Why Brits in Italy say they've been ‘hung out to dry' over €2K healthcare fee

Jessica Lionnel
Jessica Lionnel - [email protected]
Why Brits in Italy say they've been ‘hung out to dry' over €2K healthcare fee
Medical staff members (Photo by Miguel MEDINA / AFP)

After Italy hiked minimum annual healthcare fees to €2,000 from January, The Local's British readers covered by post-Brexit rules say a lack of clarity and communication about how this applies to them has made the increase much worse.


Italy’s foreign residents who make voluntary contributions into the Italian healthcare system (Servizio sanitario nazionale, or SSN) until last year paid a minimum fee of €387 per year. 

But from the beginning of 2024, this minimum has shot up by more than sixfold to €2,000, meaning that volunteers, people on elective residency visas and people over the age of 65 on family reunification visas will all have to pay this much - or more - to use the SSN.

While the steep price hike is hard for anyone to swallow, for some British residents based in Italy before the Brexit transition period ended, there is added frustration at being told they have to pay the charge when their healthcare should be free.

Under European law they are protected by the post-Brexit Withdrawal agreement (WA) which states that their conditions within Italy should remain the same as before.

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

And those who have been legally resident in Italy for more than five years are eligible for permanent residency, which brings with it the right to free healthcare.

But some British citizens covered by the WA say they're having problems proving their residency rights, or are dealing with varying official interpretations of the rules - which risks leaving them without healthcare unless they pay the €2,000 charge.

“I feel shocked and horrified. I don’t know how they’ve justified this. Where is the official line from the Ministry of Health for us WA beneficiaries? Why are we not getting clarification?” retiree Vanessa* in Lucca, Tuscany, tells The Local.

“It feels unjust. It’s like we’ve been hung out to dry.”

Vanessa is a permanent resident in Italy as she has been living here since 2016. But she says her local authority is interpreting the rules differently.


After writing emails back and forth to her local Azienda Sanitaria Locale (ASL) she was told she had to pay the €2,000 minimum or be left without healthcare.

“My nerves keep going,” she says. “I had a biopsy just before Christmas and I'm under control measures. It’s hanging over my head and I can’t even stick up for myself as my rights have not been communicated to me.”

She said even her doctor was confused as to why she’s been told she has to pay despite being a permanent resident.

The main issue, she believes, is the lack of communication and clarity on the policy among officials. She was told by her ASL the new budget law superseded the  Withdrawal Agreement in terms of residency rights, therefore affecting her access to services.

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

“It seems like everything you do here is a struggle. It's like they all have their own interpretation and they don’t read the whole thing,” she says.

“It’s inconsistent, there's no clarity, and there is a certain amount of prejudice towards us. There has to be some kind of breakthrough.”


The lack of communication is also an issue for Liguria-based Claire Francis. She’s waiting on further clarification from the health ministry as to whether the new measures will affect her husband (who she is a carer for) and herself. 

“I still feel incredulous that an increase on the fees being charged is even legal given the massive uplift,” she says. “It feels deliberately discriminatory and unjust, especially with the lack of information and clarity surrounding it.

“It’s been implemented across Italy in a haphazard way depending on the interpretation by the various comune and ASL offices.”

Jim Grant who lives in the south of the country in Ostuni says his main concern is the huge fee increase over a short period of time, and he is among those who are now considering opting for private healthcare. 

“A gradual increase over a couple of years, with some advance notice, would have been more palatable," he says. "In the years we've been here, my wife and I have not used any state medical services at all.

“The only health intervention was when I had hearing issues and I paid for this to be dealt with privately as, bizarrely, it was cheaper than the ASL voluntary contribution. I shall continue along the private route until I am eligible, if we stay in Italy.”


Greg* has also found that obtaining permanent residency is also another hurdle to obtaining healthcare, along with the new charges.

He, like Vanessa, has permanent residency rights and therefore the same healthcare rights as Italian nationals. However, a lack of communication between the comune and ASL has prevented this from happening.

“We are really frustrated with this as it happens every year and we both have serious health issues which require regular medication," he says. "In my case,  I unfortunately have blood cancer and need to visit the hospital every month for tests.

"We aren't being treated fairly.”

*Names have been changed in this article to protect the identity of the interviewees.

Have you got an opinion on the new healthcare charge? Do you agree or disagree with the opinions expressed in this article? Leave a comment below to share your thoughts or get in touch with us by email.



Comments (6)

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Jon hiscock 2024/07/04 19:05
On this basis surely Italian residents in the uk should be charged for cover by the NHS.the uk government should respond in kind.
Michelle 2024/03/09 11:52
I received this from yesterday Saying uk citizens living in Italy before 2021 doesn't pay. Read more on their website below
Ellie Rose Elliott 2024/02/08 21:31
Demanding change from the top as Clarissa Killwick appears to be doing is to completely misunderstand how Italy - a nation of separate historical identities and loyalties - functions. 'They do things differently here' applies from the comune level upwards. Go local, it's the only way. Also, it's more fun.
Clare at The Local 2024/02/06 15:48
The following comment was submitted by Clarissa Killwick of Beyond Brexit: “It is very important for Withdrawal Agreement beneficiaries in Italy to understand how much we are on our own now. People can’t just sit and wait for something to be done about WA breaches. Dedicated support from the UK government to help those having difficulties stopped a long time ago. Embassy resources have been reduced. Furthermore, there is no independent monitoring of WA implementation as there is in the UK. Our group is run by three volunteers (with day jobs!) with no funding whatsoever and we are, by no means, able to reach everyone, for example, those not on social media. Yes, we constantly raise these issues with the embassy but, more than three years on after the end of transition, problems are ongoing. Individuals also need to make as much noise as they can which could take many forms. Talk to your sindaco, make a complaint to URP of the public office you are having a problem with. Contact the embassy, using the contact form on the Living in Italy page and persist even after you get the standard answer suggesting you get a lawyer. Write to your UK MP. Make an official complaint to the European Commission. Use any contacts you have such as journalists or politicians. Do you know anyone in ANCI or ANUSCA? We all need to do what we can to raise awareness of the very particular problems that WA beneficiaries face in Italy. The current very serious issue of some people being charged the new minimum of €2000 for SSN voluntary contributions rather than €0 because they cannot prove their permanent residency is a clear example of how much damage can be caused by lack of clear guidance from the top – to all the public offices that deal with us. That is what we are asking for.”
paul baxter 2024/02/05 19:08
This is all very well reporting on the usual disfunction across the various Italian regions BUT what is being done about this by either or both the Italian and British Government/Consulate. Obviously the new budget cannot supercede the WA without Brussels and Whitehalls approval which it would never get. Is it possible for you to make the necessary representations to eg the British consulate please ? - I’m sure it will get sorted in the fullness of time but in the meantime people are suffering
  • Clare at The Local 2024/02/06 09:07
    Hi, campaigners and groups such as Beyond Brexit are doing fantastic work on this issue. We'll continue to report on the progress they make. Thanks for reading, - Clare
Anon 2024/02/05 15:05
Typical Italian confusion and jobsworths!!

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