Written by
John Spencer
John Spencer is the founder of Compare Expat Plans, where he focuses on helping people compare health plans for life abroad. He emphasizes clear information, neutral analysis, and practical decision support.
Our Top Picks
French expats have a unique advantage: the CFE (Caisse des Français de l'Étranger) offers continuation of French social security abroad. But it's not always the best choice. Here's our recommendation:
- CFE + Top-Up: Best for those who want to maintain French social security rights and plan to return. Combine with a mutuelle for complete coverage.
- Cigna Global: Best private alternative. Superior coverage and service compared to CFE, often at similar or lower cost.
- April International: French company specializing in expats. Understands French needs, competitive pricing, French-language service.
- AXA Global Healthcare: Premium French brand with excellent worldwide coverage. Familiar name, comprehensive plans.
- Allianz Care: Strong alternative with good French support and established European network.
Key Decision Point
The main question for French expats: Do you want to maintain your connection to the French social security system (choose CFE), or do you want better coverage at potentially lower cost (choose private)?
Compare Private OptionsWe may earn a commission when you apply through our links. This does not affect our recommendations.
The CFE Option
The Caisse des Français de l'Étranger is unique to France. It's essentially French social security for expatriates, allowing you to maintain your connection to the French healthcare system while living abroad.
How CFE Works
CFE provides coverage at French social security rates—meaning it reimburses approximately 70% of costs based on French tariffs. This creates challenges:
- Reimbursement is based on French prices, not local prices
- In expensive countries (US, Switzerland), you'll pay significant gaps
- In cheaper countries (Southeast Asia, Latin America), coverage may exceed costs
- No direct billing—you pay upfront and claim reimbursement
- Processing can take weeks
Why Choose CFE?
CFE makes sense if you:
- Plan to return to France and want uninterrupted social security rights
- Are accumulating retirement quarters (trimestres)
- Want French maternity benefits (excellent when combined with mutuelle)
- Are a fonctionnaire or have specific professional requirements
- Want to maintain coverage during visits to France
Why Skip CFE?
Consider private insurance instead if you:
- Are living in expensive destinations (US, UK, Switzerland)
- Want direct billing and faster service
- Don't plan to return to France
- Want comprehensive coverage without adding a mutuelle
- Prefer English-language service in international destinations
CFE + Mutuelle = Complete Coverage
If you choose CFE, you'll almost certainly need a complementary mutuelle to cover the 30% gap and additional services. April International, Henner, and Malakoff Humanis all offer CFE-compatible top-up plans. Budget €100-200/month additional.
Private Alternatives
Private international health insurance often provides better coverage than CFE at comparable or lower prices, especially for younger expats in expensive destinations.
Advantages of Private Insurance
- Direct billing at major hospitals worldwide
- Comprehensive coverage in a single policy
- Faster claims processing (often 48-72 hours)
- 24/7 assistance lines with medical coordination
- Coverage based on actual costs, not French tariffs
- Often cheaper than CFE + mutuelle combined
Disadvantages
- No French social security rights accumulation
- Returning to France requires reintegrating into PUMA
- French maternity leave benefits not available
- Annual commitment (vs. monthly CFE)
Quick Comparison
| Provider | Type | French Support | Protects Return | Starting Price |
|---|---|---|---|---|
| CFE | Public (French) | Full | Yes | €200-400/mo |
| Cigna Global | Private | French hotline | No | €180/mo |
| Allianz Care | Private | Yes | No | €200/mo |
| April International | Private (French) | Full | No | €150/mo |
| AXA Global | Private | French company | No | €220/mo |
Detailed Reviews
CFE (Caisse des Français de l'Étranger)
CFE is a public institution offering French social security coverage to expatriates. Membership is voluntary and open to all French citizens abroad (and some non-French spouses). Pricing is based on age and income, ranging from €200-400/month for basic coverage.
Coverage mirrors French sécurité sociale: 70% reimbursement for most medical expenses, based on French tarifs conventionnels. This works well in countries where costs are similar to or lower than France, but can leave significant gaps in expensive destinations.
