In December 1978, Italy saw the birth of a national concept for a universal health care system (Servizio Sanitario Nazionale [SSN]). It provides public, tax-funded medical assistance, is organized and regulated by the Ministry of Health, and is administered through regional authorities. It recognizes health as a fundamental right of every person and entitles everyone present in Italy to a form of health care free of charge, or subject to a symbolic cost.

Since then, the history of public health has been closely linked with the Italian Constitution, the country’s civil and democratic growth, and its economic and social development. 

As a consequence of the successful health care policies and the highly qualified level of doctors, Italy has seen a dramatic increase in the standard of living for all citizens, as well as an increase in quality of life. In fact, Italy is one of the healthiest countries in the world, with an average life expectancy that far outranks some of its neighbors. According to the World Health Organization, men are now reaching an average life expectancy of 80.5 years, and women are expected to live an average of 84.9 years.

The public system is financed through the collection of a) a corporate tax (called IRAP) and b) a proportional income tax (IRPEF). The taxes are collected by the central government, and distributed to the regional governments (proportionally), which are responsible for organizing and delivering health care through local health authorities (ASL). 

Some services offered by the SSN (National Health Service) to those registered are free, including:

• first tier health services, for which no appointment or referral is necessary, such as visits to your family doctor, pediatrician, family planning clinics, and services for drug addiction and mental illness
• urgent care  provided at the Emergency Department of a hospital
• some specialist care provided prior to conception or during pregnancy
• specialist care related to voluntary termination of pregnancy
• services for the early detection of certain cancers: a mammogram every two years for women aged between 45 and 69 years; a PAP smear every three years for women aged between 25 and 65 years; a colonoscopy every five years for every person over 45 years of age
• the provision of services carried out under collective prevention campaigns
• the provision of services related to blood, organ, and tissue donation
• HIV testing
• services for detainees/prison inmates

Other services demand cost sharing, and many are provided at the patient’s full expense. The co-pay fee is called a ‘ticket’, and it is applied to some emergency room visits, specialist consultations, diagnostic procedures, and lab analyses. The amount of the copay is different from region to region, and it depends on the type of services required, and on the patient’s status. 

In some cases, however, you may be granted the right to free access to health services without paying the ‘ticket’. The exemption from payment of the ‘ticket’ may be given if you fall into one of the following categories: 

• minors under the age of six, or adults aged over 65, if the annual declared household income for the previous year is not more than €36,151.98
• non-contributory pensioners with dependent family members
• unemployed or low-income pensioners aged over 60 (and their dependent family members), if the total household income in the previous year does not exceed €8,263.31 (single) or €11,362.05 (with a dependent spouse)

The maximum income for an exemption increases by €516.46 for each dependent child. In addition, an exemption can be granted if you suffer from a chronic or rare condition that is recognized by the Local Health Authority (ASL), or if you have been granted disability status.

Furthermore, it is very important to have a primary care physician, because in Italy, for almost every medicine, you will need a medical prescription. For example, without a medical prescription, pharmacists cannot dispense antibiotics.

Depending on the reason for your stay in Italy, there are 2 types of registration with the Italian NHS. Registering may be either mandatory or voluntary (as an alternative to a private health insurance policy, with payment of an annual fee).

Be aware that if you stay in Italy for a period of less than three months (for example, as a tourist), you cannot register with the National Health Service (SSN), neither mandatory nor voluntary.

If you are entitled to mandatory registration, you don’t have to pay to register with the Italian National Health Service. Non-EU citizens in Italy are entitled to mandatory registration with the National Health Service if they fall into one of the following categories:

• self-employed
• employed
• holders of a residence permit waiting for employment and registration with job centers/the unemployment office)
• people waiting for their work position to be regularized
• family reunification and family reasons (excluding parents aged over 65 years who entered Italy after 5th November 2008)
• requests for international protection and political asylum
• minors, regardless of whether or not they possess a residence permit (with some regional differences)
• medical treatment for pregnant women and for the six months following the birth of their child.

If you are not entitled to mandatory registration but will be staying on a regular basis for more than three months, there are 2 options for you.  You can:

1. Take out a private insurance policy against the risk of illness and injury (which often involves the payment of benefits with a subsequent refund) or
2. Upon payment of a fee, you may apply for voluntary registration with the National Health Service (SSN).

The main categories of persons who are entitled to voluntary registration are: 

• students and persons working as au pairs (even for a period of less than three months)
• parents aged over 65 years of age for family reunification (who entered Italy after 5th November 2008)
• other people who are excluded from mandatory registration, but who hold a residence permit that is valid for a period greater than three months

Regardless of the type of registration, the date of registration, and the expiration date of the permit, a voluntary registration will remain valid until 31st December of the year in which it was granted.

