Italy’s healthcare system consistently ranks among the best in the world, and for Americans accustomed to high premiums and complex insurance networks, it represents one of the most compelling benefits of life in Italy. The Servizio Sanitario Nazionale (SSN), Italy’s national health service, provides comprehensive medical coverage to all legal residents at a fraction of what healthcare costs in the United States. This guide explains how the system works, how to enroll, what is covered, and how to navigate care as a new resident.
How the Italian Healthcare System Works
The SSN is a universal, publicly funded healthcare system established in 1978. It is financed primarily through national and regional taxation and provides care to all legal residents of Italy, regardless of nationality, employment status, or pre-existing conditions. There are no annual enrollment periods, no network restrictions, and no claim denials.
Healthcare in Italy is administered at the regional level, meaning each of Italy’s 20 regions manages its own healthcare infrastructure. The quality and availability of services can vary somewhat between regions, with northern and central Italy generally offering shorter wait times and more specialized facilities. However, the baseline level of care is high throughout the country.
Italy routinely ranks in the top 5 to 10 countries globally for healthcare outcomes, including life expectancy (currently among the highest in Europe) and overall system performance.
Who Is Eligible
Eligibility for the SSN depends on your legal status in Italy:
Italian and EU citizens: Automatically entitled to SSN enrollment upon establishing residency (residenza) in an Italian municipality. If you have obtained Italian citizenship, you are fully eligible the moment you register your residency.
Non-EU citizens with a valid residency permit: Eligible for SSN enrollment if they hold a work visa, family reunification visa, elective residency visa, or other qualifying permit. Students and temporary visa holders may have limited access or may need private insurance.
Non-registered individuals: Emergency care is available to everyone in Italy regardless of status. Emergency rooms (pronto soccorso) cannot refuse treatment.
How to Register with the SSN
Registration is done at the ASL (Azienda Sanitaria Locale) office in the district where you have established residency. The ASL is the local health authority that manages healthcare services in your area.
Documents You Will Need
- Codice fiscale (Italian tax identification number). See our codice fiscale guide for how to obtain one.
- Proof of residency (certificato di residenza from your comune)
- Valid identification (passport or Italian ID card)
- For non-EU citizens: your permesso di soggiorno (residency permit)
Choosing Your Doctor (Medico di Base)
During registration, you will select a medico di base (general practitioner), also called medico di medicina generale. This doctor becomes your primary care physician and the gateway to the rest of the healthcare system. The ASL will provide a list of available doctors in your area, showing their location, office hours, and current patient count (each doctor has a maximum patient limit).
Your medico di base:
- Provides primary care consultations at no charge
- Writes prescriptions for medications, tests, and specialist referrals
- Issues medical certificates for work, sports, and other purposes
- Manages chronic conditions and ongoing care plans
- Makes house calls when medically necessary (a practice that still exists in Italy)
You can change your doctor at any time by visiting the ASL and selecting a new one. If you are not satisfied with your care, there is no penalty or waiting period for switching.
What the SSN Covers
The SSN provides broad coverage that exceeds what many American insurance plans offer:
- Primary care: All visits to your medico di base are free
- Emergency care: Emergency room visits and ambulance services are free for genuine emergencies
- Hospital care: Inpatient treatment, surgery, and hospital stays are fully covered
- Specialist consultations: Covered with a referral from your medico di base, subject to a modest copay
- Diagnostic testing: Blood work, imaging (X-rays, MRIs, CT scans), and other diagnostics are covered with a referral
- Prescription medications: Many medications are fully covered (Class A drugs for chronic and serious conditions); others require a small copay
- Maternity care: Full prenatal, delivery, and postnatal care at no cost
- Pediatric care: Children are assigned a dedicated pediatrician (pediatra di libera scelta) who provides free care until age 14 (or 16 with chronic conditions). See our children’s healthcare guide for details.
- Mental healthcare: Psychiatric and psychological services are available through the SSN, though access varies by region. Our mental healthcare guide covers this in depth.
- Vaccinations: Childhood and adult vaccinations are provided free through the ASL
- Rehabilitation: Physical therapy and rehabilitation services are covered with a referral
Copays and Costs
While the SSN covers most care, there are modest copays (ticket) for certain services:
- Specialist visits (with referral): EUR 30 to EUR 50 per visit
- Diagnostic tests: Variable copays, typically EUR 10 to EUR 50 depending on the test
- Emergency room (non-emergency visit): EUR 25 to EUR 50 if the visit is classified as “white code” (non-urgent)
- Prescription medications (Class C): Full cost borne by the patient for non-essential medications; Class A medications for chronic/serious conditions are free or have minimal copays of EUR 1 to EUR 5
Certain categories of patients are exempt from copays entirely, including children under 6 in households below a certain income threshold, adults over 65 with low incomes, pregnant women (for pregnancy-related care), patients with chronic conditions (for care related to their condition), and individuals with disabilities.
Compared to American healthcare costs, these figures are negligible. There are no deductibles, no out-of-pocket maximums to reach, and no surprise bills.
Wait Times and the Public vs. Private Dynamic
The most common criticism of the Italian public healthcare system is wait times for non-urgent specialist appointments and elective procedures. Depending on the region and specialty, you might wait 2 weeks for a dermatologist or 2 to 3 months for a non-urgent orthopedic consultation. Urgent cases are prioritized and seen much faster.
This is where the private healthcare sector plays a complementary role.
