Trouble proving residency rights leaves Brits in Italy paying €2k health charge

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Trouble proving residency rights leaves Brits in Italy paying €2k health charge
The huge increase in Italy's minimum healthcare fee puts British residents' difficulties in proving permanent residency rights into sharp focus. Photo by Martha Dominguez de Gouveia on Unsplash

Amid a lack of clarity about who has to pay Italy's increased healthcare fees, citizens' rights campaigner Clarissa Killwick says British nationals are wrongly being charged despite having permanent residency rights.


UK nationals living in Italy are stuck in limbo: being permanent residents but unable to prove it.

A permanent resident has at least five years' residency, whereas with less than five years you are an ordinary resident.

Why does this matter? Under the Withdrawal Agreement (WA), a permanent resident can be absent from Italy for up to five years in one go whereas for ordinary residents it is generally a maximum of six months per year. Consider someone who needs to return to the UK temporarily to care for elderly or sick family members, for example. 

Secondly – and this clearly would affect more people - there are important implications regarding healthcare. And having continuous healthcare cover in some form is required for maintaining legal residency.

Broadly, under the Withdrawal Agreement, WA beneficiaries must receive equal treatment to EU citizens in their host countries. EU citizens in Italy with an “attestazione soggiorno permanente” qualify for free registration for state healthcare, (as do ordinary residents who are employed/self-employed, amongst others such as S1 holders.)

For those who don’t qualify for free registration, the options are private healthcare insurance or voluntary contributions to the state system. 

From 2024, minimum voluntary contributions have jumped from just under €390 to €2,000 per year per person - an increase of around 500 percent. That’s without going into detail into how students are affected.

READ ALSO: Do Italy’s British residents have to pay the €2,000 healthcare fee?

As yet there are no unequivocal guidelines as to who exactly is in scope of these new rules – just non-EU citizens, or non-EU and EU, therefore WA beneficiaries too?

There could also be a legal argument concerning the principle of proportionality given the size of the increase. 


In the meantime, some UK nationals are already being charged €2,000 by their local health authorities. This is particularly harsh for those who are permanent residents, as they should not be paying at all.

Why can’t they evidence their status? Some town halls are refusing to issue WA beneficiaries the attestazione di soggiorno permanente, the same as they do for EU citizens. This is in spite of an Italian government circular stating it should be provided. (Circolare n. 2/2021 Oggetto: Brexit - Attuazione dell’Accordo sul recesso del Regno Unito e dell’Irlanda del Nord dall’Unione Europea.)

The best evidence of residency status for WA beneficiaries is the WA biometric residency card from provincial immigration offices but a significant number are refusing to issue a permanent card, (carta di soggiorno permanente Articolo 50 TUE), until five-year ordinary residency ones expire. This is in breach of the Withdrawal Agreement under article 18.4.

Even when immigration offices are willing, there can be very long delays. Communications can be difficult or, in the case of the Perugia questura, for example, non-existent.

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

In another region, one of our members has managed to get the permanent card but her health authority will not accept it for free registration. We have communicated, via the embassy, that the guidelines need to be very explicit about WA beneficiaries so there is no room for doubt or misinterpretation.

There is limited support for British citizens in Italy experiencing problems related to the Withdrawal Agreement as resources have been cut back. Some manage to get help, otherwise the standard advice from Consular Services to those in difficulty is to find a lawyer. 


The particular issue of being unable to prove permanent residency is not new - we’ve been raising it for around two years with the embassy in Rome who, in turn, engage with the Italian government. We also discussed it directly with the European Commission last May. 

But the huge increase in minimum voluntary healthcare contributions puts the seriousness of this failure into sharp focus.

One member and her husband have been paying unnecessarily for some time, at the old rate, and will have to pay the new fee if they don't get any joy soon. They have been here nearly seven years. All their efforts so far to evidence their permanent residency - including appealing to the embassy for help - have proved fruitless. 

And it is very stressful for those who have not quite reached permanent residency, with no certainty of how they will be able to prove it. 


In one such case, a woman in our group who will struggle to meet the new cost has type 1 diabetes, amongst other health issues, but without insulin quite simply she would die. She says she is stuck because she doesn’t have the money to return to the UK either.

As always, the vulnerable and those on low incomes will suffer the most.

Clarissa Killwick.

Since 2016, Clarissa has been a citizens' rights campaigner and advocate with the pan-European group, Brexpats - Hear Our Voice. She is co-founder and co-admin of the FB group in Italy, Beyond Brexit - UK citizens in Italy.


Comments (4)

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Sally 2024/01/30 09:23
We've been resident in central Italy for over 5 years and were able to get the appropriate attestation last summer from our village Comune, with no difficulty. We now both have the long-term Tessera Sanitaria. Our Comune did ask me to bring all my payment receipts from the last 5 years, to show that we had actually paid into the Italian health service for this period. I'd for some reason kept them (and the expired cards), so was able to provide what was requested.
Steven Webb 2024/01/25 16:52
Thanks Clare for clearing this up for me. I am not happy about the situation as being on a small pension, this amount takes up nearly a quarter of our total annual income.
  • Clare Speak 2024/01/26 10:55
    Glad to be able to help Steven and I'm really sorry to hear you're having to pay it. It is a huge amount of money, and I know quite a few of our readers are in a similar situation after having budgeted for lower fees when planning their move to Italy. All best wishes, - Clare
Steven Webb 2024/01/25 15:42
We moved to Italy in 2020 before Brexit and obtained our residency before the deadline. We have got our Carta di Soggiorno cards. We have been paying the voluntary health contributions for the past 3 years. We are now being asked to pay the full €2000 each before we could get our Tessera Sanitaria cards. Should we be paying the full €2000 or are we entitled to pay the reduced voluntary contributions as per previous years.
  • Clare Speak 2024/01/25 15:51
    Hi Steven, I'm sorry to say the full €2,000 is the new minimum fee, and this applies to everyone who has until now been paying the voluntary healthcare contribution at a lower rate. (If you're in any doubt though about whether you should be paying this though, check with your ASL office.) Here's all the info we have so far about how it works: - Clare
Grayson 2024/01/24 16:14
Hello. Are all PERMANENT non-EU residents (such as Americans) qualified for free healthcare, not just permanent residents from the UK who qualify as WA beneficiaries? Where can I find the information regarding these possible rights? Many thanks!
  • Clare Speak 2024/01/24 16:26
    Hi, thanks for your comment. Whether or not you're eligible depends on your personal circumstances - please find some information about who qualifies for free healthcare here:

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