How health insurance & healthcare work in Italy

Italy has one of the best healthcare systems in the world, and ranking 10th in Europe.

But there is an issue.

Most newcomers struggle to understand how it works, and that can cost a lot of money (and result in worse health outcomes during treatment).

That’s why today, we’ll guide you through how to understand Italy’s healthcare system, avoid costly mistakes, and get covered fast.

Let's get started.

Is health insurance mandatory in Italy?

If you’re moving to Italy (or even planning to stay a few months) one question comes up fast: Do I need health insurance?

The short answer? Yes.

Whether it’s SSN enrollment or private coverage, you’ll need proof of insurance to live legally and access care.

But how it works depends on:

1. Your citizenship
2. How long you plan to stay.

Let’s take a closer look.

For EU citizens

If you’re from the EU, your European Health Insurance Card (EHIC or GHIC) has you covered for short trips (under 90 days).

But once you cross that 90-day mark, things change.

To register your residence, you’ll need to either:

• Enroll in Italy’s public system, the Servizio Sanitario Nazionale (SSN), or
• Show proof of private health insurance that’s valid in Italy.

So while it’s technically optional for a short holiday, it becomes a must-have once you settle in.

For non-EU citizens

For non-EU nationals, health insurance is required by law.

You’ll need it to get a visa or a residence permit, with coverage of at least €30,000 for medical expenses. Even short-term visitors staying beyond the typical tourist window must show proof of insurance.

In short: no insurance, no visa, no permit.

For legal residents

If you’re working in Italy, good news: your employer takes care of enrollment in the SSN, and coverage starts automatically.

If you’re not employed (like a student, retiree, or freelancer), you can join the system voluntarily for a small fee.

Alternatively, you can choose private health insurance for more flexibility, especially if you want faster access to specialists or services in English.

How Italy’s healthcare system works

Italy’s healthcare system often ranks among the best in the world. But if you’re new to it, the structure can seem a bit… confusing.

Let’s break it down.

Think of the Italian system as a partnership between national, regional, and local authorities: each handling a different piece of the pie.

1. National level: Policy and funding

The Ministry of Health sets the big-picture rules: what care must be available everywhere (the Livelli Essenziali di Assistenza, or LEA), and how funds flow to each region.

2. Regional level: Day-to-day management

Italy has 20 regions, and each runs its own healthcare services.

Regions oversee hospitals, clinics, and specialist centers. They can even add extra benefits beyond the national minimums.

This is also where you’ll get your tessera sanitaria, or Italian health card.

3. Local level: Direct care

At the local level, your ASL (Azienda Sanitaria Locale) handles everything from assigning you a family doctor to organizing vaccinations and preventive care.

This is where your actual healthcare experience happens.

How to access care in Italy

There are three main ways to access treatment and healthcare in Italy.

Here’s how each works:

Primary care (your first stop)

Your medico di base (general practitioner, or GP) is your main point of contact.

Visits and home calls are free, and your GP can prescribe medications or refer you to specialists if needed.

Secondary care (specialists and hospitals)

Need an MRI, blood test, or surgery?

You’ll go through secondary care: hospitals and clinics that handle diagnostics and treatments, usually after a referral.

Emergency care (pronto soccorso)

In an emergency, dial 118 (Italy’s version of 911).

Care in the pronto soccorso is free if it’s urgent.

You’ll be triaged by color code:

• Red for critical
• Yellow for urgent
• Green or white for less serious cases.

What’s covered by Italian health insurance (and what isn’t)

In Italy’s public healthcare system (SSN) not everything is free.

And like most systems, it has limits.

So knowing what’s covered (and what’s not) can save you both money and frustration.

Let’s unpack what you actually get when you join the SSN.

What’s fully covered by the SSN

Once you’re registered, you’ll have access to a wide range of completely free healthcare services, including:

• General practitioner visits: your medico di base is your go-to for everyday care
• Pediatric care: children are fully covered up to age 14
• Emergency treatment: always free in genuine emergencies
• Hospital stays and surgeries: no bills, no hidden fees
• Maternity and childbirth care: from prenatal visits to delivery
• Preventive care: screenings, checkups, and vaccinations
• Essential medications: specifically, “Class A drugs”. These are distinct from the UK's or US's system, where “Class A” refers to highly dangerous illegal drugs. In Italy, these refer to pharmaceuticals essential for patients’ well-being.
• Rehabilitation: After surgery or injury
• Mental health services: basic psychiatric care and crisis support
• Blood tests and diagnostics

In short, the SSN covers almost everything you’d expect when it comes to emergencies, maternity, and general health.

