You may have heard people say that if you have certain medical conditions in France, 100% of your medical costs can be covered by the French government. If you have, you may also have heard them refer to this as having an ALD.
ALD stands for Affection Longue Durée, or long-term condition. It is a designation used by Assurance Maladie for certain serious or chronic medical conditions that require prolonged treatment and care.
But what does having an ALD actually mean? Who qualifies, how do you get one declared, and does “100% covered” really mean you will have nothing left to pay?
What conditions can qualify?
There is an official list of 30 categories of conditions, commonly referred to as the ALD 30. These include diabetes, Parkinson’s disease, multiple sclerosis, certain serious heart conditions, HIV and malignant tumours, including many cancers.
Having a condition on the list does not necessarily mean that every person with that diagnosis automatically qualifies. There are specific medical criteria that must be met.
There are also circumstances in which other serious or chronic conditions can qualify for ALD coverage even though they are not on the ALD 30 list.
If you have a condition that you think may qualify, ask your doctor whether an ALD request would be appropriate.
How do you get an ALD declared?
In most cases, your médecin traitant makes the request. They prepare a protocole de soins setting out your condition and the treatment and care it requires and submit it to Assurance Maladie for approval.
Other doctors involved in your treatment may contribute to the protocol, and in some circumstances, particularly when a condition is diagnosed in hospital or during an emergency, another doctor can initiate the ALD request.
What does “100% covered” actually mean?
This is where much of the confusion arises.
For care covered under your ALD, Assurance Maladie generally reimburses 100% of the applicable Social Security reimbursement basis, rather than the usual percentage.
But that does not necessarily mean 100% of the amount you are actually charged.
For example, if the Social Security reimbursement basis for a medical service is €100 and the provider charges €150, Assurance Maladie may reimburse the €100. The additional €50 is not automatically covered simply because you have an ALD.
There is another important limitation: the 100% reimbursement applies to care related to your ALD. If, for example, you have an ALD for diabetes and receive treatment for an unrelated medical problem, that care is generally reimbursed under the normal rules.
If I have an ALD, why would I still need a mutuelle?
Because an ALD does not eliminate all of your healthcare expenses.
Depending on your mutuelle contract, complementary insurance can still help cover expenses such as fees above the Social Security reimbursement basis (dépassements d’honoraires), the daily hospital charge (forfait hospitalier), certain medical devices and other costs that Assurance Maladie does not reimburse in full.
Your mutuelle also continues to complement Assurance Maladie for your healthcare that has nothing to do with your ALD.
There are also some patient contributions that remain your responsibility even with an ALD and generally cannot be reimbursed by a standard mutuelle responsable, including the €2 participation forfaitaire and applicable franchises médicales.
Since 1 October 2026, medicines classified as having a low medical benefit (service médical rendu faible) are reimbursed at 15%, including when prescribed in connection with an ALD.
So while an ALD can substantially reduce the cost of managing a serious or chronic condition, an ALD and a mutuelle serve different purposes. Having an ALD does not necessarily mean that complementary health insurance is no longer useful.
Is there a downside to having an ALD declared?
For someone who qualifies, ALD status can provide an important financial benefit by increasing the reimbursement of care related to the condition.
Your ALD care protocol contains confidential medical information. An employer, bank or insurer cannot require you to provide the protocol itself, and you can obtain an attestation de droits that does not display your ALD exemption.
However, having an ALD does not change any separate obligation you may have to answer medical questions truthfully when applying for an insurance product where health information can legally be requested.
The important thing to remember
Having an ALD does not mean that the French healthcare system simply pays every medical bill you have in full.
It means that qualifying care related to the declared condition can be reimbursed at 100% of the applicable Social Security reimbursement basis. Understanding that distinction also explains why someone with an ALD may still have out-of-pocket expenses and may still benefit from having a mutuelle.
For the official rules and current list of qualifying conditions, see the Assurance Maladie information on Affections Longue Durée (ALD).
Need help finding the right mutuelle?
For help understanding your insurance coverage options, get in touch with us at MAM ASSUR. Email us at contact@mamassur.com, or compare options and request a quote.