Is €2,000 a new minimum fee, or a flat fee for everyone?

Contrary to many initial reports, the Italian government has now confirmed that €2,000 is the new minimum fee, rather than a flat-rate fee, for registering with the national public health service (servizio sanitario nazionale, or SSN).

An Italian health ministry spokesperson told The Local on Tuesday: “As established by the law, the amount of 2,000 euros represents the minimum contribution.“

This is a steep increase to the means-tested charge which previously started at a minimum of €387.34.

And it means those already paying a higher rate above €2,000 per year will unfortunately not be getting a discount.

When do the new charges come in?

The new rules were confirmed with the publication of the final text of the 2024 budget law, meaning they will apply to anyone registering for Italian healthcare or renewing their registration as of the beginning of 2024.

As those who pay for SSN registration must renew their registration annually, the new charges will apply from the next renewal.

How do I know how much I’ll need to pay from this year?

The legal text did not mention any changes to the fee structure beyond changing the updated minimum.

The health ministry stated: “The rule limits itself to updating the minimum amount of the expected contribution.”

So if you’re already paying more than €2,000, your fee is not expected to change. If you previously paid anything less than that, your new charge should be €2,000.

As the maximum charge has not been updated either, all fees should now be between €2,000 and €2,789.

Italy’s health authority does not publish a list of fees however, because the registration fee is calculated on an individual basis.

Your registration fee will be calculated by your local Asl office at 7.5 percent of your income up to €20,658, plus 4 percent of your income above that.

(Your local health authority’s website is likely to contain this information, though every website varies: see the one for south-east Tuscany, for example.)

This means that the only way to confirm exactly what your 2024 fees will be, as in previous years, is to check with your local Asl office.

Does this apply to all non-EU nationals in Italy?

Back in October, when the plan was first mentioned, Italy’s finance ministry caused major confusion when it initially said that the €2,000 charge would apply to “all non-EU citizens”, before later clarifying that it would in fact only apply to those non-EU nationals who already have to pay an annual fee to use the public health service.

Despite all this talk of EU vs non-EU, nationality is not really the deciding factor.

Italy’s health ministry said in a statement: “The rule contained in the 2024 budget refers to specific categories of users, not entitled to mandatory registration, who can voluntarily register with the national health service through the payment of an annual flat-rate contribution.”

This means that whether or not you’ll need to pay the fee depends entirely on whether you were already entitled to ‘mandatory’ (free) healthcare registration or not.

If you were, then nothing changes for you.

The change is only expected to impact those who already pay for their registration with the SSN, i.e. those who do not qualify for free registration and are instead in the ‘voluntary’ registration category.

Find out more about these categories and who qualifies for free registration in a separate article here.

How will this affect EU nationals?

The final text of the 2024 budget updates a law from 1998 on healthcare fees which applies only to non-EU citizens – so it remains unclear whether the minimum fee has been updated for both EU and non-EU citizens.

The Local has requested clarification on this point from the health ministry.

As above, the important thing appears to be whether or not you were already entitled to ‘mandatory’ (free) registration or not, rather than your nationality.

The rules for both categories are otherwise similar. EU nationals “must have coverage from their country of origin to stay in another EU country and therefore in Italy,” the health ministry confirmed.

“Where they do not have health coverage from their country of origin, they must have their own private health insurance to remain legally in Italy.”

What about UK nationals covered by the post-Brexit Withdrawal Agreement?

Italy’s health ministry confirmed to The Local on Tuesday that British citizens who were previously entitled to register with the national health service on a ‘mandatory’ (i.e., free) basis would be able to continue doing so.

“British citizens residing in Italy prior to Brexit, covered by the withdrawal agreement, who have accrued a permanent right, retain the right to mandatory enrolment,” a health ministry spokesperson said.

This appears to mean that nothing has changed for those British nationals who were previously entitled to free healthcare.

What about spouses of Italian citizens both of whom are resident in Italy?

If the spouse was entitled to ‘mandatory’ (free) healthcare registration previously, then they will likely still be able to register on this basis from 2024.

As the rules are complex, it’s advisable to check how they apply in your circumstances with your local Asl (local health authority) office.

What if my spouse and I pay a combined ‘family’ registration fee?

The text of the new law did not mention any changes to the way fees are currently calculated (see above) beyond increasing the minimum fee.

It did not appear to include any change to the rules allowing couples or families to make joint applications.

Therefore, if you already pay more than the new minimum 2,000 euro fee between you, this appears unlikely to change – but the only way to confirm what the 2024 fees will be in your case at the moment is the check with your local Asl office.

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.

What is meant by a registration fee?

There has been added confusion among Italy’s international residents about what exactly it means to pay a registration fee for the SSN.

This fee is charged annually upon registration with and subsequent renewal of registration with your local health authority, which entitles you, among other things, to register with a medico di base (family doctor, or general practitioner).

This fee is not the same thing as the INPS (health, social security and pension) payments due if you’re obliged to pay your own contributions in Italy, such as in the case of those who are self-employed under a partita IVA.

In this case, you would be entitled to ‘mandatory’ registration with the SSN, with no fee – but as INPS contributions in this case are charged at around 23-26 percent of your income, the total of these payments usually comes to much more than 2,000 euros a year.

How do you pay the registration fee?

As Italy’s healthcare system is managed on a regional basis, the fee is paid to your regional authority when you register or renew.

Italy’s health ministry guidelines state that the payment should be made in one lump sum, either by bank transfer (you can request the details from the Asl, or local health authority, where you register as a patient), or through your F24 tax form.

Note that the fee covers your registration for the calendar year running from January 1st to December 31st. That means that if you apply in August, you’ll still have to pay the full amount, but will only be covered until the end of the year.

Can I sign up for private healthcare instead?

If you’re in the ‘voluntary’ category, then yes. You must have healthcare coverage as an Italian resident, but it doesn’t have to be with the SSN.

You can opt out of the public system and choose to pay for private healthcare instead. Though whether or not this would prove better value will depend on the type of healthcare coverage you need.