Keep in mind that the annual fee for the NHS never exceeds €400.

Required documents to register with the NHS and obtain a health insurance card:

• your passport
• a valid permit to stay, or the appointment receipt gotten from the post office or the police headquarters (if you are renewing it)
• a valid Codice Fiscale (Italian tax code) 
• self-declaration of residency or place of abode 
• the receipt of payment for the registration to the SSN from the post office (if required)
• if you are a student or au pair, a document confirming you are enrolled at a school, or your au pair contract
• a copy of all of the above original documents

Registration with the NHS can be done in person.  Please follow the following steps:

• call the local health authorities (ASL)
• only if you are applying for a voluntary registration, go to the post office to obtain it, fill it out, and pay for a postal order (Bollettino Postale) for the annual fee. Keep the receipt, make a copy, and bring it to the ASL (Local Health Authority) with you, along with all of the documents listed below
• go to the ASL on the day of your appointment
• while the registration is instant, the health insurance card will be delivered to you at a later date. Keep the receipt you receive after completing the registration, you will use it as proof of registration until you receive your health insurance card
• bring your registration documents to your primary care physician (Medico di Base or Medico di Famiglia) that you have selected, so that they can register you as an official patient.

In comparison to the public health care system, getting private insurance may appear to be a luxury in Italy.

On the other hand, as most Italians rely on public health care, private medical services are rarely overcrowded and usually provide a more comfortable experience and better customer care. They grant direct access to private doctors and specialists.

The private medical sector is highly organized; you will not have to deal with the negative aspects of the public health care system, like: 

• long wait times (can be quite substantial) 
• getting a consultation with a specialist doctor only after consultation with a general practitioner, thus lengthening the deadlines
• the disparities between the quality care in the region you live in (the quality of service is different in the North and the South)

In any case, If you aren’t entitled to public health care benefits, and you don’t want to opt into voluntary registration at the NHS, private health insurance is mandatory for non-EU citizens applying for/renewing a residence permit.

Italian and foreign health insurance companies offer different plans, in order to guarantee the right health coverage for every need.

Be aware that if you need a visa to enter Italy, you must have valid travel insurance to apply for the Italian visa in the first place, which covers the entire period of your stay in Italy.

Private insurance is also required to apply for a residence permit.

The National Health Service does not provide dental care coverage unless it is for young people (aged 16 or younger), those who are considered members of vulnerable groups, or those in need of absolute emergency dental intervention. 

However, a number of dental clinics run by the local health authorities (ASL) and other NHS-affiliated clinics offer a number of dental treatments for the NHS. These treatments are subject to co-payment (‘ticket’) and, usually, long waiting lists.

Consequently, as all dental care is mostly private, dental insurance is a good idea if you want to make sure you are covered.

There are two types of insurance for vision care: medical insurance (only private) and vision insurance (only private). While vision insurance covers your optical needs, such as annual vision testing, eyeglasses, and contact lenses, it does not cover any part of your vision care that is considered “medical.” Many vision insurance plans also do not cover contact lens fittings and yearly evaluations.

Medical insurance covers cases that fall under medical necessity. Therefore, if you have an eye disease or problem that causes problems with your eyes, you can usually use your medical insurance. Some common examples of conditions for which we can bill your medical insurance include:

• comprehensive eye exams, with dilation (not including the refraction/vision testing part of the exam)
• eye infection
• diabetes eye exams
• monitoring cataract development
• examination of patients who use medications with possible ocular side effects, such as steroid medications and arthritis medications
• management and treatment of macular degeneration
• monitoring and treatment of glaucoma
• emergency visits for loss of vision due to a medical condition

Cosmetic surgery is not covered by public health care, and very often, not even by private health care. 

A private health plan will typically not cover the costs of any elective cosmetic treatment. This generally also includes cosmetic surgery needed to correct a previous cosmetic procedure.

There are several reasons why health insurers don’t cover elective cosmetic treatment. From a consumer perspective, the most critical of these is cost. Insurance premiums would have to be astronomical to provide coverage and fund treatment costs every time a plan holder wanted to undergo a treatment or procedure. 

So, most, if not all, health plans won’t cover elective cosmetic treatment costs. However, there are some limited circumstances where you might be able to get the costs of cosmetic treatment covered.

Although will find it almost impossible to get coverage for elective cosmetic surgery, the insurer will usually cover the costs if someone needs to undergo cosmetic treatment to restore function or appearance following a disfiguring accident, for example.