The healthcare system is funded from taxation and workers and employers pay contributions directly into the system. Currently, the plan covers all residents and is run overall by the Ministry of Health, but set up regionally.

Everyone who is resident in Italy is covered by the SSN, including expats.

If you are working for a company based in Italy, they should register you for state medical insurance.

If not, you can sign up yourself by going to your local Post Office and completing a form known as MODELLO F24. This is not free if you are a non-EU citizen: you will need to pay a sum of around €150 in order to register and this is renewable annually.

You will then need to take the following documents to the nearest ASL in order to be enrolled in the system:

• your ID
• a copy of your work contract (contratto di lavoro)
• a copy of your most recent payslip (busta di paga)
• a family status notice if you want to claim for any dependents (certificato di stato di famiglia)
• your fiscal code (codice fiscale)
• a registration card (attestato di iscrizione) from the Unemployment Office if you are not working

The self-enrolment fee only applies to non-EU nationals in particular fields, such as au pairs, students and religious personnel. You can find a list (PDF file) of these these areas on the government website.

The ASL will issue your Italian health insurance card (tessera sanitaria) and a green card with information about your doctor (documento personale di iscrizione al servizio sanitario nazionale) and will sign you up with a doctor: you can choose which practice you are enrolled with.

You will not be treated under the public system unless you take your health insurance card with you, and you will need to renew your health insurance card every year.

This is not a reimbursement system. 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 ‘ticket’ (the rest of the fee) is covered by the SSN.

Your care will be completely covered by national insurance. Do make sure that if you are admitted to a hospital – for instance, during an emergency – it is a public rather than a private one, as this can cause complications.

If you are an EU citizen and have an EHIC card, you can use this in an emergency but the card should not be used as a substitute for other cover.

Your health insurance card will expire when your residency does.

Outpatient treatment and home visits are covered, and some prescriptions, although you may need to pay a small fee for these unless they are what’s known as ‘life-saving’ medication. Italy uses a referral system when it comes to medical specialists: you will need to be sent by your GP.

Yes, if you are a retired expat, you will be eligible for state medical insurance. However, you will need to have proof of income, including:

• social security checks
• a pension
• investment returns and dividends
• retirement accounts such as 401ks or Roth IRAs
• property income

If you are an EU national, and are not a British early retiree, you will need to fill in an S1 form, which will enable you to register with the SSN at no cost.

If you are an international student, you will need to take out health insurance before your arrival in the country. You will need to take this to the Italian Consulate nearest to you, and to the Questura, or police station, within eight days of entrance into Italy.

You may be able to register with the ASL and have the costs covered by your home country: check with the ASL to confirm if there is a reciprocal agreement.

Your family (spouse, children up to the age of 21 and parents) will be covered, but will need to be registered with the SSN.

Some dental treatment is covered, if it is deemed necessary rather than cosmetic.

Your contributions are deducted at source out of your gross salary (about 10%). Your employer will contribute about 35%. Different industries have different rates.

If you are self-employed, you will have to make contributions into a social security fund called a cassa, which is linked to your profession, or directly to the National Institute for Social Security (Istituto Nazionale della Previdenza Sociale/INPS).

If you are on maternity leave, the state will pay your contributions (contributi accreditati).

Though of an excellent quality, Italian healthcare is subject to the same issues which beset other healthcare systems in Europe: long wait times, underfunding and overstretching. Italy has the second-oldest population in the world and that is putting a strain on resources. In 2013 SIMEU, the Italian Association for Emergency Medicine, reported that 24 million people accessed emergency room care per year and 15% of those cases were deemed to be non-urgent.

Despite being listed among the top in the world by the World Health Organization, many Italians report being unhappy with their medical provision, and this may be because standards vary over regions. Healthcare tends to be best in the big cities of the north, but you might run into patchy provision elsewhere in Italy, along with limited English skills among medical personnel.

The system is also subject to excessive bureaucracy and mismanagement: there is general agreement that further reforms will become necessary in the near future if Italy is to retain its current WHO ranking.

Many expats prefer to take out private medical insurance (assicurazione sulla salute), but note that there have been a few scandals relating to private insurance cover in Italy.

Be careful, for instance, that you do not find that your policy has suddenly and unilaterally been cancelled (recesso or facoltà di rescessione) when you have fallen seriously ill, or once you have reached a particular age (età massima assicurabile). Ideally, you want a minimum five-year policy which cannot be cancelled and which must cover you for even serious illnesses.

Private primary care and hospital treatment will be covered, although this does depend on the kind of package that you opt for.

It also depends on whether you choose one of the big international providers — perhaps you already have private insurance in your own country and want to extend it to cover your stay in Italy — or a local Italian insurance company.

If you opt for the latter, then check exactly what is on offer. You may find that visits to your GP are not covered, which could be a problem if you are a non-EU national or do not fall under the SSN.

For those seeking international private medical insurance (iPMI) cover for multiple countries including Italy, numerous variables can have an impact on the cost.

The most important variables are:

• age (the higher the more expensive)
• area of cover (i.e. in addition to Italy, which other areas is coverage required in? If those other areas include any of the US, the Caribbean, Singapore, China, Hong Kong or Dubai this can significantly increase the overall price)
• product choice (higher end insurance products are more expensive)

Other variables include:

• deductibles
• co-insurance
• payment frequency
• gender
• nationality
• country of residence

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.

Private health insurance providers include:

• Aetna
• AXA
• Baltica
• Bupa Global
• Columbus Healthcare
• Europa Assistance
• National Insurance Institute (Instituto Nazionale delle Assicurazioni/INA – recently privatised)
• Pacific Prime
• Sanicard

assicurazione sulla salute - private medical insurance

Azienda Sanitaria Locale - Local Health Agency

documento personale di iscrizione al servizio sanitario nazionale - Green card with information about your doctor

polizza per nucleo familiar - Nuclear family option

polizza di indennità giornaliera - loss of earning cover

recesso or facoltà di rescessione - cancellation of your policy

scelta e revoca del medico - Choice and Revocation of GP

Servizio Sanitario Nazionale - National insurance plan or SSN

Tessera Sanitaria - Italian Health Card