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AMERICANS IN ITALY

Americans in Italy: Public vs private healthcare and can you bring Italian cheeses to the US?

From US customs rules to public and private healthcare options in Italy and where to track down American foodstuffs, here's our latest Americans in Italy newsletter.

Published: 25 May 2023 19:37 CEST

Can you bring Italian cheeses to the US from Italy in your baggage? Justin Sullivan/Getty Images/AFP.

Welcome to our regular look at everything you need to know about life in Italy for The Local’s readers from the US. This newsletter is published monthly and you can receive it directly to your inbox before we publish by going to newsletter preferences in ‘My Account’ or following the instructions in the newsletter box below.

One of the first things new Italian residents will want to sort out on arrival is their healthcare situation.

Italy’s free public healthcare has a reputation for being one of the best in the world – but in reality, users’ experiences can be mixed, with a 2015 report finding “profound regional differences” depending on where patients live.

Lengthy wait times are one of the main complaints with the current system; which is why a number of private clinics have sprung up in Italy in recent years.

But these paid services aren’t necessarily better than their public counterparts, and they can be very pricey. So which should you choose? We analysed the pros and cons of either option to help simplify your decision:

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

Milan’s Raffaele hospital. Italy is home to some highly-rated healthcare facilites – but how good is public healthcare in general? (Photo by Miguel MEDINA / AFP)

Bringing Italian cheeses and meats to the US

If you live in Italy, you’re bound to get plenty of requests from friends and family in the US asking if you could bring back a little Parmigiano Reggiano or salami the next time you make the journey home.

Or perhaps you visit Italy on holiday once or twice a year and want to pack an edible souvenir of your trip in your hand luggage.

Either way, it’s important to make sure you comply with US customs regulations to avoid getting into trouble, and these have become increasingly complex over the years.

Fortunately, so long as you declare everything to customs, the worst that can happen is that your item gets confiscated – but that’s still a situation you’ll want to avoid by familiarising yourself with the current rules.

What are the rules on bringing cheeses and meats to the US from Italy?

Can you bring Parmigiano Reggiano cheese into the US from Italy? Photo by MARCO BERTORELLO / AFP.

Sourcing US snacks in Italy

Speaking of gourmet foods, living in Italy may give you access to some of the best in the world; but sometimes all you really need is a taste of home.

From Milan to Rome to Naples to Palermo, most major Italian cities have at least one American foods store that stocks imported US candy, salty snacks and soft drinks, or global minimarket with items like pecans or cranberry sauce.

For those who don’t live near such a facility, many of them also operate online stores that allow you to order directly to your home: so you can get your Reeses cups or Betty Crocker cake mix wherever you are in the country.

Which stores across Italy sell American foods and drinks?

It’s not impossible to find American cereals in Italy – you just have to know where to look. Photo by Samantha Gades on Unsplash

Tips for Americans moving to Italy

We’re gathering your tips about life in Italy as an US national, and we also want to hear your questions. Get in touch with either one HERE.

Italy’s widely available fresh produce is a key draw for many foreigners. Peter in Polignano a Mare, in the southern region of Puglia, recommends buying local not only to get the best of what the area has to offer, but also to forge connections within the community.

“Buy fruits and vegetables from open markets and small sellers if possible. And buy bread, biscotti and local cheeses fresh, often daily,” he suggests.

“You’ll get great food and make friends.”

Thanks for reading and please get in touch with us by email if you have any feedback on this newsletter.

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Six hard facts Americans should be aware of before moving to Italy

From the food to the climate, there’s a long list of quality-of-life positives that come with a move to Italy that could make you happier than you are in the US.

But before you start considering a permanent or long-term move to the country of your dreams, you should first think of the practicalities and potential downsides of such a big life change.

Here are six practical points Americans should factor in before embarking on a move to Italy, from work to taxes and healthcare.

Finding work or building a career isn’t easy

You’ll no doubt already know that Italy is renowned for its high unemployment rate, unstable work market and relatively low wages, but as a non-EU national there is an added set of obstacles to consider.

Firstly, applying for residency through a contract job is near impossible. Italian employers would have to first demonstrate that they have been unable to find a suitable EU candidate for the position before being able to sponsor/hire you.

Italy does release an annual quota of work visas through its decreto flussi , or ‘flows decree’, but these are massively oversubscribed, and almost entirely allocated to jobs in the agricultural, care, and seasonal hospitality sectors.

Highly-skilled workers with a job offer from an Italian employer may be eligible for the EU Blue Card, which isn’t subject to decreto flussi quotas.

Italy also recently approved a digital nomad visa which has relatively low entry requirements on paper, though it’s still unclear at this stage how easy it will be to access the visa in practice, as Italian consulates can – and do – set their own rules.

Italy’s new digital nomad visa might be an option for some hoping to move to the country. (Photo by Claudio CRUZ / AFP).

