How does Top-Up health cover fill the gaps?

3 minutes read

Living in France offers excellent healthcare, but understanding your Top-Up health insurance – complementary or the mutuelle -  whether you're reviewing, switching providers, or getting it for the first time – is key to maximising your benefits and minimising out-of-pocket expenses.

Beyond the carte vitale - bridging the healthcare gaps

If you’ve lived in France for a while or recently moved to the country after obtaining a visa, you’ll know that receiving your carte vitale from the French state insurance agency CPAM is not the end of the process for securing comprehensive healthcare. That’s because while CPAM will pay approximately 70% of your healthcare costs, you need to fund the remaining 30%. 

For occasional medical treatments or a visit to your GP this may be an affordable sum; however, if you require a stay in hospital, need long-term or specialist treatment the costs could be significant – leaving you with an expensive medical bill to pay… 

Top-Up health insurance is the cost-effective solution, covering all or part of the difference between the total cost and the amount refunded by CPAM.

It’s also important to note that everyone living in France must have some form of cover – the Régime Obligatoire; otherwise, you will need full private healthcare insurance to bridge the gap.

What are the benefits of Top-Up health insurance?

Top-Up health insurance offers peace of mind across the broadest range of healthcare as well as being beneficial in specific areas. Let’s look at a few examples:

• Optical care

The carte vitale offers basic cover for essential eye health needs like GP-prescribed ophthalmologist visits, but it limits reimbursement for everyday optical necessities such as frames, lenses, and contact lenses. As we get older, it’s possible that we will need more frequent eye tests, different lenses and possibly even surgery. Therefore, Top-Up health insurance can help you look after your eyes and your pocket!

• Dental care

Similarly, the carte vitale mainly covers basic dental care, such as routine check-ups and fillings; whilst offering less financial assistance for costly procedures, e.g. for crowns and implants. This may deter individuals from obtaining the necessary treatment due to the expense. However, a good Top-Up insurance plan offers varied coverage for a wide range of dental services, including preventative and major work. This allows individuals to prioritise their oral health without prohibitive costs.

• Access to specialists

In France, you typically need a GP referral (médecin traitant) to see a specialist. While the carte vitale covers the base cost, specialists can charge dépassements d'honoraires (extra charges). Top-Up insurance often covers these extra fees, improving access to the care you need. Some premium plans may even allow direct specialist access in certain cases, ensuring timely care.

• Hospital stays and single room supplements

It’s true to say that your carte vitale covers a significant portion of hospital costs. However, there may be a forfait hospitalier – a daily charge – as well as potential dépassements d'honoraires for surgeons/anaesthetists in private or certain types of hospitals for which CPAM will not pay. 

In France typically CPAM does not cover single room supplements. Many Top-Up insurance policies help by covering the forfait hospitalier and offering varied reimbursement for these extra fees.

CA Britline - the bank that speaks your language

Our friendly and bicultural team of English-speaking advisors have been helping our customers with all their banking needs in France since 1999. Most of the team have lived both in the UK and France, so they can understand what life is like both sides of the Channel.

Feel reassured that you will always have access to real people who understand you and speak your language: Contact our friendly team of English-speaking advisors who will help you set up your bank account. 

We look forward to hearing from you!

First published: 23th May 2025
 

Image used is provided by Getty Images.