Italy’s public healthcare system is known as the Servizio Sanitario Nazionale (SSN). Established in 1978, the SSN is a universal system that automatically covers all Italian citizens and legal foreign residents, providing a full range of medical services largely free at the point of use.

The system is founded on principles of universal coverage and solidarity – meaning everyone has access, and care is funded through taxes. In practice, this means most primary care, hospital treatments, and emergency services are either free or very low-cost for patients. For example, SSN coverage includes access to general practitioners (family doctors), treatment in public hospitals, subsidized prescription medicines, laboratory tests, ambulances, and certain specialist care.

Co-payments (known as ticket in Italian) are required for some specialist visits, diagnostic tests, or prescriptions, but these fees are generally modest. Quality and Outcomes: Italy consistently ranks among the top healthcare systems globally. The World Health Organization has rated Italy’s system as one of the world’s best, and Italians enjoy one of the highest life expectancies in the world.

The focus on preventative care and broad coverage has contributed to Italians living long, healthy lives. Italian doctors are well-trained (many study for years and often speak some English), and medical facilities – especially in major cities – are modern and well-equipped.

However, like any system, the SSN has its challenges. Public facilities can suffer from crowding and long waiting times for certain services. Non-urgent specialist appointments might take weeks or even months to schedule, and popular hospitals can be busy.

These issues vary by region (more on that later) but are something to be aware of when using public healthcare. Despite these challenges, the SSN remains efficient and affordable overall, offering peace of mind that you’ll be cared for without breaking the bank.

When relocating, you’ll hear about both public and private healthcare in Italy.

Most residents (including expats with legal residency) rely on the public SSN for the bulk of their needs – it’s comprehensive and free or low-cost. That said, many people (locals and foreigners alike) also make use of private healthcare for certain situations.

Here’s a comparison of the two systems, including pros, cons, and costs:

Public healthcare (SSN) in Italy

Pros:

• The public system covers almost all essential health services with minimal out-of-pocket cost.
• Primary care and hospital treatments are free under the SSN, and there’s no basic insurance premium since it’s tax-funded.
• You have access to a nationwide network of hospitals, clinics, and specialists.
• The SSN emphasizes preventive care and equal access – no one can be denied care for financial reasons.
• Emergency care is universally provided.

For expats who become residents, public insurance is a huge benefit: you’ll get treatment for everything from doctor visits to surgeries, often without any bill.

Cons:

• The quality and convenience of public facilities can vary by region (north vs south).
• Public hospitals and clinics sometimes experience long waiting lists, especially for non-urgent specialist visits or elective surgeries.
• It’s not uncommon to wait several months to see a specialist or get a non-urgent procedure in the public system.
• There can also be bureaucratic hurdles (e.g. needing referrals, dealing with paperwork in Italian).
• While many doctors in Italy speak some English, you might encounter language barriers in public facilities (particularly outside major cities).
• Comfort and amenities in public hospitals might be more basic compared to private clinics – for example, shared hospital rooms are the norm in the public system.

Private healthcare in Italy

Pros:

• Private healthcare offers faster access and more personalized service. If you need to see a specialist quickly or prefer to choose specific doctors, private clinics or hospitals can schedule you sooner and with less waiting-room time.
• Facilities are often state-of-the-art with more comforts (for example, private rooms).
• You also have greater freedom to select English-speaking providers – doctors and nurses in private practice are more likely to speak English or cater to international patients.
• Many top Italian physicians practice both in the SSN and privately, so going private can simply mean faster access to the same specialists.

Private healthcare is especially popular in parts of southern Italy, where public facilities may be more limited, giving patients additional options that might not be locally available through the SSN. Overall, private care can help you bypass the queues and feel more in control of scheduling and choice of doctors.

Cons:

• Cost is the biggest downside. Private healthcare in Italy can be expensive if paid out-of-pocket. There is no opting out of the public system (you’re still covered by SSN if eligible), so private insurance or payments come in addition to the taxes you already contribute.
• Prices for private consultations or surgeries vary, but a single specialist visit might cost €100–€250, and daily hospital rates or procedures can climb into the thousands. The Italian Ministry of Health sets minimum fees for private treatments, ensuring high costs for complex care. Because of this, having health insurance (international or Italian private insurance) is highly recommended if you plan to use private services.
• Unlike some countries, private health insurance premiums in Italy are generally not tax-deductible, so most locals stick with the public system.
• Private clinics might not be available in very rural areas, so access to private care is better in cities. And for emergency trauma care, public hospitals are still the main providers (you’d typically go to a public ER even if you have private insurance).

Cost comparison

If you use the public SSN as a resident, your costs are minimal – think a few euros for prescription co-pays or specialist tickets.

