IDEL bookkeeping in France: the self-employed nurse and micro-BNC

“Self-employed nurse in a micro-entreprise (France’s micro-business regime)”: that’s what many IDELs (self-employed registered nurses) search for when setting up, and the answer comes in two steps. A self-employed nurse under the national agreement (conventionnée) can’t be an auto-entrepreneur (a self-employed person under France’s micro-business regime): the URSSAF (the body that collects social-security contributions) says so in black and white. On the other hand, she can choose micro-BNC, the simplified tax regime, which calculates her tax and her contributions on her takings after a flat-rate allowance (abattement forfaitaire). This IDEL bookkeeping “on the micro” is simple, but it has nothing to do with an auto-entrepreneur’s monthly declarations. Here’s how it works, then what changes for physiotherapists, speech therapists, orthoptists and chiropodist-podiatrists.

The rules and figures are those in force in 2026, checked on urssaf.fr, ameli.fr, carpimko.com, impots.gouv.fr, the BOFiP (the tax administration’s official doctrine) and Entreprendre.Service-Public.fr on 30 September 2026.

Why a self-employed nurse isn’t an auto-entrepreneur

The auto-entrepreneur, officially the micro-entrepreneur, falls under the micro social-security regime (régime micro-social): they declare their turnover to the URSSAF every month or every quarter and pay a percentage of it. This regime isn’t open to health professions under the national agreement.

The URSSAF is explicit: « En tant que praticien ou auxiliaire médical vous ne pouvez pas être auto-entrepreneur. » (As a practitioner or medical auxiliary, you can’t be an auto-entrepreneur.) A nurse who practises under the agreement with the Assurance maladie (the national health insurance) falls under, according to Service-Public, the PAMC scheme (praticiens et auxiliaires médicaux conventionnés, for health professionals under the national agreement). Her contacts are:

• the URSSAF for her contributions, except pension;
• the CPAM (the local health insurance fund) for her health cover and her billing;
• CARPIMKO (the pension fund of nurses and allied health professionals) for her pension and her provident cover.

What she can choose is her tax regime. And the micro-entreprise’s tax regime, micro-BNC, is open to her.

The micro social-security regime and the micro tax regime (régime micro-fiscal) are two separate things. The auto-entrepreneur has both. An IDEL under the national agreement can have the micro tax regime (micro-BNC), never the micro social-security regime. It’s the most frequent confusion at the time of setting up.

Micro-BNC for an IDEL: how it works

According to Service-Public, you can fall under micro-BNC if your takings excluding VAT didn’t exceed €83,600 in 2025 or in 2024 (the threshold applicable to 2026 income). You only leave it if that threshold is exceeded two consecutive years.

Under micro-BNC:

• you don’t deduct your actual expenses; the tax administration applies a flat-rate allowance of 34%, with a minimum of €305;
• your taxable profit is therefore 66% of your takings;
• you declare your gross takings once a year, on your income tax return, with no business return, form 2035 (the BNC results return).

Your social-security contributions follow the same logic: since the reform of the contribution base, the URSSAF calculates them, for PAMC under the micro tax regime, on your takings after the same 34% allowance.

The 34% flat rate never looks at your actual expenses. If your car, your rent and your equipment come to more than that third of your takings, the déclaration contrôlée (the BNC standard regime), on the real regime, may make you pay less. The article leaving the micro regime explains the switch and the 2035.

How you declare your income: a single return

PAMC no longer have a separate social declaration. According to the tax office’s 2026 brochure, you declare your income on impots.gouv.fr, in your usual income tax return, completed with a volet social PAMC (the PAMC social section). The data is passed automatically to the URSSAF and to your pension fund.

Three rules for this return:

• it’s mandatory, even if your income is nil or a loss, even if you’re not taxable;
• if it’s late, a penalty of 5% of your social-security contributions and levies applies;
• a paper return passes nothing to the URSSAF: do it online.

If you don’t see the social section, tick the box stating that you fall under « du régime des praticiens et auxiliaires médicaux conventionnés - PAMC » (the scheme for practitioners and medical auxiliaries under the national agreement), at the start of your return.

Your URSSAF contributions

For the first two years, since no income is known yet, the URSSAF calculates your contributions on flat-rate bases: 19% of the annual social security ceiling, i.e. €9,131, in particular for family allowances; 40%, i.e. €19,224, for sickness and daily allowances. They’re then adjusted to your actual income. You pay on the 5th of each month, or on 5 February, May, August and November if you chose quarterly payment.

The rates the URSSAF publishes for a medical auxiliary:

The advantage of the agreement is the coverage (prise en charge): the Assurance maladie pays most of your sickness contribution on the income from your activity under the agreement, excluding fees above the agreed rates (dépassements d’honoraires).

If your actual activity differs a lot from the starting flat rate, declare an estimated income in your area on urssaf.fr. The URSSAF recalculates your contributions, and a gap with your actual income carries no penalty.

Your pension and provident cover: CARPIMKO

Your pension doesn’t go through the URSSAF. It falls under CARPIMKO, the fund of nurses, masseur-physiotherapists, chiropodist-podiatrists, speech therapists and orthoptists. You contribute to four schemes:

CARPIMKO contributions are payable annually and in advance. The basic pension contribution is adjusted the following year, once your income is known from the return filed on impots.gouv.fr.

With the URSSAF on one side and CARPIMKO on the other, your charges aren’t a simple percentage of your takings, as they are for an auto-entrepreneur. The CARPIMKO flat amounts (€1,022 for disability-death, the ASV share) are due even with small takings: set money aside every month.

