Long-Term Care in France for American Retirees: How an EHPAD Is Billed, What the APA and ASH Pay, and Why Medicare Does Not (2026)

An American who needs daily care in France usually ends up in an EHPAD, the French nursing home, and Medicare will not pay for it. Medicare.gov says that Medicare and most health insurance, Medigap included, do not pay for long-term care, including a stay in a nursing home, and that you pay all costs for services it does not cover. What helps is French: a care rate paid by Health Insurance, and aid from the department and the tax office that depends on your level of dependency, your resources and your residence status.

The Short Answer

Source: service-public.gouv.fr (Ehpad, 1 January 2026) and medicare.gov (long-term care).

If you are still choosing a country or a visa, the guide on retiring in France as an American covers the move itself. This page is about the later question: what happens, and what it costs, when you need care every day.

What an EHPAD Is and Who It Takes

Service-public describes an EHPAD as a medical facility, formerly called a retirement home, where people who are usually at least 60 years old and need daily care and help are accommodated, full time or part time, temporarily or permanently. To be admitted you must be at least 60 and need daily care and support for the acts of everyday life, for example getting up or eating meals.

The same page lists what every EHPAD provides at a minimum: general administration, a room with access to a bathroom, three meals a day plus snacks, laundry services and group activities. It also lists the team an EHPAD must have, including a coordinating doctor, a coordinating nurse, nurses and nursing aides. Some homes are authorised to take people who may receive the ASH social assistance, and some specialise in Alzheimer’s disease.

For admission, service-public says you can apply online in some homes or with a form, and advises applying to several homes at once, because the head of the home decides after hearing the coordinating doctor, and contacts you when a place opens. You may refuse the place if you have found another one.

The Three Bills

Service-public and the CNSA information on Santé.fr describe the same structure. An EHPAD applies three daily rates:

Source: service-public.gouv.fr (Ehpad, 1 January 2026); sante.fr, information from the CNSA (16 January 2026).

Two details from those pages matter when you compare homes. In a place approved for social assistance, the departmental council sets the accommodation price. In a place that is not approved, the home’s manager sets it freely. And the price written in the residence contract cannot change during the year; it is reviewed once a year.

I am giving no euro amount for the accommodation rate, because none of the pages I read states a current one. Prices differ from home to home. Service-public and Santé.fr both point to the official directory and price comparison of the national portal for older people, where each home’s accommodation price and dependency rate are shown.

Whether you are covered by French Health Insurance is a separate question. How an American resident gets into the system is covered in the guide to joining French public healthcare and, for those who arrive on a visitor visa, the guide to the PUMa contribution.

How Dependency Is Measured: the GIR

The dependency rate depends on the resident’s GIR, the level of loss of autonomy on a scale from GIR 1 (the strongest loss) to GIR 6 (the weakest). Service-public says the state of dependency in an EHPAD is evaluated by the home’s coordinating doctor with the AGGIR grid. On the APA page, it adds that for the APA in a home the evaluation is done by the host institution.

Only GIR 1 to 4 give the right to the APA. A person classified GIR 5 or 6 is not entitled to it.

The APA: What It Pays and What Stays with You

The APA, the personalised autonomy allowance, is the aid that pays part of the dependency rate. The APA page of service-public gives four conditions for the APA in an institution: you must be at least 60, you must be classified GIR 1 to 4, the home must be in France and accommodate at least 25 dependent older people (if it has fewer, you apply for the home APA instead), and you must not be receiving certain other benefits at the same time, such as the disability compensation benefit.

To apply, you ask the home’s management how to proceed, and its staff can help you with the application. The department decides within 2 months of receiving a complete file, and the APA is owed from the date of the complete application.

The APA may not cover the whole dependency rate. What stays with you depends on the dependency rate your home charges and on your monthly resources, and service-public gives the scale:

Source: service-public.gouv.fr (Apa, 1 June 2026).

The resources counted are the income declared on your last tax or non-tax notice, proceeds from financial investments subject to the withholding tax, your property other than your main home, and capital that is neither used nor invested. The page lists what is excluded: among other things the reimbursement of care by Health Insurance under the PUMa, housing allowances, death capital, and financial help from your children for loss of autonomy. For a couple, the total monthly resources are divided by 2 before the scale is applied.

Service-public does not say how income earned abroad, such as a US pension or Social Security, is read in this calculation, so I do not state it. If you are in that situation, ask the department when you apply, and keep your tax notice and your pension statements ready.

The ASH: Social Assistance for Accommodation

The ASH, the social assistance for accommodation, pays the difference between the accommodation costs and what the older person, and sometimes the people the law compels to support them, can pay. Service-public lists its conditions: you must be over 65 (or over 60 if found unfit for work), live in France on a stable and regular basis, and, if you are a foreign national, have a valid residence permit. The home must also have places reserved for social assistance recipients, and your income must be lower than the accommodation costs.

Three points from that page deserve attention before you plan around it:

• The family is looked at. The department may take into account the income of the spouse and of the people compelled to support you, who may be your children, sons-in-law and daughters-in-law. A grandchild is exempt.
• It can be recovered. The department can recover the sums paid if your situation improves, for example by an inheritance, or on a gift you made within 10 years before or after the application, and on your death from the net estate passed to your heirs.
• Timing counts. To have costs covered from the day you enter the home, apply within 2 months of that date.

