How the Italian public healthcare system (SSN) works

Moving to Italy is exciting. But before settling in, it helps to understand how healthcare works here.

Italy’s Servizio Sanitario Nazionale (SSN), or National Health Service, gives residents access to public healthcare funded by taxes. It’s known for strong emergency and hospital care, though speed and quality can vary between regions.

If you’re registered as a resident and signed up for the SSN (either mandatorily through employment or voluntarily) you’re covered for most medical needs. That includes emergencies, hospital stays, specialist visits, and prescriptions, usually at no cost or with a small co-payment (called a “ticket”).

Co-payments apply up to €36 for a specialist visit or prescription and up to €25 for a hospital visit.

With the basics out of the way, let’s get into the specifics…

How to sign up for the public health system in Italy

To join the SSN, you’ll first need to become a registered resident. Once that’s complete, visit your local ASL (Azienda Sanitaria Locale) — the regional health office — to enroll. You’ll then choose or be assigned a family doctor (medico di base), who’ll be your first point of contact for non-urgent care.

The process and waiting times can differ by region, and some doctors may already have full patient lists. It’s best to register as soon as your residency is confirmed.

Who can register voluntarily?

If you’re not automatically covered through employment, you may still qualify for voluntary enrollment (iscrizione volontaria) in the regional health system.

You can register voluntarily if you:

• Hold a valid residence permit for more than three months, or are an EU citizen living in Italy without healthcare coverage from your home country.
• Fall into one of these categories:
  • Residents with elective residence permits (and their dependents)
  • Residents for religious, diplomatic, or business purposes (and dependents)
  • Students and au pairs
  • Volunteers participating in recognized programs
  • Specific workers who pay contributions abroad
  • Elderly family members (over 65) joining relatives in Italy through family reunification, if their permit was issued after 5 November 2008

What you’ll need to register

To register at your local ASL’s Scelta e Revoca office, you’ll need:

• A valid residence permit (or, for first-time student applicants, the receipt showing your permit request)
• Proof of residence or habitual domicile
• Your tax code (codice fiscale)
• Proof of payment for the annual contribution (contributo annuo)

This contribution is non-refundable and non-divisible, meaning you pay the full yearly amount regardless of when you register. Payments are made via Form F24.

How much does it cost?

The voluntary contribution depends on your situation and income:

• Minimum contribution: €2,000 per year
  • Applies to foreign residents not eligible for mandatory registration, including those with elective residence, religious personnel, students with dependents, and elderly family members joining relatives
  • Valid for total annual income up to €31,925
• Higher income contribution: €2,000 + 4% on income between €31,925 and €51,646
  • Maximum total: €2,788.87
• Flat-rate contribution:
  • Students or religious staff without dependents: €700 per year
  • Au pairs without dependents: €1,200 per year

Foreign nationals with tourist visas, permits for medical treatment, or permits shorter than three months are not eligible for SSN enrollment (even voluntarily).

Strengths of the SSN

• Reliable emergency care: You’ll be treated quickly in life-threatening situations, no questions asked.
• Comprehensive hospital coverage: Surgeries, hospital stays, and urgent treatments are all included.
• Financial protection: You won’t face unexpected bills for critical care.

Where the SSN falls short

• Long waits for non-urgent care: Appointments for specialists or scans can take weeks or months.
• Limited flexibility: You can’t always choose your doctor or appointment time.
• Language barriers: Finding English-speaking staff can be difficult.
• Calendar-year limitation: Sign-ups cover only full years — inconvenient for shorter or mid-year stays.
• No Schengen coverage: Voluntary SSN coverage applies only within Italy.

What this means for expats

The SSN gives you essential protection, especially for emergencies and pre-existing conditions that private insurance might not cover. However, routine care can be slow.

Many expats rely on the SSN for major needs and add private insurance for faster access, flexibility, and peace of mind.

Why do many expats buy private insurance?

Private health insurance is the fast lane for everyday healthcare. It complements the SSN by giving you:

• Shorter waits: See specialists or book tests in days, not months.
• Freedom of choice: Pick your doctor or clinic directly.
• Comfort and clarity: Access English-speaking doctors and international facilities.

Examples:

• Need an MRI for knee pain? The SSN might take months, but you can schedule one privately next week.
• Do you need to check a mole that changed rapidly? Public waitlists are long, while private clinics often have next-day appointments.

Private insurance is especially useful for frequent travelers, students, and anyone who values speed and convenience.

How Feather helps

Feather can be more convenient than the voluntary SSN subscription, but in case of preexisting conditions entering the public system might be advisable. In those cases, you can still choose to combine both.

You can:

• Stay protected by the SSN for preexisting conditions private insurance cannot cover
• Use Feather to access faster private care, English-speaking doctors, and clinics that understand expat needs.
• Be covered through Feather across Europe

Feather’s health insurance is also fully compliant with Italian visa and residence permit requirements, so you can use it to apply for your visa, permesso di soggiorno, and residency without delay.

We recommend starting with Feather when you arrive: It keeps you covered from day one, helps with your residence paperwork, and gives you time to review your setup later. That way, you’re protected from the moment you land in Italy to every adventure that follows.