The “90% Rule”: Why Healthcare Is Better in Strasbourg

The Alsace Advantage: Understanding the Régime Local

If you are planning a move to Strasbourg, you aren’t just gaining beautiful canals and world-class wine — you are also entering a region with one of the most generous healthcare systems in France. Known as the Régime Local d’Assurance Maladie, this special system is a historical legacy of Alsace-Moselle’s unique Franco-German past, and it remains a major quality-of-life advantage for residents of the Bas-Rhin.

In most of France, the national health system typically reimburses about 70% of standard medical costs. In Strasbourg and the surrounding region, the Régime Local steps in to reimburse significantly more, often reducing out-of-pocket expenses and reliance on private insurance.

The Benefits for 2026

The biggest draw is the reimbursement level. While the general French system covers around 70% of many basic medical acts, the Régime Local increases coverage to around 90% for most routine care.

This commonly applies to:

• GP and specialist visits: You pay noticeably less out-of-pocket.

• Pharmacy: Many prescription medications are reimbursed at a higher rate.

• Hospital stays: Hospital costs are generally better covered, often including the daily hospital fee (forfait journalier), offering an important financial safety net.

What Does It Cost?

As we move into 2026, the contribution rate remains approximately 1.3% of gross salary for employees. While this is a small additional payroll deduction, many residents find the trade-off worthwhile. Because the Régime Local covers a larger share of healthcare costs, private mutuelle (top-up insurance) premiums are often lower than in cities like Paris or Lyon, where the standard system leaves larger gaps.

Who Is Eligible?

Eligibility is not based on nationality, but on your affiliation with the French health system in the Alsace-Moselle region. Employees working in Bas-Rhin, Haut-Rhin, or Moselle are typically enrolled automatically. Some categories — such as certain students, retirees, or self-employed profiles — may be subject to different rules, but for most salaried workers, enrollment is straightforward.

It’s a fascinating example of how history can create a modern-day benefit. Often described as a form of “Social Security Plus,” the Régime Local is a point of pride for locals and a welcome advantage for newcomers. Next time you visit a doctor in the Capital of Europe, remember that in Strasbourg, your healthcare is supported by a system refined over more than a century.

Disclaimer:
Information is provided for general guidance only. Healthcare coverage, reimbursement rates, and eligibility under the Régime Local may change and depend on individual circumstances. Always confirm details with Assurance Maladie or a qualified professional.

Photo credits:

Photo by chan lee on Unsplash

Photo by Thomas Dorgler on Unsplash