The page adds that the ASH is set so that you keep at least 10% of your income each month, and never less than €125 a month. Rules of payment vary from department to department.

Because the ASH can reach the estate, it connects to inheritance planning. Our guides on French inheritance law for Americans and on making a will in France cover how a French estate works.

Housing Allowance and the Tax Reduction

Service-public names housing allowance (APL or ALS) as the third aid: it pays part of the accommodation rate, and these aids are cumulative. The page also says a resident may receive an energy cheque.

There is also a tax reduction for dependency and accommodation expenses. The tax page says you must be housed in an EHPAD or long-term care unit, be tax domiciled in France, and that the home must be in France or in another country of the European Economic Area (Liechtenstein excepted). The reduction is 25% of the expenses actually paid, after deducting aid such as the APA, within an annual limit of €10,000 per resident, which makes a maximum reduction of €2,500 per resident. You declare it in your French tax return. If you file one, the guide to the French income tax return explains the filing itself.

That page was verified on 1 January 2026 and says the 2026 finance law could change the rules it presents, so check the current figures when you file.

What a Family Should Know Before Signing

Service-public lists several protections and obligations in the EHPAD section:

• A residence contract must be signed between the home and the resident as soon as the stay can last more than 2 months. It must state, among other things, the conditions of stay, how each charge is calculated and the right of withdrawal.
• A guarantee can be requested. An EHPAD can ask the people who support the older person, children and grandchildren among them, to sign a deed of joint and several guarantee, by which they undertake to pay the accommodation costs when the older person can no longer do so. Read what you sign, especially if you live abroad.
• A security deposit can be requested, up to the monthly accommodation rate, and returned within 30 days of permanent departure, minus any debt.
• A trusted person is proposed on entry, and a personalised support plan is agreed with the resident. To name one in advance, see the guide to the mandat de protection future, advance directives and the trusted person.

What to Do If You Are Planning, Not in a Hurry

If you are in your 60s or 70s and healthy, none of this has to be decided now, but a few facts from the pages above change what is worth doing early:

• Medicare will not pay. If you were counting on it for care at home or in a nursing home, the Medicare.gov page says to start planning non-medical long-term care now and that you may be eligible through Medicaid in your US state, or can choose to buy private long-term care insurance. What those policies pay for care given in France is not on that page, so ask the insurer in writing. Veterans can read what the VA Foreign Medical Program does not cover, long-term care in nursing homes among it, in the guide to TRICARE For Life and the VA Foreign Medical Program.
• Your residence document matters. Both the APA at home and the ASH ask a foreign national for a valid residence card or permit, so check which document you hold, and what it allows, before you plan around these aids.
• Your French health coverage matters. The care rate rests on Health Insurance. The mutuelle guide covers the complementary cover that sits on top of it.
• For the full picture of what care costs, see Is Healthcare Free in France? The Real Costs for Americans.

Frequently Asked Questions

Does Medicare pay for a nursing home in France?

No. Medicare.gov says Medicare and most health insurance, including Medigap, do not pay for long-term care, including care in a nursing home or in the community, and that you pay all costs for the services it does not cover.

Can a foreigner get the APA or the ASH?

The APA page of service-public asks a foreign national applying for the home APA for a residence card or permit, and asks a non-EU foreign national for a photocopy of a valid residence card or permit among the supporting documents. For the ASH, the page says a foreign national must have a valid residence permit. For the APA in an institution, ask the home what it needs, because the page does not list the documents.

Do my children have to pay for my nursing home?

Not automatically. Service-public says an EHPAD can ask the people who support the older person to sign a joint and several guarantee, and that the department can take the income of the people compelled to support you, including children, sons-in-law and daughters-in-law, into account when it sets the ASH. Grandchildren are exempt from the maintenance obligation for the ASH.

Can the state take my estate to recover the aid?

For the ASH, yes: service-public says the department can recover the sums paid, from the net estate passed to your heirs on your death, and on gifts made within 10 years before or after the application. For the APA the answer is no: the APA page says that after the death of the elderly person the amount of the APA received is not to be repaid, and is not recoverable from the estate, a legatee, a donee or a beneficiary of a life insurance contract.

Is there a tax break for nursing home costs?

Service-public describes a reduction of 25% of the dependency and accommodation expenses you actually paid, after deducting aid such as the APA, up to €10,000 a year per resident, which is at most €2,500. You must be tax domiciled in France.

How do I compare homes?

Service-public and Santé.fr both point to the official directory and price comparison of the national portal for older people, where each home’s accommodation price and dependency rate are shown, along with whether it is approved for the ASH.

Conclusion

In France a nursing home bill splits three ways: an accommodation rate and a dependency rate you pay, and a care rate Health Insurance pays. Medicare pays none of it. The APA, housing allowance and, in some homes, the ASH reduce what you pay, depending on your dependency level, your resources and your residence status, and the ASH and the family’s guarantee reach your relatives and your estate. Read the rates and the residence contract, ask what status the aid requires, and plan before you need care, not after.