You can read an updated version of this article here.
In France healthcare costs - whether it's a doctor's appointment or a prescription or medical procedure - are paid for up front by the patient.
The patient is then refunded some or all of the cost, but who refunds the costs and how it happens depends on your individual circumstances and the scheme you belong to.
Everyone who is a full-time resident in France is entitled to register in the French healthcare system and get the carte vitale health card - here's how to do that.
If you are working in France you are entitled to have most of your healthcare costs refunded by the state - you can find out more about that here, but it operates on the simple principle that you pay taxes or social charges in France, therefore you are entitled to state healthcare.
Brits in France who receive a UK state pension are eligible for the S1 scheme whereby the UK covers their health costs. The S1 also offers cover to people on certain types of disability benefits, some posted workers and students.
The same applies to people who receive a pension from another EU country.
But if you are not working and you are not eligible for the S1 (or similar) the picture is a little more complicated, and here is where PUMa comes in.
Since January 1st 2016, France has had Protection Universelle Maladie (universal sickness cover) commonly abbreviated to PUMa.
PUMa is based on residency - so as long as you have been legally resident in France for three months you are entitled to register for it and it covers people who fall into the 'grey area' of not working in France, but not receiving a state pension - the most common PUMa candidates are people who took early retirement but it can cover anyone who falls in the 'grey area'.
To get yourself registered with PUMa you can download the form here and begin the process of applying. Documentation is likely to vary according to your situation, but you will definitely need to supply a passport, birth certificate and proof of a stable residence in France - for example a rental contract, house deeds and utility bills.
Be warned - the process is not a speedy one. It varies from place to place but many people wait six months or longer for their application to be processed - although if you need healthcare in the meantime you can ask your doctor to supply a feuille de soins (type of receipt) and get the costs reimbursed once you are in the system.
Another drawback is that although it entitles you to free or greatly reduced medical treatment other charges can apply, notably social charges and extra charges for anyone with other capital income of more €20,262 a year - for example from investments or rental income outside of France.
These charges are called "cotisation subsidiaire maladie (CSM)." You can learn more about the yearly payment calculation here.
One final note - this is only open to people who are French residents.
Once you are registered with PUMa you receive a carte vitale and you can use that in exactly the same way that other French residents do.
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