Private Healthcare (Sanita Privata)
Many Italians and expats use a combination of public and private care. The private system offers:
- Shorter wait times (often same-week appointments for specialists)
- Choice of specific doctors and facilities
- More comfortable hospital rooms and amenities
- Extended consultation times
Private consultations typically cost EUR 80 to EUR 200 per specialist visit, with more complex procedures costing proportionally more. Even at private rates, Italian healthcare costs are a fraction of U.S. prices.
Many private facilities in Italy also operate under convenzione (agreement) with the SSN, meaning they accept public patients for certain services. Your medico di base can often refer you to these accredited private facilities, where you pay only the standard SSN copay.
Health Insurance in Italy
Do You Need Private Insurance?
If you are enrolled in the SSN, private insurance is not necessary but can be a useful supplement. Private health insurance in Italy typically costs EUR 80 to EUR 200 per month, dramatically less than comparable coverage in the United States. For more details on insurance options and providers, see our health insurance guide.
Common reasons to carry supplemental private insurance:
- Faster access to specialists for non-urgent issues
- Dental care (not comprehensively covered by the SSN for adults)
- Private hospital room preferences
- Coverage while traveling outside Italy
Many Italian employers offer supplemental private health insurance (assicurazione sanitaria integrativa) as a workplace benefit.
Before SSN Enrollment
If you are in Italy before your SSN enrollment is complete (for example, during the residency registration process), you should carry travel or international health insurance to cover any medical needs in the interim. Once enrolled in the SSN, this becomes unnecessary for care within Italy.
Pharmacies
Italian pharmacies (farmacie) play a larger role in daily healthcare than their American counterparts. Pharmacists are highly trained and can provide medical advice, administer certain medications, and help with minor health issues without a doctor’s visit. Pharmacies are identified by a green cross sign and operate on a rotation system so that at least one pharmacy in each area is always open, including nights, weekends, and holidays (the farmacia di turno).
Prescription medications are classified into categories:
- Class A: Essential medications for chronic and serious conditions, fully covered by the SSN (you pay nothing or a minimal regional copay)
- Class C: Non-essential medications, paid in full by the patient. These include many over-the-counter equivalents and lifestyle medications.
Many common American over-the-counter medications require a prescription in Italy, so consult your medico di base or pharmacist about local equivalents for any medications you currently take.
Emergency Care
Italy’s emergency services are accessible by calling 112 (the unified European emergency number) or 118 (the dedicated medical emergency number). Emergency rooms operate on a color-coded triage system:
- Red code: Life-threatening emergency, immediate treatment
- Yellow code: Serious but not immediately life-threatening, seen within 15 to 30 minutes
- Green code: Non-urgent but requires medical attention, wait times of 1 to 4 hours
- White code: Non-emergency, could be handled by a general practitioner. Longest wait times and a copay of EUR 25 to EUR 50 applies.
For more on emergency services, including non-medical emergencies, see our emergency services guide.
Healthcare for Specific Populations
Italy offers specialized healthcare pathways for different groups:
Women’s healthcare: The SSN provides comprehensive gynecological care, family planning services, fertility treatments (with some regional variation), and full maternity coverage. Consultori familiari (family health clinics) offer free reproductive healthcare services. Our women’s healthcare guide covers this in detail.
Children: Every child registered in Italy is assigned a pediatra di libera scelta (family pediatrician) who provides free, ongoing care including vaccinations, developmental monitoring, and sick visits. The children’s healthcare guide explains the pediatric system.
Seniors and retirees: Italy’s healthcare system is particularly strong for older adults, with comprehensive chronic disease management, home care services for those with limited mobility, and one of the highest life expectancies in Europe.
Common Questions
Can I keep my American doctor or insurance?
American insurance plans generally do not cover care in Italy (except some travel insurance or international plans). Once enrolled in the SSN, you will use Italian doctors and facilities. If you maintain a part-time presence in the U.S., you may want to keep a U.S. insurance plan for care during visits home.
Do Italian doctors speak English?
In major cities and tourist areas, many doctors speak at least some English, and some practices cater specifically to international patients. In smaller towns, Italian will likely be the primary language of care. Having at least basic Italian for medical interactions is helpful, and our language guide can help you get started.
How does Italian healthcare compare to American healthcare?
In most measurable outcomes, favorably. Italy has higher life expectancy, lower infant mortality, and universal coverage at roughly one-third the per-capita cost of the U.S. system. Wait times for non-urgent care can be longer than in the U.S. private system, but the cost difference is dramatic. An MRI that might cost $1,500 to $3,000 out-of-pocket in the U.S. costs EUR 30 to EUR 50 as an SSN copay in Italy, or EUR 100 to EUR 250 at a private facility.
What about dental care?
Dental care for adults is not comprehensively covered by the SSN, though some basic services and emergency dental care are available. Most Italians use private dentists, with costs that are significantly lower than in the U.S. (a routine cleaning might cost EUR 60 to EUR 100, and a filling EUR 80 to EUR 150).
Getting Started
Access to Italy’s healthcare system is one of the most valuable practical benefits of Italian residency. For Americans exploring a move to Italy, understanding your eligibility for healthcare enrollment starts with understanding your legal status. Italian citizens have the simplest path: register your residency, visit the ASL, and you are covered.
If you are considering Italian citizenship by descent as your path to residency, PortaleItaly’s pre-qualification assessment can help you determine your eligibility and plan the process from ancestry research through SSN enrollment and beyond.