With private healthcare, costs depend on the service and whether you have insurance. Many expats purchase a private insurance plan to cover or reimburse private care costs.

It’s worth noting that some employers in Italy offer private health insurance as a perk, covering you (and sometimes family) at private facilities. Otherwise, expats can choose to buy their own private insurance plan or pay out-of-pocket as needed.

One unique aspect of Italian healthcare is that it’s administered at the regional level. While the SSN sets national standards and funding, each of Italy’s 19 regions (and 2 autonomous provinces) manages its own health services and budget. This means that healthcare quality, access, and resources can vary significantly by region.

Expats should be aware of these differences, especially when choosing where to live:

Northern & Central Italy

Generally, northern regions like Lombardy (Milan), Emilia-Romagna (Bologna), Veneto (Venice), and Tuscany (Florence) are known for well-funded healthcare facilities and high standards of care.

Public hospitals in the north and center often have more modern equipment, better staffing ratios, and shorter wait times compared to some southern areas. For example, a public hospital in Milan or Bologna is likely to offer a standard of care on par with other Western European countries.

In fact, in northern cities you’ll find some of Italy’s top hospitals and specialist centers, which attract patients from all over the country. Expats in northern Italy tend to report very positive experiences with the healthcare system.

Southern Italy

In the south (for instance, regions like Calabria, Sicily, or parts of Campania), the healthcare system, while still part of the SSN, may be under-resourced compared to the north.

There are fewer hospitals and doctors per capita, and facilities might be older. It’s not that the doctors are any less qualified – Italy’s medical training is uniformly high – but the infrastructure and funding gaps can impact service.

As a result, wait times in the public system are often longer in the south, and certain specialized treatments might only be available by traveling to a larger city in the north. In practice, it’s common for patients in the south to travel to Rome or northern cities for complicated procedures or faster service. This phenomenon can further strain northern hospitals, as they end up serving more than just the local population.

One of the first things to do after moving to Italy long-term is to register for the SSN and get your health insurance card, known as the Tessera Sanitaria. The Tessera Sanitaria is an Italian health card that proves your entitlement to public healthcare.

You typically must show it when visiting a doctor, hospital, or pharmacy.

Who can register

If you are an official resident of Italy (meaning you have a residence permit or have registered residency as an EU citizen), you can enroll in the SSN.

Registration may be mandatory or voluntary depending on your status:

• Mandatory enrollment: If you are working in Italy (either employed or self-employed) or are an Italian/EU citizen residing in Italy, you are typically automatically entitled to SSN coverage – it’s essentially included as part of your employment taxes or residency rights. Certain other categories, like family dependents of workers, minors, pregnant women, asylum seekers, and those with specific visas, also qualify for public healthcare as a right.
• Voluntary enrollment: If you’re not covered automatically (for instance, non-EU citizens on a student visa, holders of a family reunion visa over age 65, or others without a work contract), you can still apply to join the SSN by paying an annual fee. We’ll discuss this fee in the next section on insurance options. Tourists and holders of very short-term visas, however, are not eligible to enroll in the SSN.

Once you’re in Italy with the proper visa or permit, follow these steps to register for public healthcare and get your Tessera Sanitaria:

