Country guide — Africa and the Indian Ocean
Expat insurance and health insurance in Madagascar
In short
Madagascar imposes no legal health insurance requirement for a French national on entry or for most stays, but France Diplomatie calls it essential: Malagasy healthcare facilities don't meet European standards, and the only recourse for a serious case is evacuation to Réunion or France. The France-Madagascar social security agreement (1967/1968) doesn't coordinate sickness cover generally; only an annex protocol maintains cash benefits for 6 months when transferring residence. An employee in Madagascar falls, for health-maternity cover, under an inter-company health scheme funded by their employer (OSTIE, AMIT...), unconnected to French social security. Without cover, the private facilities in Antananarivo — the only ones truly equipped for imaging or surgery — require payment for care upfront.
Key figures
- 17,155 French nationals registered with the consular register in 2025 (17,602 in 2024, -2.54%).
- Life expectancy at birth: 63.84 years in 2024.
- Health spending: 17.44 USD per capita in 2023, 3.43% of GDP.
Local healthcare system
Madagascar has no social security scheme covering sickness for the whole population. The CNaPS (National social welfare fund) only manages workplace accidents, old-age/disability/death and family benefits for formal-sector employees — around 10% of the working population. Health-maternity cover for employees falls under separate inter-company health schemes (OSTIE, AMIT, ESIA, FUNHECE...), which every employer must join. Universal health coverage (CSU) has been under construction since the 2015 law, with a new 2025-2030 sector plan, but its rollout remains very gradual. In practice, nearly all French residents rely on the private sector, concentrated in Antananarivo, the only city with technical facilities comparable to Western standards (CT scanner, operating theatre, doctors trained abroad).
Legal and visa obligations
- No Malagasy legal requirement for health insurance identified for entry, stay or a resident card.
- France Diplomatie calls taking out an assistance contract essential, covering hospitalisation, medical costs and repatriation/medical evacuation — local healthcare facilities "don't meet European standards" and the only recourse for a serious case is a transfer to Réunion or France.
- The visa application (short or long stay) generally lists travel insurance among the required documents, without a specific health cover formally required beyond that.
- Yellow fever vaccination is required only when arriving from a risk area for transmission (not for every traveller departing from France).
- The French state points towards the CFE — Madagascar classed in zone 1, with reimbursement of up to 67% of hospitalisation costs —, to be supplemented with a mutuelle.
Cost of some medical procedures
Orders of magnitude from specialised sources, not official fee schedules.
| Procedure | Public sector | Private sector |
|---|---|---|
| GP consultation (public sector) | 5,000 to 15,000 Ar | — |
| GP consultation (private sector) | — | 30,000 to 80,000 Ar — sources consulted diverge (20,000 to 100,000 Ar depending on facility) |
| Specialist consultation | 10,000 to 25,000 Ar | 50,000 to 150,000 Ar |
| Hospital room (night, private sector) | — | ≈100,000 to 400,000 Ar/night (excluding care and fees) |
| Common surgical procedure (appendicitis, fracture) | — | ≈1,000 to 5,000 € (private clinic rate) |
| Childbirth | — | rate varies by facility, not reliably published publicly (sources consulted diverge strongly) |
| Medical evacuation (medically equipped flight to Réunion or France) | — | ≈15,000 to 40,000 € |
| Ambulance / SAMU (no. 124, Antananarivo) | rate not published publicly | rate varies by facility, not published publicly |
Social security agreements with France
The France-Madagascar social security agreement, signed on 8 May 1967 (in force since 1 March 1968), coordinates workplace accidents and occupational diseases as well as family benefits. Sickness isn't subject to general coordination.
An annex protocol of 8 May 1967 maintains health insurance cash benefits for a limited period of 6 months when transferring residence — a temporary maintenance of rights, not cover for care received locally.
- No reimbursement of care received in Madagascar under a French pension (confirmed by CLEISS).
- A seconded employee can, under conditions and per the general French secondment rules (independent of the bilateral agreement), remain registered with their French scheme and get reimbursed for care received abroad on presentation of form S 3125c.
