How to Register for the Italian Health System (SSN)

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:

  1. Your permesso di soggiorno (or the proof that you have applied and are waiting for the card)
  2. 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.
  3. 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.
  4. Proof of identity, e.g. your passport.
  5. Proof of payment for the voluntary enrollment (described above).
  6. Photo copies of everything.
  7. 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).

 

23 Comments

  • Reply Elaine Smyth October 9, 2017 at 7:02 pm

    Hi,

    Do this then mean that all medical treatment is free? Here in the U.K. under our National Health Service we receive free access to a local doctor (GP) and hospital treatment if referred by your GP to see a specialist or admitted as an emergency and then depending on our wages we have to pay for some of our dental treatment and eye care. This is all paid by national insurance contributions taken from everyone’s wages before the receive them.
    How does it work in Italy? What is it you actually get?

    Regards
    Elaine

    • Reply Natalie October 10, 2017 at 7:15 am

      Hi Elaine – it is very similar to the UK system you describe in which dental and eye care fall outside of the SSN. Medications are capped at a certain price, and not every test is free. The system is a mix of pubic and private, and so even some of the services that are offered at public hospitals are contracted to private doctors and thus come with a cost.

  • Reply Denisa December 4, 2017 at 2:57 pm

    Dear Natalie,
    God bless you for this! I have been living in Italy for over three years now, but still having a hard time understanding certain office procedures. Thanks a lot!

    • Reply Natalie December 5, 2017 at 10:42 am

      My pleasure! I hope it helps — and GOOD LUCK!

  • Reply Lizzie July 6, 2018 at 8:24 pm

    Hey Natalie,
    I’ve just moved to Italy from the UK but am continuing to work via my UK office therefore not paying Italian contributions. I’m trying to get my head around the residency requirements and from a health insurance perspective they are basically saying I need private cover or an e106 (which I’m not eligible for!) am I right in thinking that you managed to get around that by simply paying the voluntary contribution and showing the receipt? Was that a fairly straightforward process? Thank you!

  • Reply Kumar Pawar July 17, 2018 at 10:52 am

    How early can we apply for next year’s insurance?

    • Reply Natalie July 23, 2018 at 10:47 am

      Hi Kumar! I’m afraid I don’t know the answer to this one. I have always applied in early January.

  • Reply Michael August 18, 2018 at 2:13 am

    Is there really no way to estimate in advance the contribution? I would like to have a ballpark figure for myself and my wife, with an estimated annual income of €50,000. I visited this page and the table in the middle doesn’t really give any answers other than what band one would fit in:
    http://www.regione.toscana.it/cittadini/salute/ticket

  • Reply Michael August 18, 2018 at 2:13 am

    Is there really no way to estimate in advance the contribution? I would like to have a ballpark figure for myself and my wife, with an estimated annual income of €50,000. I visited this page and the table in the middle doesn’t really give any answers other than what band one would fit in:
    http://www.regione.toscana.it/cittadini/salute/ticket

    • Reply Natalie August 18, 2018 at 10:17 pm

      You should call the ASL in Tuscany if that is where you plan to register. It is a set % of your income above a certain cut off but this is decided yearly at the regional level so I am not able to help estimate.

  • Reply Ken August 29, 2018 at 2:08 pm

    Hi Natalie!
    Thanks for providing such a detailed roadmap! My wife and I are in the early stages of planning a move to Italy. We would be generating most (if not all) of our income through real estate in the US. Assuming that neither of us are working in Italy, can we still participate in the SSN? We can afford to pay for private insurance but would like to become part of the public system at some time. Sorry if this question is too specific – but hoping that you might have some insight! Thanks and have a great day!

  • Reply robert October 3, 2018 at 8:36 am

    this is not correct the ssn informs me that voluntary insurance is 7.5% of income not 387 euros

    please correct your information, don’t know where you got incorrect information, quite misleading

    thanks

    • Reply Natalie October 3, 2018 at 10:28 am

      Hi Robert,

      As you can see the photo with the price is a document provided directly by the ASL (health agency). This was the price in Lazio in 2017. You need to check with your region in the year that you want to enroll. People who make an income over a certain threshold (again, check with your local ASL) THEN pay a percentage based on that income, which is likely what you are referring to.

      Good luck!

    • Reply Ron Ritter December 24, 2018 at 10:50 am

      hi, yes very misleading information no in the SSN know about this and seems to be an error in this blog , can you make this clear 7.5% of gross world wide income, thanks Ron

  • Reply Jurgen October 3, 2018 at 1:37 pm

    Hi Natalie,
    You started something….. good??. But I missed the reply to a question by Lizzie as follows:

    . I’m trying to get my head around the residency requirements and from a health insurance perspective they are basically saying I need private cover or an e106 (which I’m not eligible for!) am I right in thinking that you managed to get around that by simply paying the voluntary contribution and showing the receipt?

    My family plans to move to Italy, I am retired and get pension from 2 EU countries. Will they ask me to buy Private Insurance as said by Lizzie?

    Guess several people are interested to know.
    Thanks

    • Reply Natalie October 7, 2018 at 11:07 am

      Hi! I’m sorry but I am not sure. I would say the best thing to do is to go to ASL. You may need private insurance for residency and then, once a resident, you can try to enroll. We did get around the residency with a receipt but I can’t promise that will work everywhere

  • Reply Desireed October 11, 2018 at 11:29 pm

    Hey, super useful info thanks very much, it seems that my first step after obtaining residency as a EU citizin is to go to my ASL office and seee what documents they need for my registration into the ssn syrem aka health card. How did you find out which ASL office to go to? I am in the furio camillo area and i think Re di Roma is the closest but not sure and like to know before I show up there. Do you have any useful info about this

  • Reply Jack December 5, 2018 at 10:53 am

    Who did you use for private insurance? There seems to be a wide range of companies but all seem called “expat” insurance. Was wondering if there were private Italian insurance companies

  • Reply Julian December 23, 2018 at 1:54 pm

    Useful healthcare summary but I agree with Robert that the costs of voluntary subscription are misleading. We found it cheaper to take private cover than pay the subs for SSN which the agency calculated for us. UK resident expats can no longer rely on reciprocal EU cover until you reach national retirement age and DWP provide the S1 NI contribution certificate. But that will likely change with Brexit.

    • Reply Natalie January 1, 2019 at 3:52 pm

      I agree that they are incredibly variable and it depends on age, income, location, employment status, residency status, etc. I highly suggest going in person to your local ASL office but I am glad you found an alternative private solution! This is also what we used for most of our time in Italy.

  • Reply Peter Grantham February 18, 2019 at 1:07 am

    stumbled across and noted this, INA – Assitalia Insurance. Euros 98 per year gives access to emergency rooms. May help

  • Reply Cindy Kelly April 18, 2019 at 5:17 pm

    I have dual citizenship but live in the United States right now. Can you recommend private insurance in Italy or that can be used both in Italy and the U.S.

    • Reply Natalie April 19, 2019 at 1:37 pm

      I am not an expert but I believe you need to be a resident in one country (wherever you spend 180 days or more) and get insurance there that works in both. I have my insurance and then a travel policy

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