ALD in France: How a Long-Term Illness Gets Covered at 100%, What Still Costs Money, and What American Residents Should Know (2026)

If you have a serious chronic illness in France, the system can pay the care linked to it at 100% of the Sécurité sociale reimbursement base. The status is called ALD, for affection de longue durée, and it is opened by a form your doctor fills in, not by a policy you buy. It does not make everything free, and it does not cover care unrelated to the illness at 100%.

The Short Answer

Source: ameli.fr, the pages on the ALD (19 October 2026, 30 September 2026).

The page assumes you are insured in the French system and have a treating doctor. How an American resident gets there is covered in the guide to joining French public healthcare, and the guide to the treating doctor covers choosing the doctor who can start the protocol.

What an ALD Is and What It Is Not

Ameli.fr describes the ALD as an illness whose seriousness or chronic nature requires prolonged treatment. If you have a serious illness that evolves for more than 6 months and needs costly treatment, the health costs linked to it are paid at the maximum reimbursable by the Sécurité sociale, after your doctor draws up a care protocol and the medical service of your health insurance office agrees. Ameli adds an important warning: some costs stay with you.

It is not a complementary insurance, and it does not pay the whole bill. The “100%” is a rate applied to the reimbursement base set by the Sécurité sociale, which is not always what the practitioner charges.

Which Illnesses Qualify

Ameli.fr lists three routes:

• The list of 30 (ALD 30). A decree lists the illnesses. Among them are type 1 and type 2 diabetes, malignant tumours and malignant diseases of the lymphatic or blood-forming tissue (the page names cancers of the colon and rectum, skin, prostate, thyroid, bladder, upper aerodigestive tract, cervix, lung and breast, and lymphoma), Alzheimer’s disease and other dementias, Parkinson’s disease, multiple sclerosis, severe heart failure and serious heart rhythm disorders, coronary disease including heart attack, severe chronic respiratory failure (COPD, severe asthma), progressive rheumatoid arthritis, serious chronic kidney disease, and disabling stroke.
• Outside the list (ALD 31). Serious illnesses not on the list that evolve for a foreseeable period of more than 6 months and whose treatment is particularly costly. The care must include a drug treatment or a device, and 2 of 4 criteria: an upcoming hospital stay, repeated technical medical acts, repeated laboratory tests, or frequent and regular paramedical care.
• Several conditions together (ALD 32). A combination of illnesses causing a disabling state that needs treatment for more than 6 months and is particularly costly.

One detail matters to many retirees. Ameli.fr says severe high blood pressure was removed from the list in 2011, because the Haute Autorité de santé considers isolated high blood pressure a risk factor rather than an established illness. Blood pressure treatments prescribed as part of another ALD, such as diabetes or a heart condition, are still covered like any treatment under that ALD.

How You Get One: the Protocole de Soins

Ameli.fr describes the steps:

1. A doctor asks. The doctor you see about the illness, who can be your treating doctor, fills in the protocole de soins. It says which illness the request covers and lists the treatments, laboratory tests, consultations with medical and paramedical professionals, and illness-related transport.
2. The insurance adviser agrees. The protocol is drawn up jointly by your doctor and the Assurance Maladie doctor, who gives agreement for 100% coverage of part or all of the care.
3. It is registered. The ALD is recorded in your file within 48 hours of the protocol being received, and you receive a letter confirming it in the following days. If your doctor filled in the electronic form and you agree, you can read the patient copy in Mon espace santé.
4. You get a copy and sign. Your doctor gives you a copy and the information you need, and you sign the protocol with them. Keep it and show it to the professionals who treat you.

The page says the document belongs to you and is strictly personal and confidential: show it only to the doctors who treat you and to the Assurance Maladie medical advisers.

What “100%” Does and Does Not Mean

Ameli.fr says that for care linked to your ALD, you are covered at 100% of the Sécurité sociale reimbursement base, which is called the exemption from the ticket modérateur. With the third-party payment system, you do not have to advance the costs if the practitioner uses it. The exceptions are drugs with low medical benefit, which are covered at 15% of their price.

Source: ameli.fr (what the 100% coverage is for, 30 September 2026).

The page adds that the part left to you, other than the flat fee and the medical deductible, may be reimbursed in whole or in part by your mutuelle if your contract provides for it.

The Two-Zone Prescription

For illness-related care, the practitioner uses a special prescription called the ordonnance bizone. Ameli.fr says it is divided into two parts:

Source: ameli.fr (what the 100% coverage is for, 30 September 2026).