You need strong finances to ‘buy’ Italian residency

If you’re retired or don’t plan to work in Italy, then you’ll need to show you have the financial means to cover your costs.

This can best be done through Italy’s elective residency visa (ERV), which allows you to live in Italy without working.

The government’s official minimum passive income threshold for the ERV is €31,000 per person or €38,000 per married couple per year, plus five percent per dependent minor.

However, some individual consulates are known to raise the limit much higher than this – in certain cases, by as much as three or four times the minimum threshold.

Alternatively, you can purchase an Italian investor or ‘golden’ visa, but you’ll need to make a minimum investment of €250,000 in an Italian start up, €500,000 in an Italian limited company, €1 million in a philanthropic initiative, or €2 million in government bonds.

So in all, applying for Italian residency as a US citizen who can’t or doesn’t want to work in Italy involves having a lot of money saved up.

Public healthcare is the standard in Italy, but access to it as an American is subject to conditions

As you hail from a country that notoriously lacks universal healthcare, you may have assumed that here in Italy, where the approach is starkly different, anyone can walk into a public hospital and receive treatment.

That’s true if you have to go to the emergency room, or pronto soccorso – but if you otherwise want to access Italy’s public health system (Servizio Sanitario Nazionale, or SSN), things are a bit more complicated.

Some categories of non-EU resident – including employees of Italian companies, the self-employed, and those on family permits, among other groups – are eligible for ‘mandatory’ registration or registration-by-right (iscrizione obbligatoria).

Others, such as pensioners on elective residence visas, diplomatic staff of foreign governments, employees of international organisations, and volunteer workers, among others, can opt in to the SSN through iscrizione volontaria, or voluntary registration.

Italy’s government raised the minimum annual charge for voluntary registration significantly at the start of this year, from around €387 to €2,000.

Milan’s San Raffaele Hospital. (Photo by Piero CRUCIATTI / AFP)

Even if you have registration-by-right, you’ll still need to make a co-payment for some services upfront, and then claim the costs back in your tax return.

It’s worth noting that many Italian visas, including the elective residency visa and the digital nomad visa, require you to take out comprehensive private health insurance in order for your application to be approved – something that can be difficult and costly if you have pre-existing conditions.

You’ll have to resit your driving exam

Like the US, Italy is for the most part a nation of drivers, where chances are you’ll need your own vehicle to get around. If you live in a town or city you may also be able to use public transport, but this isn’t always a reliable option.

If you plan to buy a car and continue driving in Italy, it’s important to know that Italy and the United States have no reciprocal licence exchange agreement or recognition scheme.

That means that after 12 months of residency, you will need to resit your driving exam again in Italy and get an Italian driving licence (for the first 12 months, you’ll need an international driving permit in order to drive on your US licence).

It’s frustrating to think that you will have to cough up a considerable amount of money for something that you already know how to do, but on the plus side you’ll get to understand Italian roads and driving, and possibly learn how to use a stick (gearbox) as almost all cars in Italy are manual.

You have to pay taxes in Italy even if you’re not working here

As an Italian resident (someone who spends more than 183 days in a calendar year in Italy), you have to pay taxes here on your worldwide income, that is income generated anywhere in the world.

Under Italian law, tax residents are required to declare bank accounts, including joint accounts, held abroad by completing the foreign earnings and finances section of their yearly tax return form.

The only exception is for bank accounts whose balance never exceeded €15,000 at any point during the relevant tax year, and whose average balance for the year was below €5,000.

As a US citizen living abroad, you’ll also have to file a US tax return every year, even if you fall below the income threshold for paying US taxes.

Fortunately, there is a treaty in place between Italy and the US which helps determine which country to pay taxes to and the tax deadlines.

Tax office, Italy

An employee goes through paper files in a tax office in Rome in November 2017. Photo by ANDREAS SOLARO / AFP

You have to commit to living in Italy

Keep in mind that when you obtain Italian residency, it won’t necessarily entitle you to enter and leave the country for the rest of your life, especially if you spend extended periods of time outside of Italy. Permits have to be renewed and their conditions respected.

If you have a residency permit of less than two years and are a non-EU citizen, you can leave the country for six months continuously without declaring it, or for a continuous period of no more than half the duration of your permit if your permit is for two years or more.

Breaking this rule means the government could refuse to renew or extend your stay permit.

One notable exception is Italy’s investor visa, which doesn’t require the holder to become an Italian resident for the first two years (after that, you’ll need to decide whether you want to renew and become a resident, at which point you’ll be subject to the same rules as everyone else).

None of this means that you can’t spend several months at a time back home in the States – in fact extenuating circumstances such as caring for a sick family member, work or study allow for a bit more time outside Italy – just keep in mind that you have keep tabs on long absences outside of Italy as a non-EU citizen.

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