Healthcare

Healthcare in Italy for Americans: How the SSN Works (2026)

By Giacomo AmendolaFacts checked October 24, 2026

Who runs it

The state sets the essential levels of care; regions organize and deliver them

Must enroll

Employees, the self-employed, family permits and other categories in the law

Voluntary enrollment

At least €2,000 a year (students €700), valid January 1 to December 31

No charge once enrolled

Family doctor, pediatrician, hospital stays, screening programs

Specialist visits and tests

A ticket (co-payment) of up to €36.15 per prescription, unless exempt

Emergencies

Call 112 or 118, free, 24 hours a day

Visitors (up to 90 days)

No enrollment; care is billed at regional rates (Piedmont)

How the Italian national health service is organized

Italy's Servizio Sanitario Nazionale (SSN, national health service) was created by Law 833 of 1978. Its founding principles are universality, equality and equity.

The work is split between Rome and the regions. The state sets the LEA (livelli essenziali di assistenza, essential levels of care) that must be guaranteed everywhere. Each region plans and runs healthcare on its own territory.

Care is delivered by aziende sanitarie locali (ASL, local health authorities), hospital trusts and private facilities accredited with the SSN. Names change by region: Lombardy uses ATS and ASST, Tuscany has 3 USL, and Sicily has one azienda sanitaria provinciale per province. This guide says ASL for all of them.

Enrollment offices, booking systems and some charges vary by region. Where a rule below comes from one region or one ASL, it says so.

Who must enroll and who can choose

Your route depends on the reason printed on your permesso di soggiorno (residence permit). Article 34 of Legislative Decree 286/1998, the immigration law, sets the categories.

Enrollment is mandatory for foreigners who legally reside and work as employees or are self-employed, or are registered as job seekers. It is also mandatory on permits for employment, self-employment, family reasons, asylum and several other listed reasons. That includes people who have applied to renew one. You get the same rights and contribution duties as Italian citizens. Dependent family members who legally reside are covered too.

Everyone else must insure themselves. The law offers two ways:

• a policy covering illness, injury and maternity, from an Italian or foreign insurer, valid in Italy
• voluntary enrollment in the SSN, which also covers dependent family members

Elective residence is in this second group. Regione Piemonte and ASL Sassari both list it among the permits that allow voluntary enrollment. See the elective residence visa guide.

In ruling 97 of 2026, filed June 5, 2026, the Constitutional Court read the law as giving free, mandatory enrollment to one narrow group. They are people whose work or family permit was converted to elective residence after they were granted an Italian civil disability pension. If you arrive on an elective residence visa, the voluntary rules apply.

What voluntary enrollment costs

Voluntary enrollment carries an annual contribution. It is the same percentage Italians pay, applied to your total income from the previous year, in Italy and abroad.

The law allows the minimums to be adjusted each year by ministerial decree, taking account of consumer prices. Confirm the current figure with your ASL before you pay.

The contribution buys a calendar year. ASL Sassari states that enrollment runs from January 1 to December 31, whatever your permit's expiry date, and cannot be split or backdated. Regione Lombardia and Regione Piemonte describe the same calendar-year rule.

How to calculate and pay it, step by step, is in the voluntary SSN enrollment guide.

How to enroll and choose a family doctor

You enroll at the ufficio scelta e revoca (registration and doctor-choice office) of the ASL where you live. The Ministry of Health lists what to bring:

1. Your permesso di soggiorno, or the post office or questura (police immigration office) receipt for a renewal.
2. Proof of address: a self-certification of residence, or a declaration of where you actually live as shown on the permesso.
3. Your codice fiscale (tax code), or a self-certification of it.
4. For a first employment (lavoro subordinato) or family permit, the receipt for your application. Family applicants also bring the entry visa and a copy of the nulla osta (clearance).
5. For voluntary enrollment, proof that you paid the contribution and a self-certification of your income (ASL Sassari's list).

The Ministry's list accepts an application receipt only for first employment and family permits. On other first permits, ask your ASL whether it will enroll you before the permit card is issued.

At the same visit you choose a medico di base (family doctor) or, for a child, a pediatra (pediatrician). The doctor's name goes on your health card, and visits to that doctor are free.

You normally choose among doctors practicing in your area. ATS Milano's doctor search marks each one green when places are available and red when they are not. It warns that its data are not updated in real time. In Lombardy you can also choose online through the Fascicolo Sanitario Elettronico (electronic health record).

Offices organize the visit differently. In Florence, USL Toscana Centro sees people by appointment, booked through 055 54 54 54, option 2, or at local pharmacies. Check your ASL's page before you go. The SSN registration guide covers the visit in detail.

The tessera sanitaria

The tessera sanitaria (health card) is the document that proves you are enrolled. The Ministry of Health describes it as the personal document you use to access care.

The first card is requested only through your ASL, and it requires both a codice fiscale and SSN enrollment. If you do not have a codice fiscale yet, the codice fiscale guide explains how it is assigned.

For non-EU residents, the card lasts as long as the permesso di soggiorno. If you lose it, or it never arrives, order a new one online from the Agenzia delle Entrate (Revenue Agency). You log in with SPID, CIE or CNS digital identity. You can also print a copy of your current card from the Agenzia's online account.

What is free and what costs a ticket

The ticket is a co-payment set by law. Enrolled foreign residents pay it on the same terms as Italians, and the Ministry of Health lists what it applies to.

Many regions set their own tariffs, so the same test can cost different amounts in different places. Exemptions exist for some income and age groups, chronic and rare diseases, disability and pregnancy. Your ASL issues the exemption card.