What’s only partially covered (with a “ticket”, or co-payment)

For certain services, you’ll pay a small co-payment, known as a ticket. The amount varies by region, but expect something in this range:

• Specialist visits: €20–50
• Diagnostic imaging (like MRIs or CT scans): €10–100
• Non-essential medications (Class C drugs): €5-25
• Physiotherapy: €35-60
• Dental treatment (emergencies only; routine cleanings aren’t included): €100+

These fees help keep the system financially sustainable while still making advanced care accessible for everyone.

What the SSN doesn’t cover

There are some things the SSN simply doesn’t handle.

Why?

Usually, because they’re considered “elective” (non-essential):

• Routine dental care (cleanings, crowns, braces)
• Cosmetic procedures
• Alternative therapies (like acupuncture or homeopathy)
• Private hospital rooms
• Eyeglasses or contact lenses, unless medically necessary
• Long-term psychotherapy beyond crisis care
• Experimental treatments or non-approved drugs

It’s possible to get these services covered if they matter to you. It’s why 1 in 4 Italians opt to fill gaps in their coverage via supplementary insurance.

Coverage differences by region

Italy’s healthcare system is nationally managed but regionally run, meaning your experience can vary depending on where you live.

For example:

• Northern regions (Lombardy, Veneto, Emilia-Romagna) have well-funded hospitals, shorter wait times, and more specialists.
• Southern regions have excellent doctors, but longer waits and fewer local specialists.
• Special autonomous regions (Trentino-Alto Adige, Valle d’Aosta) often include extra coverage or faster services.

Your health insurance options: Public, private, or expat?

When you move to Italy, one of the first big questions is: which type of health insurance should I get?

You’ve got three main routes:

• The public system (SSN)
• Italian private plans
• Or international expat health insurance.

Each comes with its own perks depending on your stay length, lifestyle, and how much flexibility you want.

Let’s break them down.

1. SSN registration (Public)

The Servizio Sanitario Nazionale (SSN) is one of the best-value options.

If you’re employed in Italy, you’ll be automatically enrolled through your employer.

Coverage starts right away, and you’ll get your tessera sanitaria (health card) in a few weeks.

Public health insurance is mandatory for:

• Employees (enrolled automatically)
• EU citizens registering residence in Italy
• Family reunification visa holders

Public health insurance is optional if you’re self-employed, studying, or retired. In that case, you can join the SSN by paying a yearly fee:

• Students: €149.77/year
• Au pairs: €219.49/year
• Religious personnel: €387.34/year
• Retirees: €387.34/year
• Self-employed: 7.5% of declared income (minimum €387.34)

Should you choose the SSN?

Generally, yes. If you are officially an Italian resident, it’s almost always a smart choice:

• It’s comprehensive
• It’s low-cost
• It gives you access to almost all medical services
• And if it’s not enough for you, you can choose to get private health insurance on top of it.

2. Private Italian health insurance

Private insurance is the go-to option for anyone who wants faster appointments, private hospitals, or specialized coverage (like dental or vision).

Popular providers include:

• Generali
• UniSalute
• Allianz Care
• AXA
• Cattolica Assicurazioni

Unlike with the SSN, where the government defines what’s covered and to what extent, private health insurance products are built by private companies.

That means coverage, price, and other contract terms can vary widely. For example, a dental insurance policy from AXA will have virtually zero overlap with Generali’s comprehensive private health insurance.

With that said, these are some of the benefits you can choose to include in your policy:

• Access to private hospitals and clinics
• Shorter waiting times
• Your choice of doctors and specialists
• Private rooms and better amenities
• Optional international add-ons for travel coverage

Typical costs range from €800–3,600 per year (€65-300 per month), depending on your plan and coverage level.

Should you choose a private health insurance plan?

For most people, private health insurance is a smart move. But not for everyone.

You should get private health insurance if:

• You value convenience
• You expect a certain level of comfort during your treatment
• Access to English-speaking doctors is important
• You expect a high level of coverage for non-essential services (dental, vision, etc.)

3. International expat health insurance

For newcomers, digital nomads, and frequent travelers, international expat insurance offers the most flexibility.

Feather, for example, specializes in expat health insurance built for those building a new life abroad.

With online signup, English support, and direct billing, it’s one of the easiest ways to stay covered before or after SSN enrollment.

Some advantages of Feather’s expat health insurance include:

• Coverage is valid across multiple countries (across the EU, or worldwide; your choice)
• English-speaking customer service that’s on your side (check out our reviews)
• Medical evacuation and repatriation
• Direct billing with hospitals

Other well-known international providers include Cigna Global, Bupa Global, and Allianz Worldwide Care.

Should you choose a private health insurance plan?

It’s ideal if you move between countries often or need coverage before you’re officially in the Italian system.

