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Who can register for national healthcare in Italy?

The Local Italy
The Local Italy - [email protected]
Who can register for national healthcare in Italy?
Registering for public healthcare in Italy will allow you to get medication at a subsidised rate. Photo: Andreas Solaro/AFP

Who is entitled to free registration with Italy's national service health service, and what are the options for people who aren't? Here's a guide to the basics.

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The Italian National Health Service (SSN – Servizio Sanitario Nazionale) is open to anyone living in Italy, and registering with it guarantees foreign residents all the same care available to Italian nationals at the same cost.

But that process is more straightforward – and cheaper – for some than for others.

Here's what you need to know about registering with Italy's public healthcare system.

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Who can register for free?

Certain people are entitled to iscrizione obbligatoria, 'mandatory registration' or 'registration by right', in the national health service.

That means you can register with the SSN for free.

Iscrizione obbligatoria applies to the following categories:

  • Immediate family members of an Italian citizen living in Italy
  • People with a valid work contract from an employer in Italy
  • Self-employed people with a partita IVA (VAT number)
  • People who previously worked in Italy but are currently unemployed and registered on the unemployment lists (liste di collocamento)
  • People who have a residence permit expressly for the purpose of applying for citizenship, fostering or adopting children, or because they are pregnant or have given birth in the past six months
  • Asylum seekers, refugees and others under international protection

People in these categories are also allowed to register their spouse, children or other dependents under the same conditions, with the exception of elderly parents.

Who else can register?

If you don't fall into any of these categories, you can also opt in to the Italian health service (iscrizione volontaria or 'voluntary registration').

It involves paying an annual registration fee in order to access public healthcare.

Once registered, you'll pay the exact same for the care you receive as people who enrolled for free.

READ ALSO: Tessera sanitaria: How do you apply for or renew your Italian health card?


Photo: Filippo Monteforte/AFP

Voluntary registration is open to anyone legally resident in Italy who doesn't qualify for free registration, notably non-working elective residents, students, diplomats, volunteers, people aged 65 or over who have moved Italy to be with their children, or anyone else who doesn't pay social security contributions.

The only condition is that you must be staying in Italy for more than three months – unless you are a student or an au pair, in which case you are still allowed to register for healthcare during a short stay at a redced fee.

You can also extend voluntary registration to your dependent family members.

How much does it cost?

The fee for voluntary registration is calculated by your local health authority (ASL – Azienda Sanitaria Locale) according to your means. It therefore varies depending on where you live in Italy and your financial circumstances.

The minimum annual fee is €387.34, rising to a maximum of €2,788.86. One fee also covers any dependents you're registering at the same time.

READ ALSO: Codice fiscale: How to get your Italian tax code

Students and au pairs can benefit from fixed fees of around €150 and €220 respectively, though this will not allow you to register any dependents (you can do so by opting to pay the full fee instead).

NB: the fee is fixed for the calendar year, so you'll pay the same amount whether you register in January or November. If it's late in the year, it might work out better value to wait and if necessary use private healthcare for a month or two before registering.

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How do you register?

You register directly with your nearest ASL. Find a list here

You will need:

  • Your passport
  • Your certificate of residence (for EU citizens and Brits) or permesso di soggiorno (for non-EU citizens), or an official receipt to show you have applied for it
  • Your codice fiscale, or tax code
  • For iscrizione obbligatoria: a work contract, payslip, declaration from an employer, VAT registration, UK S1 form, or any other document that shows your entitlement to free registration.
  • For iscrizione volontaria: evidence of your previous year's income, such as a tax return.
  • If registering dependents: birth or marriage certificates that document your relationship, as well as evidence of family members' income.
  • If registering as a student or au pair: proof of enrolment in a study programme or a contract with a family.

Ask your ASL exactly which documents you require for your particular circumstances.

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If you're registering voluntarily, you'll also need to have your ASL calculate your annual fee, which you have to go to the nearest Post Office to pay by postal order (bollettino postale). You'll then return to the ASL office to show receipt of payment and complete your registration.

Either way, be prepared for multiple consultations – in person – before the process is complete.

And since registration is annual, you can expect to repeat it all over again the following year.

READ ALSO: How do you renew your Italian health card?

The following video explains the process for British nationals and may be applicable to others too:

What are you entitled to once you register?

The benefits of registering are that you'll be able to access the Italian public healthcare system for free or at a subsidised rate.

Once registered, you'll receive a tessera sanitaria or health card that shows you're entitled to public healthcare. You can also register with a family doctor (medico di base) and register your children with a paediatrician, whom you can consult without charge.

Other forms of care may require you to pay part of the cost (a co-pay known in Italian as the ticket), but the amount will be subsidised by the national health service.

READ ALSO: How to book a doctor's appointment in Italy

Registering can also help you secure residency in Italy: proving you have healthcare is a condition of being granted a residency permit, in many cases, so if you've registered with the SSN (or can at least show you're in the process of doing so), that will meet the requirement.

However, since residency is a condition of registering it can be a Catch-22 situation. You may be able to persuade officials to accept provisional documents, but there are no guarantees.

You might find it more expedient to take out private health insurance in the short term to allow you to secure the residency permit you need to register with the SSN; or if you prefer, you can opt to skip the public health system altogether and pay for private care throughout your time in Italy.

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Comments (4)

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Anonymous 2023/01/12 13:57
I have been told that even Italians pay for their healthcare out of their paychecks, so no Italian health insurance is actually free to anyone. I think absolutely everyone must pay annually according to their income levels. I see many Italians in line each year to file their form, just like me. Can anyone with for-sure knowledge about this comment and instruct or perhaps the editors of local.it search for the guidance because I also have been here now over 5 years and would love to stop paying thousands per year if it were possible. And lastly, can someone informed about this also comment on whether as a voluntary participant in the system we are only entitled to Italian healthcare, so whenever we travel in other European countries are we in need of purchasing supplement travel insurance? Many thanks!
Anonymous 2021/05/01 17:26
Just a comment about the article - after you've been legally resident for 5 years, you no longer have to pay for your tessera sanitaria. I don't know if that only applies to people who've paid in from the start of their official period of residency, or whether people who have had private heath insurance can "claim" their card when they become permanently resident. I also assume this will only apply to those of us who are here on pre-Brexit terms. We're retired in Marche and currently pay around €2,700 a year (for two of us), as we have a combined household income of over €50,000 per annum (the top band in our region) and aren't of UK state pension age.
  • Anonymous 2021/08/18 18:59
    I thought that the tesserae sanitary was free after 5 years but was told it did not become free until after you receive Italian citizenship. Which is hard to do unless you study Italian and get the appropriate language certificate from the University or College
Anonymous 2020/12/18 19:01
"f you prefer, you can opt to skip the public health system altogether and pay for private care throughout your time in Italy". It is true that proving that you have a private health care insurance policy helps. But (and it is a BIG BUT), you might find (as we did after having paid out thousands of euros in premiums for 3 years) that you cannot access your private insurance benefits without having a tessera sanitaria and going through your local public medico.
  • Anonymous 2021/03/08 22:09
    Oh my god, that’s awful! I have private insurance for this year 2021 but how do I see a doctor? Can I go to any doctor? Wouldn’t I have to register first? I ask this because when I went to register with a doctor, I was told by the ASL (and the doctor I’d chosen in my village), that I couldn’t see her because I wasn’t registered with the health service! It seemed like a catch 22 situation.
Anonymous 2020/12/17 14:26
Just FYI, your codice fiscale needs to have your address in Italy. I got a codice when I moved here before finding a house and realised I had to change the address when I applied for the health card.

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