Technical article

Who Decides What Your Health Insurance Pays: France, the Netherlands and Greece

Who decides what the public system pays for, and how much is left for us?

By Neil Solomon · 5 min read

Picture a couple named Dan and Carol. Both are 66. At home, their insurer decides what is covered, and they find out after the bill arrives. They are looking at Europe and ask one question. Who decides what the public system pays for, and how much is left for us?

France: a share of every bill

The French health insurance site publishes a table of rates. The rate is the share the system pays. You pay the rest, or a second insurance pays it.

For people who receive certain minimum pensions (FSV or Aspa), the GP rate is 80% and transport is 100%. So in France the rule is written as a percentage for each kind of care. The page I read does not mention complementary insurance. How a newly arrived foreign resident joins is in the section below.

The Netherlands: the government sets one package

The Dutch government says: "Everyone who lives or works in the Netherlands is legally obliged to take out standard health insurance." It also says: "The government decides on the cover provided by the standard package." All insurers offer the same package, and they must charge the same fixed premium whatever your age or health. A separate contribution based on income is also paid.

The National Health Care Institute advises the minister. For medicines, it says: "The National Health Care Institute advises the Minister of VWS on whether to include medicines in the basic package." The minister then decides. Physiotherapy and dental care fall under optional extra insurance. The Dutch government page on the deductible (last changed 28 July 2026) says: "Het verplichte eigen risico voor 2026 is € 385." That is EUR 385 a year (2026) that you pay before the insurer pays for most care. The pages in the sources show no premium amount.

Greece: it depends on where your pension comes from

The page I found is from the Greek contact point for EU cross-border care, last updated 23 December 2021. It is written for EU citizens. For a retiree it says: "If you receive a Greek pension, you are covered by the Greek system." With no Greek pension, treatment is possible if you are entitled to it in the country paying your pension. You ask that country for an S1 form. The page does not list costs. For retirees from outside the EU, no official page is among the sources.

How a newcomer joins

• France. The Assurance Maladie page on universal health protection says that anyone who works, or who lives in France in a "stable and regular" way, has the right to cover. A person who lives in France for more than three months may ask for their rights to be opened. A retired foreign national sends form S1106 with a copy of the passport and a document that proves the stay is regular, such as a residence card or a visa. The list of residence titles that count is in a decree of 10 May 2017 (read 11 October 2026).
• Netherlands. The government page for people who start work says they must arrange Dutch health insurance within 4 months, and that this applies even if they still have foreign insurance. Anyone who lives or works in the Netherlands must take out the standard package. A late start can bring a fine (Rijksoverheid, read 11 October 2026).
• Spain. The Ministry of Health page says that foreigners who are legally and habitually resident, and who do not have to show cover by another route, are entitled to care. Habitual residence is shown by registration at the town hall. The ministry's "special agreement" page describes a paid scheme for people who are not otherwise covered, with no co-payments. It asks for effective residence in Spain for a continuous year before the application and registration with a municipality (read 11 October 2026).

What is left open

• Austria. The social insurance site says the prescription fee in 2026 is EUR 7.55 per package ("Im Jahr 2026 beträgt die Rezeptgebühr EUR 7,55 pro Packung"). The same page names other co-payments, for hospital stays and medical aids, without amounts. How a newcomer joins is not stated on the page in the sources.
• Spain. The Ministry of Health page points to a Royal Decree (1030/2006) that sets the common list of services and how it is updated.
• France, Greece. The waiting time for a newcomer is not stated on the pages in the sources. For Greece, nothing is given for retirees from outside the EU.