Steps to register

• Obtain a Codice Fiscale (Tax Code): The Codice Fiscale is like an Italian tax and identification number, and it’s required for many bureaucratic processes, including healthcare registration. You may have received one when applying for your visa or at the Italian consulate. If not, you can get it through the Italian Revenue Agency (Agenzia delle Entrate) – often the local Agenzia Entrate office or even the embassy/consulate can issue it. This code will be printed on your health card. Make sure you have your Codice Fiscale before proceeding.
• Secure your residency permit: Non-EU expats will need a Permesso di Soggiorno (residence permit). After arriving in Italy, you must apply for this permit (at a Post Office and complete the process at a Questura/police immigration office). You don’t have to wait for the plastic permit card to start healthcare registration – the postal receipt proving you’ve applied is usually sufficient as a temporary proof. EU citizens, on the other hand, should register their residence with the local Anagrafe (Town Registry) if staying more than 3 months. Upon doing so, EU citizens get a residence certificate or card. Essentially, you need to show that you are a resident (or in the process of obtaining residency) to join the SSN.
• Visit the local health authority (ASL): Italy’s local health administrations are known as Azienda Sanitaria Locale (ASL) or in some regions ATS. Find the ASL office nearest to your residence (each town or city district has an assigned office). At the ASL, you will request to register with the SSN. Take the necessary documents: passport or ID, your residence permit (or receipt), your Codice Fiscale, and proof of address. The staff will provide you with forms to fill out for enrollment. If you are voluntarily enrolling (not through work), they will inform you of the annual fee to pay and give you a payment slip (usually a bollettino postale – a postal payment form).
• Pay the annual fee (if required): If you fall under the voluntary category (e.g., a non-EU student, self-sufficient retiree, etc.), you’ll need to pay the yearly SSN subscription fee before getting your health card. This is done at any Italian Post Office using the bollettino form provided (the ASL can guide you on how to fill it). Keep the payment receipt – you must show proof of payment to the ASL to complete registration. (If you are employed in Italy or otherwise exempt, you won’t have to pay this fee – your employer’s contributions or your status covers it.)
• Complete the registration at ASL: Return to the ASL with your documents and the payment receipt (if applicable). You will fill out and submit the registration form. The ASL clerk will process your application. In many cases, they will issue a temporary certificate of enrollment on the spot (or a piece of paper confirming you are now registered for the SSN). This serves as proof of health coverage until your actual card arrives.
• Choose a primary doctor (Medico di Base): As part of the registration, you’ll be asked to choose your family doctor (general practitioner) known as Medico di Base or Medico di Famiglia. The ASL will provide a list of local doctors accepting new patients. You can pick one based on proximity, recommendations, or language skills. This doctor will be your go-to physician for primary care, referrals to specialists, and general health needs. Once chosen, you’ll receive documentation to take to the doctor’s office. It’s a good idea to visit or call the doctor’s office to register as a patient – they will take your info and let you know their office hours. Remember, in Italy you generally stick with one primary doctor at a time (if you need to change later, you can request a change through the ASL).
• Receive your Tessera Sanitaria: After your ASL registration is done, you will be issued the Tessera Sanitaria (Italian health insurance card). In many regions, the card is not given immediately at the ASL office; instead, it is mailed to your address (this can take a few weeks). Make sure the ASL has your correct local address. In the meantime, your registration certificate and receipt act as proof. The Tessera Sanitaria is a plastic card (usually with a microchip) that displays your name, tax code, and an expiration date, among other details. This card is essential for accessing healthcare services – you will present it whenever you visit a doctor, hospital, or pharmacy to show you’re covered under the SSN. The card’s expiration is typically tied to the duration of your residence permit (for non-EU) or a set period for EU citizens, so you’ll renew it as needed (usually each year or upon permit renewal).

An example of the Tessera Sanitaria, Italy’s health insurance card.

Tips: When you get your Tessera Sanitaria, keep it in your wallet just like you would an insurance card. Pharmacists will often ask for it when filling a prescription to apply the correct subsidy. If you ever lose the card, don’t panic – you can request a replacement from the ASL or the Agenzia delle Entrate.

Also note, if you move to a different region in Italy, you may need to re-register at the new local ASL and get a new doctor, but your number and card generally remain the same (it’s national).

Whether you can rely solely on the SSN or need private health insurance depends on your situation – primarily your citizenship and the purpose of your stay. Here we outline scenarios for EU citizens and Non-EU citizens, including timelines, costs, and how to choose insurance providers.

EU/EEA/Swiss Citizens

If you are from the EU, EEA, or Switzerland, you benefit from agreements that simplify healthcare access in Italy:

• For short stays (e.g. extended vacations or business trips up to 90 days), you can use your European Health Insurance Card (EHIC) from your home country to get necessary public healthcare in Italy. The EHIC (or the UK’s equivalent GHIC for British travelers) lets you access urgent or essential treatment in the Italian system, with costs billed to your home country’s health service. Keep in mind the EHIC is for temporary visits; it covers treatments that can’t wait until you return home, not elective procedures.
• If you move to Italy long-term (over 3 months), you should register as an Italian resident (as discussed earlier) and then you have the right to enroll in the SSN. Many EU expats working in Italy will automatically pay into the system through taxes and receive SSN coverage like any resident. If you are not working (retiree or job-seeker), you can still voluntarily enroll in the SSN by paying the annual fee, or maintain private insurance – the choice is yours. Note that EU job-seekers can initially use an EHIC for the first three months; after that, to remain covered, you should either join the SSN or get private insurance.

Special cases (EU): If you’re a pensioner from the EU drawing a state pension, you might be eligible for an S1 form (formerly E121). An S1 form essentially allows you to transfer your health coverage to Italy at no cost – Italy will bill your home country for your healthcare. Many retired expats from EU countries use this to access the SSN without paying Italian premiums. Check with your home country’s health authority if you qualify for an S1. Otherwise, you can voluntarily enroll in SSN by paying the fee (detailed below). EU students in Italy can also either use an EHIC for urgent care or join the SSN for a fee (which applies equally to EU and non-EU students).