- The agreement covers neither unemployment nor sickness for the self-employed.
Which insurance for my profile
General matrix — does not recommend any specific product or insurer.
| Profile | Regulatory constraint | Points of attention |
|---|---|---|
| Working holiday visa | No France-Madagascar agreement identified | Not applicable |
| Student | No specific legal health insurance requirement confirmed for the student visa, beyond travel insurance generally requested in the application | Check the host institution's own requirements; health/repatriation cover strongly recommended as for all residents |
| Seconded employee / expat | The 1967 agreement excludes general sickness cover; the employer must register the employee with a Malagasy inter-company health scheme (OSTIE, AMIT...) | This local registration doesn't replace cover recognised in France; CFE or private insurance recommended in addition |
| Retiree | No sickness cover via the agreement; CLEISS confirms the absence of reimbursement for care received in Madagascar | CFE (zone 1, up to 67% of hospitalisation) or private insurance essential, with medical evacuation included |
| Family with children | No specific scheme identified for children | Check the registration of each family member separately, especially if a parent is locally employed |
Hospitals and care network
- Antananarivo — Polyclinique d'Ilafy: reference private facility for expats and embassies, on-site CT scanner, team partly trained in France.
- Antananarivo — Espace Médical (Ankadivato / Ambodivona): emergency department, hospitalisation, imaging and operating theatre, recommended by several embassies.
- Antananarivo — CHU Joseph Ravoahangy Andrianavalona (HJRA): main reference public hospital, 24/7 emergency department, significant waiting times.
Practical steps
- Before departure: check the contract covers medical evacuation to Réunion or France — the only recourse for a serious case per France Diplomatie —, in addition to hospitalisation and medical costs.
- Before departure: medical consultation/vaccination centre visit to assess the need for yellow fever vaccination (depending on origin), hepatitis A/B, typhoid, and malaria prophylaxis suited to the area.
- Employee: check that the employer registers the position with an inter-company health scheme (OSTIE, AMIT...) for health-maternity cover.
- Registration with the roll of French nationals living abroad recommended (Consulate General in Antananarivo).
- Voluntary CFE registration recommended given the absence of sickness coordination (Madagascar classed zone 1).
Frequently asked questions
Is health insurance mandatory to settle in Madagascar?
Not legally, but France Diplomatie calls it essential: local healthcare facilities don't meet European standards, and the only recourse for a serious case is evacuation to Réunion or France, at the traveller's expense without cover.
Does French social security cover me in Madagascar?
Not for sickness: the 1967 agreement doesn't coordinate this branch generally. Only an annex protocol maintains cash benefits for 6 months when transferring residence.
Is an employee seconded to Madagascar covered by a local scheme?
Their employer must register them with a Malagasy inter-company health scheme (OSTIE, AMIT...) for health-maternity cover, but this local cover doesn't replace insurance recognised in France.
What does the CFE cover in Madagascar?
Madagascar is classed zone 1 by the Caisse des Français de l'étranger, with reimbursement of up to 67% of hospitalisation costs; supplementary mutuelle cover remains necessary for the rest.
What happens in a serious emergency without cover?
The private facilities in Antananarivo, the only ones truly equipped, require payment for care upfront; without insurance, a medical evacuation to Réunion or France can cost 15,000 to 40,000 €.
Moving to Madagascar? Get a quote
Written by Expavy
Sources
- France Diplomatie — Madagascar, Health
- France Diplomatie — Madagascar, Entry / stay
- France Diplomatie — Register of French nationals abroad (carte-registre, 2024-2025 data)
- CLEISS — France-Madagascar social security agreement
- CLEISS — Social security in Madagascar (CNaPS, inter-company health schemes)
- CLEISS — Working in Madagascar as a seconded employee
- CLEISS — Retiring in Madagascar
- World Bank — Life expectancy at birth, Madagascar
- World Bank — Current health expenditure, Madagascar (% GDP and per capita)
- Mada360 — Getting treated in Antananarivo: clinics, specialists and costs by need
- Magellan.mg — Health, emergency and cover guide for expats in Madagascar (2026)