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 She was told by her ASL the new budget law superseded the  Withdrawal Agreement in terms of residency rights, therefore affecting her access to services.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.

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