People who should consider expat health insurance include:

• Expats waiting to join the SSN (expat insurance acts as a safety bridge)
• Visa and residence permit applications (where proof of insurance is required)
• Digital nomads who prefer to stay flexible without local admin

Public vs private vs expat health insurance: At a glance

For most expats, the best setup is a mix:

• Register with the SSN for affordable, universal coverage.
• Add private or international insurance for faster access and flexibility. Especially if you’re new, traveling often, or prefer care in English.

This way, you’re covered from day one and protected wherever life in Italy (or beyond) takes you.

How to get health insurance in Italy (step-by-step)

Whether you’re joining the public system (SSN) or signing up for private coverage, here’s a step-by-step look at how it all works, from people who’ve done it.

How to register for the SSN as an employee

If you’re employed in Italy, congratulations; you’re automatically covered by the Servizio Sanitario Nazionale (SSN).

That means access to doctors, hospitals, and emergency care without any additional cost.

But there are a few steps you’ll still need to follow:

Step 0: Get temporary expat health insurance (optional)

Even if you’ll soon be covered by the SSN, it’s smart to have expat health insurance before your first paycheck.

Here’s why:

• You’ll need proof of insurance when applying for a visa or residence permit.
• Coverage doesn’t start until your employer registers you (and delays happen, even with the best HR team).
• It keeps you protected during that gray zone between arrival and official coverage.

In short, it’s optional for employees, but highly recommended.

Step 1: Get your codice fiscale

This is your Italian tax ID number, and you’ll need it for almost everything. From health insurance registration, to renting an apartment.

Here’s how to get it:

• Go to your nearest Agenzia delle Entrate office.
• Bring your passport and employment contract.
• You’ll get your Codice Fiscale on the same day.

Step 2: Employer handles SSN registration

Once you start your job, your employer automatically registers you with the SSN.

Contributions are deducted from your salary, and coverage begins right away.

Regularly follow up with your point of contact in HR to know when you’re officially part of the SSN.

Step 3: Choose your family doctor (GP)

Visit your local ASL (Azienda Sanitaria Locale) office to pick a medico di base (general practitioner).

You can change your doctor if needed, but only once a year.

Step 4: Receive your tessera sanitaria

Your health card (tessera sanitaria) arrives by post in 2–4 weeks, but you can get a temporary paper version at the ASL to use immediately.

How to voluntarily register for the SSN as a student, retiree, or self-employed individual

If you’re not employed, you can still access Italy’s public system by registering voluntarily with your local ASL.

Here’s how:

Step 0: Get expat health insurance first

Until you’re officially registered, you’re not covered. This makes expat insurance essential (at least temporarily).

It’s also mandatory for visa or residence permit applications.

This short-term coverage acts as your safety net while your SSN paperwork is processed (and if you’ve ever dealt with Italian bureaucracy, you’ll know that’s worth having).

Make sure to choose a plan you can cancel anytime (like Feather’s), and not one where you’ll be stuck with the policy for a year or more.

Step 1: Gather your documents

Bring the following to your local ASL office:

• Passport (and copies)
• Codice Fiscale (you can get it at the Agenzia delle Entrate office).
• Residence permit (or proof of your application)
• Proof of income or study enrollment
• Completed ASL application form (the exact form varies by region)

Step 2: Submit your application and pay the fee

Head to your local ASL office. They’ll help you submit your application and ask that you pay an annual fee. The amount depends on your status:

• Students: €149.77
• Au pairs: €219.49
• Religious workers: €387.34
• Retirees: €387.34
• Self-employed: 7.5% of declared income (minimum €387.34)

You’ll get a temporary certificate that acts as proof of coverage while your application is processed.

Step 3: Choosing your primary doctor

Once your application is accepted, choose a doctor from your region’s list.

Each doctor can only take a limited number of patients, so act fast (especially in smaller towns).

Step 4: Receive your tessera sanitaria

You’ll receive your permanent card within 2–4 weeks. It’s valid for the duration of your residence permit and must be renewed when your permit is.

How to get private health insurance

Even with SSN access, many expats choose private insurance for better benefits.

Here’s how:

Step 1: Compare providers

Request quotes from at least 3–5 companies and check what’s actually included: hospital access, dental coverage, and other services can vary widely.

Step 2: Fill out a medical questionnaire

Most insurers require a brief health declaration. Some may ask for a medical exam, and pre-existing conditions might be excluded or limited.

Step 3: Submit your application

You can apply online or through a licensed broker. Upload your ID, choose your coverage level, and submit your application.

Step 4: Get your confirmation of coverage

Once your insurer has reviewed your application, they’ll let you know whether or not they can cover you.

At that point, you’ll need to start paying your premiums.

Some insurance companies will provide you with a card you can use at the doctor’s office.

But, most of the time, you’ll have to pay for treatment upfront, collect the bill, and submit a claim via your insurer’s portal.

