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HEALTH

Which foreign residents have to pay for healthcare in Italy?

Italy's government wants to charge a €2,000 annual fee for some foreign nationals to register with the Italian national health service - but many already pay this much, or more. What are the rules and what would change under the plans?

Published: 17 October 2023 16:34 CEST
Updated: 19 October 2023 11:08 CEST
Who has to pay to access Italy's national health service?
Who has to pay to access Italy's national health service? Photo by Fred TANNEAU / AFP.

There was concern this week about new proposals from the Italian government to charge non-EU nationals higher fees to use Italy’s national health service (servizio sanitario nazionale, or SSN).

Under the 2024 budget plan, a €2,000 charge for registering with the health service would apply to “foreign residents who are citizens of countries that are not members of the European Union”, according to a statement published by the Italian economy and finance ministry (MEF) on Monday.

READ ALSO: What we know about Italy’s plan to charge non-EU residents €2,000 for healthcare

Italy’s health ministry later clarified that the 2,000-euro charge would not in fact apply to all non-EU nationals, but only to those who already pay an annual fee to use the SSN.

Though a number of questions about the proposal remain, this still appears to mean a steep cost increase for many of Italy’s international residents who are not eligible for free healthcare.

Who will the new rules apply to?

For many foreign nationals resident in Italy, enrolling with Italy’s SSN means paying an annual registration fee under what’s called ‘voluntary’ registration.

For others, registration is deemed ‘mandatory’ and is therefore free, and healthcare services are then paid for at the same rates as for Italian nationals.

“The rule contained in the 2024 budget refers to specific categories, not entitled to compulsory registration, who can voluntarily register with the SSN through the payment of an annual flat-rate contribution,” the health ministry stated.

“The rule is limited to updating the stipulated lump-sum contribution,” it said, suggesting that the new charge would replace existing fees.

Registration fees could therefore increase for people who are now paying a rate below €2,000 a year – though it remains unclear whether it could also be revised down for those who are already paying more.

Who can currently register for free?

Certain people are entitled to iscrizione obbligatoria, ‘mandatory registration’ or ‘registration by right’, in the national health service, which means you can register with the SSN for free.

Iscrizione obbligatoria applies to the following categories, according to current health ministry guidelines:

  • Residents who have a regular ongoing contract with an Italian employer, are self-employed, or are registered on Italy’s unemployment lists (liste di collocamento).
  • People who are waiting for their residency permit to be issued on the basis of employment or family reasons.
  • People who are waiting for their residency permit to be renewed on the basis of employment or self-employment, for family reasons, for asylum, for subsidiary protection, ‘special cases’, or special protection; for medical treatment, for those waiting to adopt or foster children, and for those in the process of acquiring citizenship.
  • All minors, including unaccompanied foreign minors, regardless of their legal basis in Italy.

The health ministry’s statement indicates that people in these categories would continue to be able to register with the SSN for free even if the €2,000 charge remains in the final draft of the budget law.

Who needs to pay to register?

Anyone who doesn’t fall into any of the categories listed above can opt in to the SSN through iscrizione volontaria, or voluntary registration.

This includes pensioners on elective residence visas, diplomatic and consular staff working for foreign governments, employees of international organisations, volunteer workers, and people over the age of 65 in Italy for family reunification reasons (who arrived after November 5th, 2008).

People in this situation must pay a fee of at least €387.34, rising to as high as €2,788.87 based on income calculations.

However foreign students in Italy who have no income besides scholarships or financial aid provided by Italian public institutions pay a flat fee of €149.77, while au pairs pay €219.49.

The MEF said in its statement on Monday that students and au pairs would continue to pay a discounted fee, without giving further details.

The registration is valid for the calendar year starting on January 1st and running to December 31st, regardless of when the payment is made.

If the rule is included in the final draft of the budget, it’s people who fall into this ‘voluntary registration’ category who would pay the €2,000 charge.

Member comments

  1. Replying to paying into health service. I am copying an email received regarding the EU declaration protecting rights for those that had residency before

    It won’t let me copy the text. So will try and summarise… if resident in Italy before Brexit. You are classified as having permanent residency after 5 years. That means article 23 of the withdrawal agreement and article 24 of the directive 2004/38 apply.

    It therefore follows that, as permanent residents, you should be entitled to access the Italian public healthcare system free of charge under the same conditions which apply to Italian nationals (referred to as compulsory affiliation ).