Non-EU Citizens (Including UK, post-Brexit)

Non-EU expats typically must have some form of health insurance from day one, as it’s often a visa requirement. Here’s how it usually works:

• Before arrival (visa stage): If you need an entry visa for Italy (e.g. work visa, study visa, elective residence visa), Italian authorities will require proof of health insurance coverage for the duration of your visa. This can be a private international travel health insurance policy that meets certain coverage minimums (often around €30,000 coverage for emergencies, per Schengen visa rules). You’ll show this when applying for the visa. For instance, a non-EU job seeker or a digital nomad coming to Italy must purchase private insurance for the initial stay as part of the visa conditions.
• After arrival (residence permit): Once in Italy, you apply for the permesso di soggiorno. With the receipt of your application or the permit in hand, you can then register for the SSN if you wish (and if your visa type allows it). Essentially, after you’re a resident, non-EU citizens have the option to join the public healthcare system. If you are employed by an Italian company (or self-employed with regular work), your enrollment in SSN is mandatory and automatic – your payroll contributions support it, and you won’t pay the SSN fee out of pocket. You would just register at the ASL to get your Tessera (with your work contract as proof). If you are not working (or on a visa that doesn’t mandate SSN) – for example, a non-EU spouse, a self-sufficient retiree, or a student – you can voluntarily enroll by paying an annual fee.

Costs for Voluntary SSN Enrollment: The fee for non-employed expats to join the SSN used to be quite low (around €388 per year for most, and ~€150 for students in the past).

However, as of January 2024, Italy introduced new fee rules. Now, all foreigners (non-EU and EU alike) face a minimum annual fee of €2,000 to voluntarily enroll in SSN, unless they qualify for a reduced student/au pair rate. This means even if a calculated percentage of your income would suggest a lower payment, you still pay at least €2,000. For example, previously an expat with €25,000 income might pay ~€1,723, but now they must pay €2,000 minimum.

If your income is high enough that the percentage-based calculation exceeds €2,000, you pay the higher amount. There are exceptions: international students, au pairs, and certain religious workers pay a lower minimum (around €700 per year for students or clergy, and €1,200 for au pairs).

Dependents and others still pay the full €2,000 minimum. For instance, students saw their annual SSN fee jump to €700 in 2024 (up from about €150 before). And most other non-working expats (including those on elective residence visas, etc.) now pay €2,000 each year.

It’s important to budget for this change if you plan to voluntarily join the public system. Also note: this fee is per calendar year and not prorated – even if you arrive mid-year, you pay for the full year, and if your stay spans into the next year, you’d pay again for that year.

Given these costs, some non-EU expats choose to maintain private health insurance instead, especially for shorter stays. Once you do have your permesso and Tessera Sanitaria, though, you’ll have full access to SSN services, which can greatly reduce your out-of-pocket medical expenses.

Private health insurance for expats

Whether EU or non-EU, many expats purchase private health insurance plans for Italy, either as a temporary solution or to supplement the SSN.

If you’re not (yet) eligible for the SSN – say you’re on a short assignment or still waiting on residency – a private policy is crucial. Even if you are in the SSN, you might want private insurance for additional cover (like private hospital rooms, dental/vision care, or global coverage when traveling). Here are some tips on selecting a provider:

• International vs local providers: International insurance companies often offer expat-friendly plans that cover you in Italy and abroad. Major insurers operating in Italy include Allianz Care, Cigna Global, and APRIL International, among others. These plans are known for comprehensive coverage and English customer service, but can be pricey.
• Local Italian insurance companies (like Generali, UnipolSai, RBM Salute, etc.) also offer health policies – sometimes these are supplemental plans designed to cover co-pays or provide a daily allowance if you go private. If you go local, check if the policy requires you to use certain networks of doctors and whether they have English support.

Cost and deductibles

Premiums will depend on your age, coverage level, and any deductibles or co-pays. Some insurers let you reduce the premium if you agree to pay, say, the first €500 or €1000 of costs yourself. Just be sure you can afford that in an emergency. Also check if there are coverage limits (some plans cap the amount payable per year or per condition).

A practical tip – some international plans have arrangements with certain Italian hospitals for direct billing (meaning you don’t pay upfront). This is worth checking, especially if you’re concerned about navigating Italian medical bills.

If finding an English-speaking doctor is important to you, ask insurers if they have a list of recommended English-speaking providers or an international clinic network in Italy.

Lastly, remember that if you qualify for the SSN, that will typically become your primary insurance. Private insurance then acts as a supplement. Many expats feel secure once they’re in the SSN because it covers the big expenses. You can always add private insurance for extras and convenience.

Remember, Italian healthcare for expats is not as scary as it seems: the quality is high, the coverage is broad, and people are generally helpful. Whether you choose public, private, or a mix of both, you can feel confident that you’ll have access to the care you need while enjoying your new life in Italy.

Alla tua salute! (To your health!)