Prescriptions and pharmacies

Your medico di base writes the ricetta (prescription) for medicines, specialist visits and tests. You book specialist care through your region's system, usually the CUP (centro unico di prenotazione, central booking office). If you ask the pharmacy for a branded medicine when a generic exists, you pay the price difference. The pharmacy guide covers how pharmacies work.

Emergencies: 112, 118 and the pronto soccorso

For a medical emergency, call 118 or 112. Both are free. The Ministry of Health describes 118 as active across Italy, 24 hours a day, from any landline or mobile.

112 is the single European emergency number. Calls are free even from a phone without a SIM card. Where a region's 112 center is active, it takes the call, locates you and passes it to the 118 medical service. It also offers support in other languages.

Call when someone's life or safety may be at risk: sudden illness, injury, burns, poisoning, accidents or near-drowning. Give your phone number, the town, street and house number, and whether the person responds, breathes or bleeds. Then keep the line free, because the center may call back.

At the pronto soccorso (emergency room), a triage nurse assigns a priority code. National guidelines from 2019 set numeric codes from 1, the most serious, to 5, and let each region pair them with a color.

Meanings, times and colors in the table are from Regione Lazio's triage manual, which applies the national guidelines. Other regions may use other colors.

The guidelines also set a maximum of 8 hours from triage to the end of the emergency room visit. Triage is repeated while you wait, so your code can change. Lazio's manual reassesses codes 3 to 5 when the patient asks, so tell the triage nurse if you feel worse.

The emergency numbers guide covers 112 and 118 in more detail.

Waiting times, and the private and intramoenia options

The rule. Every prescription for specialist care must state a priority class, which sets your deadline. Under the national waiting-list plan for 2026 to 2028, adopted June 26, 2026, the maximum waits are:

• U (urgent): 72 hours
• B (brief): 10 days
• D (deferrable): 30 days for visits, 60 days for diagnostic tests
• P (planned): 120 days

Regions must adopt their own plans within 120 days of the national plan taking effect. The plan also requires every booking agenda, public, accredited private and intramoenia (private practice by public-system doctors), to sit in the CUP.

What people report. In 2024, 9.9% of Italy's population gave up a needed specialist visit or test, according to ISTAT (national statistics institute). For 6.8%, the reason was long waiting lists; for 5.3%, cost.

The share was highest in Sardinia (17.2%), Abruzzo (12.6%), Umbria (12.2%) and Lazio (12.0%). The same year, the share of people who paid the full cost of their last specialist visit or test themselves, without insurance reimbursement, rose from 19.9% to 23.9%.

What you can do:

1. Check the priority class on your prescription before you call the CUP.
2. Ask for the lista di tutela (protected waiting list) if the CUP cannot book you in time. The CUP must call you back within 5 days for class B, 10 for D visits, 15 for D tests and 30 for P.
3. Ask about intramoenia. Under Legislative Decree 124/1998, if your wait passes the limit set by your local health authority, you can ask for intramoenia care at the ticket price. The law applies this pending regional rules, so ask your ASL how your region handles it.
4. Book intramoenia or private care directly. Intramoenia means seeing a doctor of the public health system privately, usually in its own facilities. You pay the full fee and can choose the doctor (Regione Toscana's description).

Private health insurance

For residents outside the mandatory categories, a private policy is the alternative to voluntary enrollment. The law asks for a policy from an Italian or foreign insurer, valid in Italy, covering illness, injury and maternity.

Compare its price and exclusions with the voluntary contribution for your income. The private health insurance guide covers what policies include. Insurance asked for at the visa stage is a separate question, covered in the visa insurance guide.

How care differs by region

The Ministry of Health scores each region every year on 3 areas of public care: prevention, assistenza distrettuale (community care) and hospital care. Each area is scored from 0 to 100, with 60 as the pass mark, and a strong area cannot offset a weak one.

The 2024 results, published July 10, 2026, show every region passing all 3 areas except 3. The autonomous province of Bolzano and Sicily fell short on prevention, and Calabria on community care.

Totals are AGI's and Sky TG24's sums of the Ministry's area scores. They measure regional public-system averages, not individual hospitals. The best places to live guide puts them next to rent and climate.

Visitors and new arrivals not yet enrolled

Regione Piemonte states that people staying up to 90 days, for tourism, business or visits, cannot enroll in the SSN, except students and au pairs. They can use urgent and planned care, paying the regional tariffs.

New residents need to enroll to use the SSN, the Ministry of Health says. Until then, Regione Lombardia guarantees urgent or medically necessary care to people who are not enrolled. Equal treatment with Italians applies once you are enrolled. Keep travel or international coverage in force until your enrollment or Italian policy starts.

Common problems and fixes

Not knowing where to enroll. Newcomers in Turin, Milan, Pisa and Abruzzo report being unsure which office handles the health card. Ask for the ufficio scelta e revoca of your ASL, and bring the documents listed above.

A card that expires within months. Newcomers report cards valid for 6 months or tied to their permit's date. That is the rule: enrollment lasts as long as the permit. While you wait for a first employment or family permit, it is temporary. Go back to the ASL with your renewal receipt or new permit to extend it.

A voluntary year that ends before your permit renewal. Applicants report that the December 31 expiry does not line up with their permesso renewal dates. The contribution covers only the calendar year and cannot be split. Ask your ASL when it accepts next year's payment, and keep every year's receipt.

No family doctor with open places. ATS Milano's search shows doctors with no current places in red. Choose one marked available, and ask the scelta e revoca office to confirm, since online data can lag.

A specialist date months away. Check the priority class, ask for the lista di tutela, and ask about intramoenia under the rules above.

Do you need help with this?

Most people can enroll on their own once their permesso and address are in order, especially on a work or family permit. It gets harder on a voluntary route with income from several countries, or when the permit, enrollment and renewal dates do not line up.