    Hope this helps and you can update the topic to share

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For members

TAXES

IMU: Who has to pay Italy’s property tax?

The first instalment of Italy’s main property tax IMU is due by Monday, June 17th, this year – but not all homeowners in the country have to pay it.

Published: 14 June 2024 12:24 CEST
IMU: Who has to pay Italy’s property tax?

Italy’s main property tax, IMU (Imposta Municipale Unica, or Unified Municipal Tax) was introduced in 2012 to replace the local ICI levy.

It applies to both private and commercial property, building areas and agricultural land, and its exact amount varies by the type, value and location of the property.

IMU must be paid in two yearly instalments, with the first payment normally due by June 16th (the deadline was moved to June 17th this year as June 16th is a Sunday) and the second one due by December 16th. 

But the tax is a frequent source of confusion for homeowners in Italy as the rules on exactly which types of property it applies to have changed multiple times over the years.

Taxpayers are fully responsible for calculating and paying the amount of IMU they owe, meaning you won’t get a bill from local authorities specifying how much you need to pay for the relevant year.

Who does IMU apply to?

IMU is generally owed by owners of the following types of property:

  • Agricultural land (or terreno agricolo in Italian)
  • Building land (area fabbricabile)
  • Private houses other than the owner’s main residence (or prima casa), meaning second, third, fourth homes etc.
  • Luxury dwellings (case di lusso) falling under Italy’s cadastral categories A1 (stately homes), A8 (villas) or A9 (castles), regardless of whether they are the owner’s main residence or not.

Essentially, besides agricultural and building land owners, IMU is owed by all second-home owners in the country and owners of properties categorised as ‘luxury’ under Italy’s cadastral system.

READ ALSO: The Italian tax calendar for 2024: Which taxes are due when?

The tax doesn’t apply to main residences (prime case) but owners must be Italian residents and be registered as such under Italy’s national registry (Anagrafe) in order to qualify for this.

If you’re a foreign resident owning property in the country, you’ll have to pay IMU on it.

There are a number of IMU exemptions and discounts available to some categories of homeowners. 

These include for instance a 50-percent discount for retirees residing abroad and claiming a ‘totalised pension’ (pensione totalizzata), meaning a hybrid ‘Italian-foreign’ pension merging contributions made in Italy and those made in the foreign nation they reside in (as long as this country has pension totalisation agreements in place with Italy).

How do I calculate IMU?

Much like most other Italian taxes, calculating IMU is by no means an easy process, especially if you have little to no experience with paying it. 

That’s why it’s generally advisable to consult a chartered accountant (commercialista) who can ensure that the correct amount is paid and even arrange the transaction for you.

READ ALSO: What is an Italian commercialista and do you really need one?

That said, as a rough guide, you’ll need to take the cadastral value, or valore catastale, of your property (this is generally reported in the public deed of purchase but you can also request it at your local land registry).

Once you know the cadastral value, you must increase it by 5 percent and then multiply that number by a coefficient, which varies by the type of property you own. For instance, private residential buildings and flats have a coefficient of 160. 

Doing this will give you your property’s taxable base and from there you’ll be charged anything from 0.5 to 1.06 percent of that figure, depending on the rate (aliquota) applied by the municipality (comune) where your property is located.

How do I pay?

IMU can be paid via Italy’s standard tax form F24, which is used when paying most types of taxes in Italy, including Irpef income tax instalments.

The form can generally be found and submitted at most bank branches and post offices in the country. Some Italian banks even offer customers the option to complete and submit an F24 form directly online.

Alternatively, you can ask an Italian accountant to complete and submit the form on your behalf.

What happens if I don’t pay?

The Italian taxman shows little in the way of leniency when it comes to late filing or failure to pay IMU. 

Late filing can be punished with a fine of up to 30 percent of the IMU owed, whereas failure to pay can lead to enforced credit recovery procedures (recupero coattivo del credito) from local authorities. 

The good news here is that Italy has a procedure known as ravvedimento operoso (literally ‘active amendment’) which allows taxpayers to self-report and quickly rectify the delay in their IMU payments in exchange for significantly reduced fines.

For example, under this system, fines for late payment are reduced to 0.1 percent of the sum owed per day if the payment is made within the first 14 days from the relevant deadline.

Please note that The Local is unable to advise on individual cases. Find more information on the Italian tax office’s website or seek independent advice from a qualified tax professional.

For more information on property in Italy, check The Local’s property section.

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