Health For Members

Which foreign residents in Italy will have to pay the €2k healthcare fee?

Elaine Allaby
Elaine Allaby - [email protected]
Which foreign residents in Italy will have to pay the €2k healthcare fee?
Who will have to pay to register with Italy's national health service from 2024? Photo by Charly TRIBALLEAU / AFP.

Italy's government has confirmed that a charge of €2,000 will apply to some foreign residents wanting to register with Italy's national health service from 2024. But who exactly stands to be affected by the change?


The introduction of a new minimum charge of €2,000 to register with Italy's public health service has been a source of alarm and confusion among Italy's international residents since it was first announced in the draft budget in October.

As the final 2024 budget law was published at the end of December, the text cleared up some of the uncertainty around what fees would apply to which categories of foreign resident, and who would be exempt - though some questions still remained.

READ ALSO: Q&A: What you need to know about Italy's €2,000 healthcare fee

An Italian health ministry spokesperson told The Local on Tuesday: "As established by the law, the amount of 2000 euros represents the minimum contribution."

See all the details we have so far about how the new rules work below.

Who has to pay?

When it comes to healthcare, Italy divides foreign residents into two categories: those who must register with the national health service (Servizio sanitario nazionale, or SSN) on a 'mandatory' basis, and those who have the option of registering on a 'voluntary' basis.

Anyone who falls into the 'mandatory' category has the right to register for free, while those who fall into the 'voluntary' category must pay to register.

Until the start of 2024, that charge was calculated on the basis of an individual's income, and ranged from €387.34 to €2,788.87.

Under changes introduced in Italy's 2024 budget law, the progressive rate has changed drastically, and fees for almost (see below) all 'voluntary' now begin at €2,000.


Who falls into the 'mandatory' category?

According to the Italian health ministry, those entitled to free mandatory registration by right are:

  • Residents who have a regular ongoing contract with an Italian employer, are self-employed, or are registered on Italy's unemployment lists (liste di collocamento).
  • People waiting for their residency permit to be issued on the basis of employment or family reasons.
  • People waiting for their residency permit to be renewed on the basis of employment or self-employment, for family reasons, for asylum, for subsidiary protection, 'special cases', or special protection; for medical treatment, for those waiting to adopt or foster children, and for those in the process of acquiring citizenship.
  • Dependant family members of people in the above categories.
  • All minors, including unaccompanied foreign minors, regardless of their legal basis in Italy.

READ ALSO: Public vs private: What are your healthcare options in Italy?

Some foreigners will have to pay significantly more to use Italy's healthcare service following a 2024 budget announcement.

Some foreigners will have to pay €2,000 to use Italy's healthcare service starting this year. Photo by Piero CRUCIATTI / AFP.

Who falls into the 'voluntary' category?

Almost everyone not named in the 'mandatory' list falls into the 'voluntary' category. According to the health ministry, that includes, but is not limited, to:

  • Students and au pairs, including those in the country for less than three months (the maximum period you can stay in Italy before registering as a resident).
  • People in Italy on an elective residence visa.
  • Religious personnel.
  • Diplomatic and consular staff of foreign governments and organisations, unless employed under an Italian contract (in which case they have the right to mandatory registration).
  • Volunteers.
  • People over the age of 65 in Italy for family reunification reasons, who arrived after November 5th, 2008.


Foreigners in Italy on a medical treatment permit and those in the country for tourism purposes are not eligible for voluntary registration.

If you're unsure which category you fall into, you should ask your commercialista (Italian accountant) for clarification.

READ ALSO: 'Very professional but underequipped': What readers think of Italy's hospitals

Are there any exceptions?

Non-EU foreigners in Italy on a study permit and au pairs pay a discounted rate - although under the new rules, they'll still have to pay significantly more than they did in the past.

Students will pay at least €700 euros, up from the previous rate of €149.77. Au pairs, meanwhile, will be charged €1,200, an increase from €219.49.


Am I legally required to pay the fee?

No - if you fall into the 'voluntary' category, you can opt to pay for private insurance instead of paying to register with the SSN.

Either way, you must have healthcare coverage as an Italian resident.

What if I'm an EU citizen/covered by the Brexit withdrawal agreement?

Many of The Local's British readers living in Italy have asked since the plan's announcement whether the new charge would apply to them or if they would be exempt under the post-Brexit Withdrawal Agreement.

An Italian health ministry spokesperson told The Local on Tuesday: "British citizens resident in Italy before Brexit, covered by the Withdrawal Agreement, who have acquired a permanent right, retain the right to compulsory registration."