Note that there may be waiting periods before you can file a claim: typically 30–180 days for non-urgent treatments or pre-existing conditions.

How much does health insurance cost in Italy?

Let’s look at what you can expect to spend depending on the type of coverage you choose.

Public healthcare (SSN) costs

Italy’s public system, the Servizio Sanitario Nazionale (SSN), is funded through taxes, which means you’re often paying less than you think.

If you’re employed, your health insurance contribution is automatically taken from your salary:

• 7.5% of gross income, split between you and your employer
• No registration fees or annual renewals
• You’ll only pay co-payments (called tickets) for certain services like specialist visits or prescriptions

If you’re not employed and joined the SSN voluntarily, you’re looking at a cost of:

• €149.77 per year for students:
• €219.49 per year for au pairs:
• €387.34 per year for retirees (with pensions), religious workers, and unemployed residents
• 7.5% of declared income (minimum €387.34) for freelancers and the self-employed.

Private health insurance costs

Private insurance costs vary based on your “risk profile”. Effectively, that means your premium varies based on:

• Your age
• Your health
• Your region of residence
• Your level of coverage

With that said, here’s a realistic breakdown:

• Basic plans, for those who want coverage for the essentials, cost around €500–€1,500 per year.
• Standard plans, for expats who want broader protection, cost anywhere between €1,500–€3,000 per year.
• Premium plans for complete coverage start at €3,000 per year but can cost up to €5,000 for the most comprehensive plans.

How co-payments work in Italy

Most Italian healthcare is public and heavily subsidized, making it highly affordable.

But for some services, you’ll pay a small co-payment, called a ticket.

Typical costs look like this:

• Specialist visits: €20–50
• Diagnostic tests: €10–100
• Non-urgent ER visits: €25–50
• Prescriptions: €0–15 per medication

Many people are exempt from tickets, including:

• Families earning under €36,152/year
• People with chronic illnesses
• Pregnant women
• Children under 6 and seniors over 65 (within income limits)
• People with disabilities

In short, Italy’s healthcare is designed to be universal. That means affordable for everyone, and free for those who need it most.

Is private (aka additional) health insurance worth it in Italy?

Private health insurance in Italy isn’t “essential”. But (there’s always a “but” in insurance), it is valuable for certain lifestyles.

If you’re a digital nomad, a frequent traveler, or someone who needs specialist care without delay, it’s absolutely worth the cost. On the other hand, if you’re fully registered with the SSN and (very) healthy, you may never need it.

So, should you get private health insurance on top of your SSN coverage?

Let’s weigh the pros and cons.

The pros

Private insurance in Italy offers convenience, speed, and choice (the things public healthcare sometimes lacks):

1. Faster appointments: In the SSN, you might wait 30–180 days to see a specialist. With private insurance, you can often book an appointment in 1–7 days. That’s a big deal if you value time or have ongoing conditions.
2. More flexibility: You can pick your own doctors, schedule appointments outside standard hours, and easily find English-speaking specialists.
3. Higher comfort: Private hospitals often feel more like hotels than clinics. Expect private rooms, modern equipment, and shorter check-in times.
4. Wider coverage: Private plans typically include dental, vision, and preventative care. Some also include alternative treatments and international coverage.

The cons

Private care isn’t for everyone. Because in Italy, it’s more of a luxury than a necessity:

1. Higher cost: You’ll pay anywhere from €1,000 to €5,000 per year. That can feel steep, especially since SSN care is either free or heavily subsidized.
2. Strong public system: Italy ranks #29 for healthcare. It’s not at the top of the list, but it ranks high nonetheless.
3. Limited added value: Private care doesn’t guarantee better medical outcomes, just faster access and nicer facilities.

When to get private health insurance

Here’s how to decide if it’s worth it for you:

Conclusion

Italy’s healthcare system strikes a rare balance between quality, affordability, and accessibility.

At its core, the SSN delivers comprehensive public care that’s either free or extremely affordable. Yet, it comes with trade-offs: longer waits, regional differences, and occasional language hurdles.

That’s where private or expat insurance can make life easier (particularly if you value flexibility or need specialist care).

Whether you rely on the SSN or add private coverage, you’ll find that healthcare here is both robust and fair.

To recap, if you’re moving to Italy, start with the SSN, because it is**:**

• Comprehensive
• Affordable
• Recognized nationwide.

Then, if you want faster access or global coverage, add a private plan.

And if you’re not yet eligible for either, consider expat health insurance.

That route gives you the best of all three:

1. Feather’s expat health insurance is easy to sign up for, and meets all visa/permit requirements
2. Italy’s SSN gives you peace of mind for all essential services
3. And private insurance gives you the freedom to access the best care available, not the best care the SSN can afford.