The page says health costs unrelated to your ALD are reimbursed at the usual rates, and that it is strongly advised to keep or take out a mutuelle even if you are in ALD. For how a mutuelle works and what it covers, see the guide to the mutuelle for Americans in France.

Transport, Sick Leave and Nursing Coordination

Ameli.fr adds three more rights. The Assurance Maladie can cover illness-related transport (taxi, ambulance, private or public transport) on medical prescription and under conditions. If your health requires it, you can be on sick leave for more than 6 months if the conditions for opening rights are met. And a patient in an ALD that exempts the ticket modérateur can name a referring nurse to coordinate their care path with the other professionals.

Privacy and Insurance Forms

Because the protocol is personal, ameli.fr says nobody can oblige you to communicate it, including an employer, a bank, an insurer or an occupational doctor. It also warns that under insurance law, if you do not declare your ALD when you take out an insurance contract, for a loan for example, you risk not being compensated later, because a false declaration can void the contract. Read the questions an insurer asks.

For documents, ameli.fr says that if you request a certificate of rights from your account for people who do not need to know you have an ALD, you can leave the “exemption from the ticket modérateur” box unticked and it will not appear on the printout.

When the ALD Ends: Renewal and Post-ALD Follow-Up

The ALD is granted for a limited period. Ameli.fr describes two situations at the end of that period. If your illness still needs active care, your doctor asks for a renewal, which is possible as long as your health justifies it, with no age limit and no limit on the number of renewals. If your illness is cured or no longer needs active treatment but examinations are still useful, you may be offered a post-ALD follow-up, with an agreement notification of an initial duration of 5 years that can be renewed as often as needed. Show that notification when you have the examinations.

What This Means If You Are an American Resident

Medicare does not enter into this. The ALD is a French Assurance Maladie status, and ameli.fr’s pages describe it for people insured in the French system. Three practical points follow from what the pages say:

• You need the French side in place first: an affiliation, a treating doctor and a carte Vitale. See the guide to registering with CPAM if you are not there yet.
• Plan the part that stays with you: extra fees, the flat fee, the deductible, the hospital daily charge and devices stay with you, and a mutuelle may cover part of the rest. Is Healthcare Free in France? puts the reimbursement rates and the real costs side by side.
• Keep the mutuelle: ameli.fr advises it even in ALD, because care unrelated to the illness is paid at the usual rates.

Frequently Asked Questions

What does ALD stand for?

Affection de longue durée, a long-term illness. Ameli.fr describes it as an illness whose seriousness or chronic nature requires prolonged treatment.

Is everything free once you are in ALD?

No. Ameli.fr says care linked to your ALD is covered at 100% of the Sécurité sociale reimbursement base, and that some costs stay with you: extra fees, the €2 flat fee and the medical deductible, the hospital daily charge, any gap on medical devices, and items that are not reimbursable.

Who applies for the ALD, me or my doctor?

Your doctor. Ameli.fr says the doctor you consult about the illness, such as your treating doctor, fills in the protocole de soins and the Assurance Maladie doctor agrees to the coverage.

How long does it take to be registered?

Ameli.fr says the ALD is recorded in your file within 48 hours of the protocol being received, and that you receive a confirmation letter in the following days.

Does the ALD cover care for other illnesses?

No. Ameli.fr says health costs unrelated to your ALD are reimbursed at the usual rates, which is why it advises keeping a mutuelle.

Does an ALD last for life?

It is granted for a limited period. Ameli.fr says it can be renewed as long as your health justifies it, with no age limit and no limit on the number of renewals, and that a post-ALD follow-up of an initial 5 years may follow if active treatment is no longer needed.

Do I have to tell my employer or insurer about my ALD?

Ameli.fr says nobody can oblige you to communicate the protocol, including an employer, a bank, an insurer or an occupational doctor. It also warns that not declaring an ALD when you take out an insurance contract can cause the contract to be void for false declaration.

Conclusion

The ALD is a French status that lets Assurance Maladie pay the care linked to a serious or long-term illness at 100% of its reimbursement base. Your doctor opens it with a protocole de soins, it is registered within 48 hours of the protocol being received, and it is renewable while your health requires it. What it does not do is as important: extra fees, the flat fee, the deductible, the hospital daily charge and anything outside the scheme stay with you, and care for other illnesses is reimbursed at the usual rates. Get the French affiliation and the treating doctor in place, and keep a mutuelle.