This appears to mean nothing has changed under the new law for British residents who were previously entitled to free (or 'mandatory') registration.

The Local has contacted Italy's health ministry and finance ministry for clarification on the situation of EU citizens

Please note that The Local is unable to advise on individual cases. For more information on how the revised healthcare fees may apply in your situation, consult your local Asl office or your Italian commercialista (accountant).


Join the conversation in our comments section below. Share your own views and experience and if you have a question or suggestion for our journalists then email us at [email protected].
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Robert 2024/01/31 17:11
Hi. I have previously been told once I reached state pension age, I will be entitled to state healthcare (mandatory). However, it looks like that isnt the case for those of us who obtained elective residence after the Brexit cut-off. Is that correct?
Matthew W 2024/01/30 16:57
Regarding my comment on 18 Jan about the €20,658.27. Just checked my notes again, and I think what the ASL person said was there was a minimum of €2,000 to pay on income up to €31,924, and that I would have to pay 4% on income above that up to an upper income threshold of €51,645.69. This upper threshold was the pre-2024 budget number, and she wasn't sure if it had changed. Anyone heard anything about this changing?
Matthew W 2024/01/18 13:54
I am an Irish citizen married to an Italian. We’ve been living in the US for 25 years and have just (8/1/24) registered as residents in a commune in Puglia. - Should we be charged at all (I am an EU citizen, but haven’t been part of an EU health care system for 30 years; my wife is an Italian citizen) - should I be charged, and my wife not charged - Should we both be charged? Btw the person at the ASL also told us that the €20,658.27 on which one would pay 7.5% had been pushed up to €31,924.
  • Clare Speak 2024/01/18 16:34
    Hi Matthew, Thanks for your comment. Hopefully the ASL can confirm whether and how the fee applies in your case, but for now here's our most recent article with more detail: Thanks too for letting us know what the ASL said about the amount for the calculation going up - we'll look into what's happening with that. - Clare
Margaret Hoskins 2024/01/11 18:38
We are resident pre Brexit but do not fall under the mandatory category as we are not yet old enough to claim our UK state pension and hence our S1 forms. We should claim our S1's in the next couple of years and also reach our 5 years required to move to permanent residency. Will we still have the right to move to the mandatory category then under the Withdrawal Rights?
  • Clare Speak 2024/01/12 14:10
    Hi Margaret, It seems that if you're covered by the WA then nothing should change for you. There has been no mention of a change to the rules on who is eligible to move to the mandatory category - just to the fees due if you're not. We would advise speaking to your local Asl office though to confirm how the rules apply in your situation. Thanks for reading, - Clare
William 2024/01/10 19:29
Thanks for all this information and for the revision. Do you have any information on what the sliding scale of payments for non-EU residents will be beyond the €2000 minimum?
  • Clare Speak 2024/01/11 16:01
    Good question. There has been no mention of the upper limit being raised, so it appears to still be on a means-tested sliding scale between €2,000 and €2,789. We'll check this though and publish any further information we get. Thanks for reading. - Clare
Jacky 2024/01/09 10:03
I am shortly to gain Irish citizenship and will therefore be a EU citizen. All reports talk of non-EU residents so does anybody know how I will be effected?
Peter Conover 2024/01/09 09:58
My wife and I just registered for the SSN last week (for the first time). Based on our 2023 income we paid the "current" maximum of €2789 each. The ASL agent wasn't aware of plans for a FLAT fee of €2000, but he seemed to think that would be the new minimum. Obviously, we will monitor this, but I'm dubious we would be intitled to any kind of refund. FYI, we are in Lombardia.
  • Clare Speak 2024/01/10 13:56
    Hi, the health ministry has now confirmed that €2000 is the new minimum fee. The article has been updated. Thanks for reading, - Clare
Vian Andrews 2024/01/09 06:22
What about spouses of Italian citizens both of whom are resident in Italy? What category do such people fall into?
  • Clare Speak 2024/01/10 14:06
    Hi, if you were previously entitled to free healthcare then this should not change, but it would likely depend on whether you meet the criteria listed in the article. It is complex though so you may need to ask your local Asl office to confirm. Thanks for reading, - Clare
Kevin Partington 2024/01/08 20:47
Does anyone know if those people from the UK who had residency before Brexit must pay the new healthcare charge? Kevin
  • Clare Speak 2024/01/10 13:57
    Hi Kevin, the Italian health ministry has now confirmed that UK nationals resident before Brexit would not have to pay the new charge if they were previously entitled to free healthcare. Here's our update:

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