When a doctor announces diabetes, multiple sclerosis, or cancer, the question of healthcare costs arises very quickly. The Health Insurance has set up a system called ALD 30 to cover 100% of the expenses related to certain serious and chronic diseases. The principle seems simple, but the reality of reimbursement holds several gray areas that this guide details.
Co-payment and ALD: what the 100% really covers
The term “100% coverage” can be misleading. It refers to the full reimbursement of the Social Security reimbursement base, not the actual billed price. The difference is far from trivial.
Specifically, when a specialist charges above the standard fees, the amount exceeding the agreed rate remains the responsibility of the patient or their health insurance. The hospital fee, medical deductibles, and flat-rate contributions do not disappear with ALD status either.
Let’s take a simple example. A patient under ALD consults a cardiologist in sector 2 who charges 70 euros for a procedure with a reimbursement base of 46.70 euros. The Health Insurance reimburses 46.70 euros instead of the usual rate minus the co-payment. The difference of over 20 euros remains due. To find the list of serious illnesses on Zone Santé allows for precise verification of which treatments and examinations are covered for each condition.
According to a study by DREES published on October 7, 2026, the exemption from the co-payment represented 19.7 billion euros in 2025, or about 1,300 euros of additional reimbursement per beneficiary on average. This amount measures the additional coverage provided by Health Insurance, not the remaining costs for the patient.
List of long-term conditions recognized by Health Insurance
The term “ALD 30” is historical. Originally, the list included 30 conditions. Severe hypertension has since been removed, but the name remains. Here are the conditions that appear on this official list:
- Disabling stroke, chronic arterial diseases with ischemic manifestations, severe heart failure, severe rhythm disorders, serious valvular and congenital heart diseases, coronary disease
- Type 1 and type 2 diabetes, cystic fibrosis, severe forms of neurological and muscular disorders (including myopathy), severe epilepsy, multiple sclerosis
- Malignant tumors (cancers), active chronic liver diseases (hepatitis B or C) and cirrhosis, severe primary immunodeficiency, HIV infection
- Severe chronic respiratory failure, Alzheimer’s disease and other dementias, Parkinson’s disease, paraplegia
- Hemophilias and severe constitutional hemostasis disorders, hemoglobinopathies and severe chronic hemolysis, bone marrow failures and other chronic cytopenias
- Severe chronic nephropathy and primary nephrotic syndrome, hereditary metabolic diseases requiring prolonged specialized treatment
- Long-term psychiatric disorders, severe spondyloarthritis, progressive rheumatoid arthritis, ulcerative colitis and progressive Crohn’s disease, post-organ transplant conditions, complicated schistosomiasis, active tuberculosis and leprosy, vasculitis, lupus, and systemic sclerosis
Each condition is associated with a care protocol that specifies the exempt acts and treatments. Only treatments directly related to the ALD benefit from the 100%. A consultation for the flu in a patient with diabetes under ALD follows the standard reimbursement path.
Exempt ALD, ALD 31, ALD 32: distinctions to know
Do you suffer from a chronic illness that is not on this list? Two other categories exist.
ALD 31 concerns serious conditions not on the list that require prolonged treatment of more than six months and costly therapy. ALD 32 applies to disabling multi-pathologies: several diseases that, taken individually, do not justify ALD, but whose combination leads to a disabling state.
The distinction between exempt and non-exempt ALD is also important to understand. A non-exempt ALD entitles the patient to a work stoppage of more than six months, but does not eliminate the co-payment. The patient continues to pay their usual share for each act.
The role of the primary care physician in recognition
The benefit of ALD depends on a medical and administrative assessment. The primary care physician writes a care protocol detailing the diagnosis, necessary treatments, and their expected duration. This document is sent to the Health Insurance medical advisor for validation.
The protocol is time-limited. It can cover a duration of two to five years depending on the condition. Upon expiration, a renewal is necessary. Without renewal, the patient loses the exemption from the co-payment.
Medications and ALD: a recent evolution to watch
A decree published in April 2026 modified the exemption rules for certain medications. This regulatory change affects common medications in the management of chronic conditions. A patient under ALD may therefore receive an unexpected bill at the pharmacy for a treatment they thought was fully covered.
The supplementary health insurance then plays its full role. It covers this differential, provided that the contract includes coverage for ALD-related care. Not all contracts are equal in this regard.
The role of health insurance for patients under ALD
Exceeding fees, the hospital fee, and medical deductibles represent a concrete out-of-pocket expense. For a patient regularly followed by several specialists in sector 2, this amount can reach several hundred euros per year.
Before subscribing to or changing health insurance, three areas deserve special attention:
- The level of coverage for exceeding fees (option “responsible” or supplementary)
- The coverage of the hospital fee in case of prolonged hospitalization, which is common for certain ALDs
- The reimbursement of medical devices (prostheses, equipment) often associated with chronic conditions
The ALD status does not exempt one from having suitable supplementary health insurance. The system covers the mandatory base, while the health insurance covers what Health Insurance leaves aside, including the out-of-pocket costs for certain medications affected by the April 2026 decree.
