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Hello,

I think the AI (LLM) is leading you astray, there is no gray area for residency to qualify for carte vitale nor PUMA.  I posed your exact question to Claude and as I usually preface it with facts only, no guessing, tell me if you do not know the answer do not hallucinate or make things up.  This is what I got back with references:

PUMA eligibility runs on residence stable et régulière, continuous residence of 3+ months and at least 6 months (183 days) in the calendar year. That's set out in CSS Article L160-1, which establishes that coverage depends on working, or if not working, residing in France in a stable and regular manner, and explicitly says the residence condition is assessed under the rules in Article L111-2-3, the same framework used for tax residency. This isn't a separate, looser bar than tax residency, it's the same continuous-presence logic, and CPAM audits it. Enrollees face random checks on where they actually live, since they have to prove 6 months of residence over the past 12 months when asked.

There's no separate "buy-in on income" tier for people who stay under that threshold. The income-based mechanism that does exist, the cotisation subsidiaire maladie, is a surtax on capital and investment income charged to people who already qualify for PUMA through residency. It's a cost layered on top of qualifying, not a substitute for qualifying. Someone without professional activity who resides in France stably and regularly can owe this contribution if they have property or capital income roughly between 23,184€ and 370,944€ and can't be exempted, but that's contingent on already meeting the residence test, not a way around it.

If you want a definitive answer instead of forum speculation, Cleiss (Centre des Liaisons Européennes et Internationales de Sécurité Sociale) handles exactly this kind of cross-border eligibility question in writing and will confirm the same thing without hedging.

Article L160-1:

ameli.fr PUMA overview:

Urssaf on the cotisation subsidiaire maladie: