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Health Insurance In Italy: A Guide For American Expats

Moving abroad is a tricky proposition from all angles, but healthcare is one of the main worries people state when they are considering making an intercontinental move. If you’re moving from the USA to Italy, you might be wondering about the quality of healthcare available, how to sign up to the healthcare system there, and whether and how to take out private health insurance, either as a supplement to your national health care or instead of it. Below, we will take a look at the options that are open to you and how to apply.

Initially, you are likely to need to register with the Italian public health system (the Azienda Sanitaria Locale or Local Health Agency: ASL) and will pay into this directly from your salary. In this case most of your primary healthcare needs, such as GP visits or hospitalization, will be covered by the state scheme, the Sistema Sanitario Nazionale (SSN), and will be free at the point of delivery.However, Italian public hospitals are sometimes basic and the national healthcare system is prone to the same problems as other state schemes in Europe, namely overcrowding and lengthy waiting times. Expats may therefore choose to take out private health cover during their time in Italy, in order to gain extra peace of mind. We will look at some of your options below.

Personalising Your Health Insurance Cover

The healthcare system is funded from taxation and workers and employers pay contributions directly into the system. Currently, the plan covers all residents, including expats.

This is not a reimbursement system. Like the UK’s NHS, it is free at the point of delivery and medical personnel in public institutions are not allowed to take money directly, with the exception of specialist care: here, you will need to make a co-payment, though the so-called ‘ticket’ (the rest of the fee) is covered by the SSN.

Visits to your GP and much of your hospital care will be covered. Some dental treatment is also covered.

Selectable Options

Check the small print of any private health insurance policy to see whether it covers treatments that you may want to access, such as specialist surgical treatment or more advanced dental care, for example, crowns or dental implants.

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Remember to check if your potential policy covers pre-existing conditions: the definition of this will vary between insurers. Usually the term applies to any conditions which present symptoms or for which you’ve been treated in the last five years. This normally includes any conditions you were diagnosed with over five years ago, but some insurers have different time limits for diagnosis.

You may also want to check out whether your policy has a ‘hospitalisation’ clause covering you for occasional hospital visits. You may need to discuss this directly with your insurer.

Take a good look at any potential policy for any cover relating to healthcare which does not apply to you: some policies have provision for maternity care, for instance, and if you are not intending to become pregnant, or if you prefer to rely on the free at delivery cover provided by the Italian maternity system, then you may wish to reduce your policy costs by having such options removed.

Cost Sharing

You may also be able to reduce the cost of your premium through ‘cost sharing’: this means that you and your insurer will share the costs of any treatment. You will pay up to an agreed limit, and your provider will cover the rest.

Different insurers will have different ways of arranging cost sharing:

Co-pay: where you pay a fixed sum for your treatment and your insurer covers the rest. For instance, if the total cost of your treatment is €85, and your co-pay amount is set at €40, then you will pay €40 and your insurer will pay €45.

Co-insurance: where you pay a fixed percentage of the total cost and your insurer covers the rest. For instance, if your co-insurance is set at 20%, you will pay 20% of €85 and your insurer will cover the remaining 80%.

Deductibles: where you pay the entire amount allowed for all services provided until the deductible is met. For instance, if your policy has a €1,000 annual deductible, you would pay €85 for each visit to a healthcare clinic. However, you would then have to pay the entire amount for 11 such visits (€1000/€85 = 11.8) before your insurance began to pay out to the doctor directly.

You may also need to take a look at whether there is an out-of-pocket maximum that you would be expected to pay after your deductible has been met.

Let’s say that your plan above, with a €1000 deductible, also has a co-insurance option of 20% and an out-of-pocket maximum of €1500. You will thus pay €85 for 11 visits to the doctor under your deductible until it is met. You will then pay €17 for each visit as your 20% coinsurance, until you reach the co-insurance ceiling of €500 (€1,500 minus the deductible of €1,000), or about 29 more visits (€500€17 = 29.4). At that point (40 total visits in a year), you would pay nothing more for the remainder of the plan year.

It’s worth doing the maths, especially if you don’t think that you’ll need to make more than a couple of visits to your GP in any one policy period. For example, if you just want dental check-ups with an occasional filling, it might be worth working out whether one or two out-of-pocket costs might be cheaper than full dental cover.

As so many variables have an effect on the cost of international private medical insurance in Italy it becomes very difficult to give accurate estimates without knowing the full details of the coverage required. However, as a very rough guide, using a standard profile of a 40 year old British male with no deductibles, no co-insurance, a middle tier plan/product, all modules included and worldwide coverage excluding the US, a ballpark price of around £4,000/$5,000 might be expected. Were coverage to be expanded to include the US then the premium could increase to almost double that amount.