For any non-Italian who becomes a legal resident of Italy, adequate health insurance is a requirement; whether that’s a private insurance policy or registration with the Italian public health service (servizio sanitario nazionale, or SSN).
Until now the default option for most has been to sign up with the SSN. Some have to pay an annual fee to register – though The Local’s readers tell us the standards of care are generally good and they’ve seen no need to pay more to go private.
Q&A: What you need to know about Italy’s €2,000 healthcare fee
But from 2024, the Italian government has hiked the minimum annual SSN registration fee from €387 to €2,000, meaning many people are now reconsidering whether private coverage might be a better option after all.
We looked at the type of cover required, and asked readers who’ve already done it for advice on finding the best policy to replace SSN coverage
Can private healthcare replace SSN?
One of the requirements of Italian residency is that you must have adequate healthcare coverage, but it doesn’t have to be with the SSN.
You can effectively opt out of the public system and choose to pay for private healthcare instead.
In fact, Italy’s new foreign residents very often find themselves with no choice other than to rely on private healthcare, at least temporarily.
This is because, upon moving to Italy, you must be able to prove that you have health cover in order to obtain a residency permit – yet you can’t sign up with the SSN until after you get your residency permit; a process which generally takes at least a year. (Some readers report that their Asl office allowed them to sign up using their residency permit application receipt, but this can’t be guaranteed in every case.)
To navigate this catch-22 situation, new arrivals will generally need to take out a short-term private healthcare policy. These can cost anything from around €300 per year (or equivalent) to €300 per month, readers report, depending on various factors including age, nationality, and the type of coverage you need.
READ ALSO: Who can register for national healthcare in Italy?
One anonymous American reader in this situation told The Local: “I went with Cigna at $297 per month. But here’s the rub, if I were to use the Cigna policy for any claim then I would be on the hook to pay for the entire year. Otherwise I can cancel the contract with 30 days notice when I’m finally able to apply for the SSN coverage. “
“Between this policy and Medicare, I’ve never paid this much for health insurance in my entire life.”
What kind of policy will I need?
If you’re among those who are now thinking of taking out a longer-term healthcare policy instead of registering (or re-registering) with the SSN, what exactly that should cover depends partly on your personal situation and requirements.
The Italian authorities do not appear to set detailed rules on what level or type of health insurance is viewed as equal to SSN coverage.
The health ministry’s website says only that foreign nationals resident in Italy “are required to insure themselves against illness, accident and for maternity by taking out a private insurance policy, or, with voluntary registration with the SSN.”
While in Italy emergency care is always free at the point of use, if you need ongoing treatment after an accident or illness your insurance policy would need to cover this, as well as any ongoing treatment for existing health conditions.
READ ALSO: How to book a doctor’s appointment in Italy
Registration with the SSN also allows you to sign up with a medico di base (family doctor, or general practitioner) so you’d need to instead arrange access to one through the private system.
Other forms of care may require you to pay part of the cost (a co-pay known in Italian as the ticket), but the amount in this case will be subsidised by the national health service.
Another thing to consider is that Italy’s public administration requests your tessera sanitaria number in all sorts of scenarios – not just for accessing healthcare. So not having one will likely prove another bureaucratic hurdle to jump.
How do I find a policy?
As there is a sizable market for private health insurance cover in Italy for Italians, who often pay for private care themselves in order to get faster treatment, there are various options for cover out there.
If you search for assicurazione sanitaria privata or polizza sanitaria you’ll find policies from Italian insurance providers as well as international insurance companies operating in Italy.
Read the small print carefully, though, as not all of these policies will be available to non-EU nationals.
Readers told us nationality makes a big difference, as well as age: and these factors mean that for some the SSN fee may turn out to be relatively low compared to the cost of private healthcare.
“The quotes I have received as a US citizen are $5,000 to $6,000 a year! The $2,000 fee for SSN coverage seems a welcome bargain,” said Charles Elliott, 73, in Casalbordino (CH).
“Age matters,” wrote one anonymous respondent who found that “those over 60 or 65 cannot be covered by some private insurance companies.”
Rome resident Philip, aged 60, pointed out: “Nationality will limit what you can get. Your employer may also augment the national system.”
Readers also stressed the importance of getting recommendations from friends and colleagues, and making sure to carefully compare several quotes.
Can I combine public and private care?
Under the Italian system, it’s very common for people to augment public healthcare with occasional use of the private system.
Many Italian citizens (who are not subject to SSN registration fees) will, if they have the means, pay for private consultations or procedures occasionally when treatment would otherwise involve a long wait.
In fact, Italy’s public and private healthcare systems are closely linked; so much so that those paying for private care are sometimes treated at the same hospitals, by the same doctors, as those treated under the SSN.
Several readers who responded to our survey said that paying for SSN registration and using a combination of public and private treatment options via the SSN in this way had been the best option for them.
“Stay with SSN and when required have a private consultation at relatively modest cost,” recommended Frank Woods, 93, in Stresa.
Under the Italian system, “private prices are always very reasonable compared to the US,” added one anonymous reader.
Have you signed up for private health insurance in Italy? Please let us know about your experience in the comments below or fill out our short survey.
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Hi,
Your statement, “you can’t sign up with the SSN until after you get your residency permit,” is not correct. You can sign up on a voluntary (fee based) basis any time. Since the fee is annual, with no reduction for subscribing for less than a full year, it obviously makes most sense to subscribe as early in the year as possible – my wife and I went to our ASL office on January 2! Note that we have applied for our PdS, but our appointments at the Questura are not until early February. Our application receipts were sufficient for our ASL here in Lombardia.
For 2024, based on our 2023 income (which included my salary for 1/2 year prior to my retirement, and my pension since then), we each had to pay the maximum (€2789). As it turns out, that is almost exactly the amount we paid Cigna for a year of private insurance. We’ve since received a refund for the unused portion of the policy, which we cancelled once we were subscribed in the SSN. Since we consider ourselves quite healthy and were comfortable with potentially paying out of pocket for routine healthcare, we took out a rather bare-bones policy that basically covered us only in the event of serious problems.
Since our income in 2024 – our first year with just retirement income – will be less, we’ll likely be down to the (new) €2000 minimum when we renew in a year. That additional savings will make having the SSN even more appealing.
One last thing: It seems that many people and businesses in Italy equate having your Tessera Sanitaria to having a Codice Fiscale. Although they are far from the same thing, the fact that the Tessera Sanitaria indicates your Codice Fiscale (and has a magnetic strip and chip not unlike a credit card) causes some people to ask for/require your Tessera Sanitaria when all they should really need is the Codice Fiscale. We were not able to open a (resident) account at some of the local banks because we did not have a Tessera Sanitaria, even though we did have our Codici Fiscale. And even the gate to our Centro Raccolta is activated by a Tessera Sanitaria!
Hi,
Thanks for your interesting points and for sharing your experience.
I should say that the Italian law on this does specify that you can’t sign up for the SSN without already having a residency permit. We’re aware that some Asl offices may allow you to do so using the application receipt (so it’s always worth asking) but this can’t be guaranteed. I’m glad to hear though that it worked out in your case in Lombardy!
Thanks for reading,
– Clare
This is a very helpful article. What is the siuation as a dual Italian / British citizen registered with AIRE and a second home in Italy? Does the 2000 euro apply? I am not registered in the Italian healthcare system (NHS only).