Best for: Expats planning to return to France who want to maintain social security rights and trimestres.
Cigna Global
Cigna Global offers comprehensive international health insurance with strong French-language support. Their Global Health Plan comes in three tiers (Silver, Gold, Platinum) with coverage from €1 million to unlimited.
French expats appreciate Cigna's French-speaking service line and efficient claims processing. Direct billing is available at most major hospitals in popular expat destinations. The network includes excellent French-speaking doctors in former French colonies and territories.
Best for: French expats who want premium private coverage with French-language support.
April International
April International is a French company (based in Lyon) specializing in expat insurance. They understand French needs perfectly: integration with CFE, understanding of French administrative requirements, and French-language everything.
Their MyHealth International plan offers good coverage at competitive prices. They also offer CFE-compatible complémentaire plans for those who want the CFE + mutuelle combination.
Best for: French expats who prefer working with a French company and want competitive pricing.
AXA Global Healthcare
AXA is a name French people trust. AXA Global Healthcare offers premium international coverage with the backing of France's largest insurance company. Plans range from International Health Plan to Global Health Plan, with coverage options up to €20 million.
Service is excellent, claims are processed efficiently, and you're dealing with a French company that understands French administrative needs. Pricing is higher than competitors, reflecting the premium positioning.
Best for: French expats who want premium coverage from a trusted French brand.
Compare Your Options
Private insurance often costs less than CFE + mutuelle while providing better coverage. Get quotes from multiple providers to compare.
Get Free QuotesWe may earn a commission when you apply through our links. This does not affect our recommendations.
Returning to France
France's PUMA (Protection Universelle Maladie) means anyone living legally in France has access to healthcare. But your rights and coverage depend on how you've managed things abroad.
If You Maintained CFE
Returning is seamless. Your social security rights are uninterrupted, and you can immediately access French healthcare. Simply inform CFE of your return and register with your local CPAM.
If You Had Private Insurance Only
You'll need to register with CPAM upon return. There's typically a 3-month waiting period before full coverage kicks in. Keep your international insurance active until French coverage begins. You won't have accumulated trimestres for retirement during your time abroad.
Carte Vitale
If you deregistered from the French system, you'll need to apply for a new Carte Vitale upon return. Keep your old card—you may be able to reactivate it rather than getting a completely new one.
Common Questions
Is CFE mandatory for French expats?
No. CFE is entirely voluntary. You can choose private international insurance instead, or combine CFE with a mutuelle. The choice depends on your situation and priorities.
Can I use my Carte Vitale abroad?
No. The Carte Vitale only works in France (and with some EU coordination). Abroad, even with CFE, you pay upfront and submit claims for reimbursement.
What about maternity coverage?
CFE offers excellent maternity benefits including congé maternité when combined with the right mutuelle. Private insurers have waiting periods (usually 10-12 months) for maternity.
Do I accumulate trimestres with private insurance?
No. Only CFE (or employer-sponsored coverage with French social security) counts toward retirement trimestres. If retirement rights matter, CFE has an advantage.
Which is better for the US?
Private insurance, almost always. CFE reimbursement based on French tariffs will cover only a fraction of US healthcare costs. Private insurance covers actual costs.
Can my non-French spouse join CFE?
Yes, spouses and children of French nationals can join CFE. They're covered as ayants droit. Children under 20 are covered free; spouses pay a reduced rate.
Final Verdict
French expats have an enviable choice: maintain your connection to the French system through CFE, or opt for often-superior private coverage. Our recommendation:
- Choose CFE + mutuelle if you're returning to France, want retirement trimestres, or are pregnant/planning pregnancy
- Choose private insurance if you want better coverage, faster service, or are living in expensive destinations
For private coverage, Cigna Global offers the best combination of quality and French-language support. April International is ideal for those who prefer a fully French experience, while AXA Global suits those wanting premium coverage from a trusted French brand.
