France’s National Assembly has quietly inserted a significant change into the 2026 social-security financing bill: an amendment that would require all non-EU nationals who come to France on a long-stay “visitor” visa (visa de long séjour valant titre de séjour – VLS-TS) to pay a flat healthcare contribution each year. The idea was tabled by centrist MP François Gernigon after constituents complained that some foreign retirees were able to drop their private insurance three months after arrival and shift the full cost of their care to France’s state system.
Under current rules, holders of a VLS-TS who can prove sufficient income and private cover become eligible for Puma (Protection universelle maladie) after three months of residency and then pay nothing unless their investment income triggers the Puma surtax. The amendment would create a new “minimal fee”, still to be set by decree, which foreigners would pay alongside their visa tax before receiving a carte Vitale. Gernigon insists the measure is about fairness, noting that “French expatriates rarely enjoy free healthcare abroad”, while the French system faces a multibillion-euro deficit.
![France moves to introduce mandatory healthcare contribution for non-EU ‘visitor’ visa holders]()
If the Senate approves the text in December, the Health and Interior ministries will have to draft implementing regulations that specify the amount, exemptions linked to bilateral social-security treaties, and payment logistics (likely via the ANEF immigration portal). Business-immigration lawyers say companies that use the VLS-TS route for accompanying spouses or gap-year interns should budget for the new levy in 2026. Private insurers, meanwhile, see an opportunity to sell top-up policies if the public-system fee buys only basic reimbursement.
Immigration-advocacy groups warn that the surcharge could discourage middle-income retirees from settling in smaller French towns that rely on their spending power. US-based relocation advisers say they will lobby for credit given to Americans who already pay Medicare or private plans. One unanswered question is whether the fee will be indexed annually or adjusted to reflect age-related actuarial risk.
Practically, foreign residents already in France on a visitor visa are unlikely to be hit retroactively, but renewal applications filed from late-2026 onward may require proof of payment. Gernigon acknowledges that the administrative burden “must remain light” and hopes the debate will push France to renegotiate outdated reciprocity clauses in several bilateral health agreements.
Under current rules, holders of a VLS-TS who can prove sufficient income and private cover become eligible for Puma (Protection universelle maladie) after three months of residency and then pay nothing unless their investment income triggers the Puma surtax. The amendment would create a new “minimal fee”, still to be set by decree, which foreigners would pay alongside their visa tax before receiving a carte Vitale. Gernigon insists the measure is about fairness, noting that “French expatriates rarely enjoy free healthcare abroad”, while the French system faces a multibillion-euro deficit.
If the Senate approves the text in December, the Health and Interior ministries will have to draft implementing regulations that specify the amount, exemptions linked to bilateral social-security treaties, and payment logistics (likely via the ANEF immigration portal). Business-immigration lawyers say companies that use the VLS-TS route for accompanying spouses or gap-year interns should budget for the new levy in 2026. Private insurers, meanwhile, see an opportunity to sell top-up policies if the public-system fee buys only basic reimbursement.
Immigration-advocacy groups warn that the surcharge could discourage middle-income retirees from settling in smaller French towns that rely on their spending power. US-based relocation advisers say they will lobby for credit given to Americans who already pay Medicare or private plans. One unanswered question is whether the fee will be indexed annually or adjusted to reflect age-related actuarial risk.
Practically, foreign residents already in France on a visitor visa are unlikely to be hit retroactively, but renewal applications filed from late-2026 onward may require proof of payment. Gernigon acknowledges that the administrative burden “must remain light” and hopes the debate will push France to renegotiate outdated reciprocity clauses in several bilateral health agreements.
