Italy is one of the healthiest countries in the world, with an average life expectancy that far outranks some of its neighbors.
While no system is perfect, part of the reason that Italy is super healthy has to do with its national healthcare system. Known as the Servizio Sanitario Nazionale (SSN), the national health service was established in 1978 to provide tax subsidized health care via a mix public – private system.
So how can you get in on this glorious healthcare?
Regardless of your status in Italy, everyone is entitled to free emergency care.
For more comprehensive healthcare, the SSN is open to Italian citizens as well as foreign residents, so it is worth considering if you are going to be living in Italy over a longer period.
As an American, I found private healthcare to be fairly affordable in Rome. However, after many years in Italy I decided it was time to enroll in the Italian national health system.
Like most bureaucratic processes, signing up for the SSN takes a bit of time, patience, and paperwork.
Here’s what to know about registering for national health insurance in Italy:
- You have to be a resident / hold a permesso di soggiorno: The first step to joining the SSN makes sense: you have to legally live in Italy. However, it can also be a catch-22 because gaining residency or applying for a permesso di soggiorno requires that you show proof of health insurance! For a permesso di soggiorno, you may want to consider short term insurance for the permit application, and then use the permesso receipt to apply for the SSN. For residency, we were able to pay for the SSN enrollment and show the payment receipt as proof at the anagrafe. THEN, we took the registered residency back to the Azienda Sanitaria Locale (ASL) office to complete the circle.
- If you have a valid work contract, your registration is free: Check with your employer, but if you have a valid contract then you will only need proof of your residency and the proof of employment. The following steps are how to enroll as a voluntary user of the Italian Health System.
- Sign up periods are for the calendar year: Registration for the SSN is valid from 1 January to 31 December. That means that you will pay the same for coverage regardless of whether if you sign up on January 1st or November 1st. If you are considering registering late in the year, you might want to consider if you can wait until the start of the next calendar year.
- The cost of registering for the SSN varies by region: The SSN is overseen by the ministry of health, but it is managed regionally. That means that the price for annual enrollment varies based on where you live. In Lazio in 2017, the cost was a nice even €387.84. Most people will pay this full amount, but students pay closer to €150. Those who earn more than a specific annual income will pay 7.75% of global income (according to the national level). How can you know how much it will cost to register for Italy’s SSN? You really really need to contact your Azienda Sanitaria Locale to confirm. Plan to go at least once in person to explain your situation and then determine which documents you need to return with, and set once and for all your contribution prices. (There are a lot of comments about how the price above is misleading, but all I can say is that you MUST go speak to someone in YOUR local ASL office to confirm).
- You have to pay at the post office: Ah, the Italian post office. My favorite of all local offices. The post office is the catch all of bureaucratic processes, and it happens to be where you will need to pay for the SSN. This is why you have to contact the ASL office first to find out the exact amount that your enrollment will cost, as well as the account number that it should be sent to. When you arrive at the post office, you will fill out all this information in triplicate. Save the receipt because you will need it in order to formally apply.
- Ask around about a medico di base: Everyone who uses the SSN is assigned a medico di base – a general doctor who practices in their neighborhood. When you sign up at the ASL, they will ask you who you want your doctor to be. If you have no idea, they will assign one to you but it might be worth speaking to friends and neighbors to see if any doctors come recommended.
- Photocopy everything: Once you have paid and gathered all your documents (see below for a list), ensure that you have copies of everything. Take these, and the originals, to your ASL office. No need to make an appointment – just take a number once you arrive.
Documents needed to register for Italy’s national health system:
- Your permesso di soggiorno (or the proof that you have applied and are waiting for the card)
- Proof of residency. If you don’t have a permesso di soggiorno because you are an EU citizen, you need to bring your attesta di residenza from the comune. If you do have a permesso di soggiorno, you can bring your registered housing contract or an “autocertificazione di residenza.” Here is an online example.
- Your codice fiscale. Registering for the SSN will grant you a tessera sanitaria – a health card. The health card is a legal confirmation of your tax code, so this is an important one. Here’s more information on how to get a codice fiscale.
- Proof of identity, e.g. your passport.
- Proof of payment for the voluntary enrollment (described above).
- Photo copies of everything.
- You may also be asked for a copy of your employment contract, or you can sign another self-certification regarding your income. They should have these forms at the ASL office.
(Here’s the hand written list that I got from my ASL office about what documents to bring).