How low is that out-of-pocket maximum?

by Brett Andrews

About Italy Healthcare

Italy’s National Health Service receives funding through federal tax revenues. Care is extended to all legal residents, mostly for free or nominal costs. This system requires no deductibles. 

Italy provides universal coverage through its National Health Service, Servizio Sanitario Nazionale (SSN). SSN has offered urgent and essential medical service to undocumented people since 1998, while Italian citizens and legal residents have benefited from this system since 1978. Healthcare delivery is decentralized across 100 local health units, providing services ranging from primary care to mental health. 

All legal residents in Italy have a right to public healthcare. Anyone staying in the country beyond 90 days is required to have coverage. Roughly 10% of the population carries additional private insurance, which may provide quicker care access, choice of specialists, and better amenities for elective procedures. 

Italy’s pharmacies (farmacia) can be readily identified by a large green cross. Many are open 24 hours a day. While over-the-counter medications require payment, doctor prescriptions are either free or heavily subsidized here. 

Here are some examples of what residents pay for health services:

Finding a Physician

To find your general practitioner (GP), simply check availability for the physicians in your area, either online or by phone. You can choose any GP you prefer, provided that their patient list hasn’t exceeded the maximum of 1,500 for GPs or 800 for pediatricians. Group practices of 3-8 GPs are common here, especially in the north. GPs cannot bill patients for any procedures delivered. 

In order to see a specialist in the public system, you’ll need a referral from your GP. Patients can choose the hospital for their specialist but not the specialist themselves. Payment rates are determined regionally, using national average rates for guidance. 

If you have private insurance in Italy, you can contact your insurer directly for recommendations or a list of approved providers, including specialists and dentists.

Public Healthcare

Public healthcare is free to all residents under the SSN system after a 90-day waiting period. Registration is free at the SSN if you meet the requirements. If you don’t qualify for the free option, you’ll register with the local Azienda Sanitaria Locale (ASL) and pay the €145 annual subscription cost. The registration process can take 2-3 months, so plan on maintaining private coverage for the duration. The SSN system excludes dental care except for children and emergencies. 

Private Healthcare

Since the SSN doesn’t allow people to opt out of the public system, private insurance exists only to enhance the public option instead of replacing it. Private options offer more comfortable hospital facilities and wider choices among care providers. Plans either cover copays (complementary) or additional services outside the public option (supplementary). About 10% of residents keep private coverage.

Out-of-pocket Options

Out-of-pocket payments are generally not recommended for expat residents in Italy. Private treatments are prohibitively expensive and paid wholly out of pocket. 

Healthcare Checklist

• Schedule final appointments with your primary care physician and any specialists you see. 
• Research your medications for availability in Italy and find alternatives where needed. 
• Stock up on prescription refills until you can get to the pharmacy in Italy. It’s a dance because you’ll save money by filling your prescriptions in Italy, but it may take time for you to learn your way around. 
• Print out and keep photographic records of all prescriptions. Request your medical records and, ideally, upload them to a cloud server where you can access them anywhere. Alternatively, printouts, desktop files, and thumb drives also work. 
• Ask your providers for referrals abroad. You never know! Apply for private insurance to cover your first six months here. If you qualify for free public healthcare, register with the Servizio Sanitario Nationale (SSN) after 90 days of residency. If you’re not eligible for free healthcare, register at the local Azienda Sanitaria Locale (ASL) and pay the €145 annual fee. For private healthcare, apply for private insurance and get physician names. Visit your expat Facebook group or other forums to ask for recommendations. 
• See your family doctor and get prescriptions and referrals.