeable. Taking out a simple travel policy for a multi-year expatriation leaves you without coverage for non-emergency care.

Young digital nomad (under 35, multi-destination, no family) → International private insurance with a basic plan (excluding USA if you do not go there), around €900-1,400/year. No need for the CFE at this stage.

Family with children (couple + 2 children, fixed destination) → CFE to maintain the French system link + tailored international complementary cover. Or a family international private policy (expect €3,000-6,000/year for a family of four). Compare both scenarios for your specific destination.

Senior (55 and over) → International private insurance becomes very expensive. Seriously evaluate the CFE (contributions indexed to income, not age) combined with complementary cover: this is often the better deal. Check admission conditions: some private insurers refuse new applicants over 65.

EU destination (Portugal, Spain) → Affiliation to the local scheme if you are active there, supplemented by an inexpensive local health policy. This is often the cheapest and most effective solution for an expat in Spain or Portugal.

Short-term assignment (6-18 months) → Maintain CPAM rights if you are within the transitional period, plus long-stay travel insurance (not expat insurance). As soon as the stay exceeds 18 months, switch to a proper expat policy.

Frequently asked questions

Can I keep my French mutuelle when moving abroad?

Most French mutuelles (Malakoff Humanis, Alan, Harmonie Mutuelle, etc.) are linked to your French social security affiliation. If you lose that affiliation by leaving, your mutuelle can no longer function. Some offer specific “expat” contracts but they remain rare and expensive compared to a dedicated international policy. Confirm directly with your provider before you leave.

Can I combine the CFE with international private insurance?

Yes, and this is often recommended. The CFE provides a baseline linked to the French system, while international private insurance tops it up by covering actual costs not reimbursed by the CFE. Some insurers offer contracts specifically designed to complement the CFE.

Is my Carte Vitale still valid abroad?

Your Carte Vitale remains in your possession, but it only serves in France for care received on French territory. It has no practical use in a foreign country. What matters abroad is your active insurance, whether that is the CFE, private cover, or local scheme affiliation.

How does reimbursement work for emergency care abroad?

With international private insurance, most insurers offer a 24/7 emergency line. For hospitalisations, they often arrange direct billing (cashless) with the hospital. For outpatient care, you pay upfront and submit receipts via a mobile app or online portal. Reimbursement timelines vary from a few days to 3-4 weeks depending on the insurer.

Getting properly covered abroad is not a matter of luck — it is a decision to make before you leave, not after your first health issue. The right solution depends on your age, destination, length of stay, and risk tolerance. Take the time to compare options for your specific situation.

For more on the less visible costs of relocating, read our article the hidden costs of expatriation.

Find all our practical guides for settling abroad: living abroad.

For health specifics by destination:

The costs and conditions stated in this guide are valid as of Q2 2026. Insurer pricing changes regularly: always check current rates directly on official provider websites before subscribing.