VAT: care is exempt

You don’t charge VAT on your care. Article 261, 4, 1° of the CGI (the general tax code) exempts care provided to people by members of the regulated medical and paramedical professions, including nurses, masseur-physiotherapists, chiropodist-podiatrists, speech therapists and orthoptists.

The BOFiP sets one condition: the act must have a therapeutic purpose, that is, to prevent, diagnose, treat or cure. The exemption doesn’t cover:

• expert assessments, which have no therapeutic aim;
• wellness or cosmetic services with no medical purpose;
• sales of products unrelated to care.

If you have an activity of this kind on the side, it follows the ordinary VAT rules, the franchise en base de TVA (the VAT exemption for small businesses) included. The article on VAT for auto-entrepreneurs details the franchise thresholds.

Billing your patients and the Assurance maladie

Your care is billed to the Assurance maladie by electronic treatment form (feuille de soins électronique, FSE), via SESAM-Vitale. ameli.fr guarantees it: as soon as you send an FSE, you’re paid on the basis of the information on the patient’s carte Vitale (health insurance card), whether it’s up to date or not.

The tiers payant (direct billing) saves the patient from paying upfront: the Assurance maladie pays you the statutory share directly, or even the whole amount together with the top-up insurance. It’s mandatory, in particular, for:

• patients with a long-term condition (ALD) or on maternity cover;
• victims of a workplace accident or an occupational disease;
• beneficiaries of the complémentaire santé solidaire (CSS, the state-supported top-up health cover);
• beneficiaries of the aide médicale de l’État (AME, state medical aid).

The BOFiP states that your receipts book (livre des recettes) follows the micro-BNC rules: for each payment received, the identity declared by the patient, the amount, the date and the form of payment. Transfers from the Assurance maladie go in like any others. The article on the receipts book shows what it looks like.

Setting up under the agreement: what ameli asks for

The nurses’ national agreement sets the conditions for setting up as a self-employed nurse under the agreement.

Experience. You must show, in the six years before your application, 24 months of experience (3,200 hours) in a general care facility, or 6 months (800 hours) as a locum (remplaçante) and 18 months (2,400 hours) in a care facility.

Location. Access to the agreement depends on the zone:

• in an over-served zone, a new practice is admitted to the agreement only to replace a departure;
• in a very under-served zone, incentive contracts signed with the CPAM and the ARS (the regional health agency) pay an allowance: €27,500 over five years for a new practice, €37,500 over five years for a first practice, €3,000 a year for a nurse already in practice.

The steps. You register with the Nursing Council (ordre des infirmiers), you get your number from your CPAM and you complete the formalities for setting up your practice, then you declare your activity on the guichet unique (the one-stop business formalities portal, run by INPI), formalites.entreprises.gouv.fr, no later than 8 days after you start your activity.

As a locum, you take on the agreement status of the nurse you replace, and she passes your fees back to you (fee-sharing, rétrocession d’honoraires), without the Assurance maladie being involved. The URSSAF asks you to complete the same steps as when starting an activity before any locum work.

Physios, speech therapists, orthoptists, chiropodist-podiatrists: what changes

Everything above also applies to the other medical auxiliaries under the agreement: no auto-entrepreneur status, micro-BNC possible below €83,600, PAMC contributions to the URSSAF, pension with CARPIMKO, VAT-exempt care. A few differences:

Masseur-physiotherapists

The same rules as the IDEL for the regime and the funds. Watch the VAT boundary: a wellness massage with no therapeutic purpose isn’t exempt care, according to the BOFiP. Keeping it separate in your receipts book makes your return easier.

Speech therapists and orthoptists

Before affiliation, the URSSAF asks you to register your diploma with the departmental office of the regional health agency (Agence régionale de santé) where you live, then to contact your CPAM and declare your activity on the guichet unique.

Chiropodist-podiatrists

It’s the only medical auxiliary profession that can choose its scheme when setting up: PAMC, or the scheme for non-PAMC liberal professionals.

• Under PAMC, the Assurance maladie covers part of your contributions, but you pay an additional sickness contribution of 3.25% on your income from fees above the agreed rates.
• As a non-PAMC liberal professional, there’s no coverage, but no additional contribution either.

The URSSAF sums up the test: if a large share of your income appears on your SNIR statement (the CPAM’s fee statement), the PAMC scheme is more advantageous; if it’s small, the liberal scheme is. Its online simulators let you compare.

In short

• An IDEL under the agreement is never an auto-entrepreneur: she falls under the PAMC scheme.
• She can choose micro-BNC below €83,600 of takings: tax and contributions on 66% of takings.
• A single return a year, on impots.gouv.fr, with the volet social PAMC.
• Sickness contributions largely covered by the Assurance maladie on the activity under the agreement; pension and provident cover with CARPIMKO.
• No VAT on care with a therapeutic purpose.

Caring is your job: once the line between micro-BNC and auto-entrepreneur is clearly drawn, your bookkeeping can stay where it belongs, in the background.
💜💙 Your BravoLisa Team

This article is for general information purposes only and does not constitute professional tax, legal, or accounting advice. Every situation is different — consult a qualified professional (tax adviser, accountant, or lawyer) for advice specific to your circumstances. BravoLisa does not accept liability for decisions made based on this information.

Last updated: September 2026. Rates and thresholds can change: always check with the URSSAF, impots.gouv or the relevant authority.

Sources (12)

Verified on 30 September 2026

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6. Entreprendre.Service-Public.fr — Régime fiscal de la micro-entreprise
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8. CARPIMKO — Ma cotisation invalidité-décès
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