Home nursing care: what French health insurance covers
Written by Rabah Slimani, State-registered nurse · · 4 min read
Reviewed on · Reviewed by Julie Martin
Prescription, sector 1, direct billing, top-up cover: the billing route explained plainly, without coding jargon.
Key points
- A prescribed nursing procedure is reimbursed under the national schedule, usually at 60 %, with a top-up insurer covering the rest.
- For a recognised long-term condition, related care is covered at 100 %.
- Direct billing removes upfront payment: the claim goes straight to the fund.
- A home visit carries a travel supplement set by the schedule, not a free-form surcharge.
The prescription comes first
Home nursing care is covered when prescribed by a doctor. Without a prescription there is no reimbursement.
Some prescriptions are valid for several months and renewable: we warn you before they expire so care is not interrupted.
A prescription's path, from the doctor's office to your home
Five handovers. Until all five are done, no nursing visit can be scheduled or billed.
Prescription
The doctor writes down the care required, its rhythm and its duration.
Receipt
You send us the prescription: a photograph, a drop-off, or a transfer from the hospital ward.
Reading
We check what is asked, what equipment it implies, and whether the address is inside our sector.
Scheduling
The visit enters the morning or the evening round, depending on what the care requires.
Handover
Every visit is recorded and reported to the doctor; renewal is requested before the prescription ends.
Sector 1 and direct billing
Working in sector 1 means applying agreed tariffs, with no extra fees.
With direct billing, the health-insurance share is not asked of you: it is paid straight to the practice.
The remaining share depends on your top-up insurer. Under long-term-condition status, cover is generally full.
What you actually pay
Three lines may remain: the top-up share if your insurer does not cover it fully, the statutory flat-rate contribution, and any procedure carried out outside a prescription at your request.
Everything else — prescribed procedures, travel, statutory night or Sunday supplements — follows the agreed schedule. We apply no extra fees.
We state before the first visit what will be billed and what will not. A patient should never discover an amount after the care.
What blocks a reimbursement, and how to avoid it
The three causes we meet most often: an expired prescription, entitlements not up to date on the Carte Vitale, and a change of top-up insurer we were not told about.
Each is solved in minutes if spotted early. So we check entitlements at the first visit, then at every prescription renewal.
If a claim is rejected, we take the file back ourselves: it is not for the patient to mediate between the practice and the insurer.
Travel costs
A flat travel allowance is added to procedures carried out at home: it is set by the national agreement and follows the same reimbursement rules.
Checking your own situation
Your health insurance fund and your ameli account remain the official source: rules change, and your personal situation takes precedence over any web page, including this one.
Reading a nursing invoice without getting lost
A nursing invoice reads in three lines: the procedure, the travel allowance and any applicable surcharge. The rest is administrative vocabulary.
Exact amounts depend on the national schedule and on your situation; only your health insurance account and statement are authoritative. What we describe here is the structure of the invoice, not a price.
| Line | What it covers | Who pays in practice |
|---|---|---|
| Procedure | The prescribed care actually delivered | Statutory health insurance |
| Travel allowance | The fact of coming to your home | Statutory health insurance |
| Co-payment | The share the statutory scheme does not cover | Top-up insurer, or you without one |
| Time surcharge | Night, Sunday, public holiday, where applicable | Same rules as the procedure |
Three situations that change everything
A recognised long-term condition changes coverage for the care linked to that condition: the statutory share rises to 100% of the base rate for that care, but not for the rest. The distinction appears on the care protocol agreed with your doctor.
Having no top-up insurance leaves the complementary share with you. It is not an obstacle to care: treatment starts, and we point you to the existing public schemes, notably the solidarity health cover.
An expired prescription stops reimbursement, never the need. We see it coming days ahead and ask the GP for a renewal.
What we never charge for
The practice charges no administrative fee, no booking fee and no supplement for an assessment visit that does not lead to care. A phone call is not a service.
We never ask for a deposit, and we never ask for bank details over the phone. A request of that kind does not come from us.
No administrative fee, no deposit, and no bank details ever requested by phone.
Reading a coverage decision without getting lost
Three questions are enough to know what will remain payable: is the procedure listed in the national schedule, is the prescription valid and dated, and does a long-term-condition or maternity exemption apply.
Everything else — top-up insurance, direct billing, travel allowance — follows from those three answers. We check them at the first visit rather than at the first bill, because an administrative surprise is always easier to fix before than after.
Which documents to keep, and for how long
This table describes our filing practice, useful in case of an audit, a change of insurer, or a transfer of the file to a colleague.
| Document | What it is for | Keep for |
|---|---|---|
| Prescription | Authorises and frames the procedures performed | The whole care period, then one year |
| Health insurance statement | Checking reimbursed amounts | Two years |
| Entitlement certificate | Proving open rights and long-term-condition status | Until renewal |
| Paper claim form | Fallback if electronic transmission failed | Until reimbursement is confirmed |
When to call
A reimbursement missing after three weeks, a prescription expiring while care continues, a change of insurance fund or top-up insurer, a long-term-condition notification received: tell us. These are settled in advance, never late.
We never advance costs on your behalf and never ask for untraced cash payment.
What we tell you before starting
Before the first procedure we state three things: which acts the prescription authorises, the billing arrangement chosen, and what may remain payable once your top-up insurer has contributed.
We prefer that two-minute conversation to an explanation after the fact. It removes most administrative misunderstandings, and it lets you raise questions with the prescriber while the prescription can still be adjusted.
Frequently asked questions on this page
Do I have to pay upfront?
What remains payable by me?
Does Sunday care cost more?
Does a long-term condition cover all nursing care?
What happens if I have no top-up insurance?
Care continues after the prescription ends. What happens?
Is there a surcharge on Sundays or at night?
What if your entitlements are not up to date?
Terms explained
- NGAP
- The official list of nursing procedures and their billing codes, which determines what can be invoiced to French health insurance.
- Long-term condition (ALD)
- A chronic condition recognised by French health insurance, granting 100 % cover for care related to that condition.
- Direct billing
- You do not pay upfront: the professional is paid directly by health insurance and, where applicable, by the top-up insurer.
- SESAM-Vitale
- The electronic claims system: the patient's Vitale card and the professional's CPS card jointly sign an invoice sent to the health fund with no paperwork.
- Prescription
- A doctor's written order stating the procedure, frequency and duration. Without it, nursing care cannot be delivered or reimbursed, apart from procedures allowed in direct access.
Official sources
What we write is based on public references you can check for yourself.
This page is informational and replaces neither a medical consultation nor a prescription.