The first time you need a doctor in Italy will probably not be dramatic: a sore throat in October, a child with a rash. What matters is knowing the path in advance. Healthcare in Italy is run by the Servizio Sanitario Nazionale (SSN), the national health service, managed locally by the ASL (Azienda Sanitaria Locale). In one sentence: use your EHIC at first, register with the ASL as soon as you are a resident, and choose a medico di base (family doctor).
What covers you in your first months?
Your European Health Insurance Card, which Italian authorities call TEAM. The Ministry of Health says it covers medically necessary care in public facilities and in private ones contracted with the SSN, under the same conditions as insured Italians. That means the visit is free apart from the ticket, the co-payment fixed by each region for some services.
Three practical points. The EHIC is for temporary stays, not for living in Italy. It does not work at private doctors outside the SSN: there you pay and ask your home insurer for a refund. And if you forget it, you advance the cost. Pensioners and posted workers should ask their insurer for an S1 form before they leave. Our moving to Italy guide places this in the full to-do list.
How do you access healthcare in Italy: registering with the ASL
Once you have a codice fiscale (how to get it) and ideally your residence registration, go to the ASL covering your Comune. The Agenzia delle Entrate states that the codice fiscale is required to enrol and choose a doctor.
What you do depends on your situation:
- Employee or self-employed in Italy: enrolment is compulsory.
- Pensioner or posted worker with an S1: you hand the S1 to the ASL, with ID, codice fiscale and, if you have one, a residence permit. Ask for the exact list.
- Neither of these: you have no right to compulsory enrolment. You need either a private policy valid in Italy (illness, accident and maternity), or voluntary enrolment in the SSN with a yearly contribution.
After enrolment, you choose a medico di base from the list at your ASL; for a child, a paediatrician. The tessera sanitaria (health card) comes by post from the Agenzia delle Entrate. For EU citizens enrolled compulsorily, its back is also the European card.
The voluntary route is the one that puzzles people: a freelancer starting out, an early retiree with no S1, a spouse who does not work. Whether you qualify for compulsory enrolment, whether your private policy meets the ASL's criteria, whether an S1 is possible: these depend on your pensions, your employer and your country. Moovy, Hello Expat's AI assistant, can help you work out which route is yours before you buy a policy or pay a contribution.
How much does voluntary enrolment cost?
The figures below come from ASL notices, so confirm them with your own ASL. The yearly contribution is calculated on the household's total income of the previous year, in Italy or abroad: 7.50% up to €20,658.28, then 4% from that figure to €51,645.69, with a minimum of €2,000 a year. Students without income pay less (€700, according to ASL Sassari) and au pairs pay €1,200. The payment is for the calendar year, cannot be split and is not retroactive. It is paid with an F24 form using tax code 8846.
Compare that with a private policy; both are legitimate, but the SSN route gives you the family doctor, the hospital and the regional services.
What does public healthcare in Italy cost day to day?
Visits to your family doctor are free. Hospital stays carry no ticket, though some emergency room visits do, depending on the colour code given at triage. At night, at weekends and on public holidays, the guardia medica (out-of-hours doctor) is free; in summer, the tourist version in holiday regions charges a fee set by the region.
Pharmacies are everywhere, marked with a green cross. The tessera sanitaria is what you show for prescriptions and for specialist referrals. Waiting times for specialists vary greatly between regions, and many Italians also use private clinics for faster appointments. That is a choice, not an obligation.
What are the emergency numbers?
112 is the single, free emergency number. 118 is medical emergency (also mountain and cave rescue), 113 the police, 115 the fire brigade. Learn them before you need them.
What changes for British and Swiss citizens?
Swiss citizens can use their Swiss card in Italy, and once resident they follow the same route as EU citizens: compulsory enrolment if working, otherwise private insurance or voluntary enrolment.
British citizens are non-EU nationals now. With a regular residence permit they enrol with the ASL of their Comune; whether enrolment is compulsory or voluntary depends on the reason for their stay. Voluntary enrolment is not possible with a permit issued for medical treatment (Rome Prefecture). British State Pension holders may be able to get an S1 from the NHS to register at the ASL, but they need a right to reside first. See moving to Italy from the UK.
If you are a retiree, the S1 described above is the document to sort out before you leave, so ask your home insurer for it early.
What can go wrong with healthcare in Italy in the first months?
The system is generous on paper and fussy about order. These are the stumbles we see most often, all of them visible in the official guidance.
- Using the EHIC at a private doctor outside the national service. The card works in public structures and in private ones contracted with the SSN. Anywhere else you pay in full and ask your home insurer for a refund.
- Forgetting the card at home. Without it you advance every cost, even in a public hospital, and claim back later. An "occasional" visit to a general practitioner is also paid and reimbursed afterwards.
- Staying on the EHIC after you move. The card is built for temporary stays. As soon as you live in Italy, your cover should come from enrolment in the SSN through work, an S1, or a voluntary route.
- Waiting for the tessera sanitaria before choosing a doctor. It is enrolment at the ASL that opens the choice of doctor. The card follows by post.
- Counting on the S1 when you also receive a local pension. If you draw a pension from the country where you live and it carries healthcare rights, that country covers you, even if you have other pensions.
How does healthcare in Italy work for children?
Children are enrolled with a paediatrician (pediatra di libera scelta) instead of a general practitioner, again through the ASL of your Comune. Vaccinations matter in two ways. For nursery and preschool, mandatory vaccinations are a condition of admission under decree-law 73/2017, and schools pass lists of pupils up to the age of 16 to the ASL to check them. If your child has a vaccination record from another country, bring it to the ASL and to the school; our guide to schools in Italy lists the other documents.
Should you take out a private policy as well?
You may have to, if you are neither an employee nor a pensioner with an S1: the alternative to voluntary enrolment is a private policy valid in Italy and covering illness, accident and maternity. Even if you are enrolled, some people keep a private plan for quicker specialist appointments, a choice rather than a duty. Before you buy one, check that it meets the ASL's conditions if you are using it in place of enrolment, and compare its cost with the voluntary contribution described above.
The practical order of play: EHIC for the first weeks, residence and codice fiscale, then the ASL. The overall sequence is in moving to Italy.
If you are still deciding where in Italy to settle, remember that the ASL, the doctor lists and the regional tickets are all organised region by region, so the details you read here will vary a little from Lombardy to Sicily. Ask your ASL, in person or on its website, for its current list of required documents; it is the one source that applies to your address.