At last! My Tessera Sanitaria card that shows enrollment in Italy's National Health Plan.

At last! My Tessera Sanitaria card showing enrollment in Italy’s National Health Plan.

After almost two years of living in Italy as an expat I now have my tessera sanitaria and I have health care coverage in Italy! Woohoo!

By some surveys Italian health care is rated #2 in the world.

Until just a few day ago I was covered with an affordable Cigna major medical plan – good anywhere in the world, except the United States (no surprise). Medical care here is pretty cheap, especially by American standards, so if I had run into a health crisis I simply would have paid my deductible and then filed a claim. Fortunately I’m in good health, so I never had to enact such a scenario.

With so many other things on my plate in my first year here, I decided to forgo making the health insurance change until 2015. Getting the tessera sanitaria isn’t necessarily a difficult thing. In fact in can go quite smoothly. But, a few factors aren’t always consistent, so educate yourself on the process, and be aware of the parts that might veer off your anticipated course.

If you’ have a permesso di soggiorno with elective residency (which you renew every year) regardless of when during a calendar year you register and pay for the national health care coverage in Italy, you pay for the full year.

That’s right, January 1 through December 31. Even if you land in Italy and sign-up in October, you’ll be paying the same as someone who signed up in January. You might want to get a private insurance policy that covers you until the beginning of the following year if that’s the case.

Not all regions in Italy handle their health care plans equally. Research the area in which you intend to reside so that you know what will be required of you and how much you can expect to pay.

In some regions, if you hold an elective residency permesso di soggiorno, you’re charged a flat fee. Other regions might ask you to declare your earned income (and in some cases ask for verification, e.g. a notarized social security 1099 from the U.S. Embassy) and then you can be charged based on a sliding scale. Other regions simply charge a flat fee.

With Italian health care, don’t be caught off guard by not getting acquainted with your region of residency, and how to navigate the process.

And, not all A.S.L. offices are created equally. The first office we visited, when I lived in Umbria,  for inquiry as to what I might anticipate paying as a fee was less than ideal. The woman with whom we spoke was having a bad day (I’ve since heard most of her days are bad days), and she didn’t know how to calculate what I would owe based on my particular circumstances. A woman from my accountant’s office had been kind enough to go with us, and even she was shaking her head in disbelief at the experience.

However, Grazie Dio (Thank God), the office with which we eventually spoke on the phone couldn’t have been more knowledgeable or more helpful. In fact, when we went to the office to make the formal application and pay the fee, they had already filled out most of the paperwork. And, to me it was evident that the woman helping us REALLY wanted to make this go smoothly. The majority of my experiences in Umbria have been thus – people will go out of their way to help, especially if you are polite and if have your act (and information) together. If you show up with any sort of entitlement attitude (regardless of your nationality) you might want to prepare yourself for a tougher go of it.

Also, documents required for a successful application can vary by office and individual processing the application. For me, I was told, during my first inquiry, with the dubious woman cited above, that my receipt for my permesso di soggiorno application wasn’t sufficient, and I would need both the actual permesso di soggiorno AND my identity card issued by the commune. It was explained that because this was my first application for my permesso di soggiorno, a post office receipt showing the application wasn’t sufficient, and in subsequent years, the receipt for the renewal would suffice.

However, I know of a woman who got her tessera sanitaria with her first permesso application receipt. She didn’t have residency or an identity card. I’ve also read stories of other people who successfully have gotten their medical insurance with their first permesso application receipt.

What are the real guidelines on this? I don’t know, and being a type-A individual, I’d err on the side of having all of your documents in hand. A trip to the A.S.L. office ahead of time, and a commitment from the people there as to what you’ll need isn’t a bad idea.

I provided:
Permesso di soggiorno
Identity card (showing residency)
Codisce Fiscale
Passport (just in case)

If the expiration date of your permesso di soggiorno is mid-year, don’t be surprised if you’re asked to return with your renewal receipt to extend the date of your tessera sanitaria through the remainder of the calendar year. Because you already will have paid the fee for the entire year, you should not be asked to pay anything additional.

At the time of your application and payment of fee (which you pay at the post office and return to the A.S.L. office with the receipt) you will be asked to choose a doctor in your locale, or be assigned one.

In my case, I had already seen a doctor in a town close by (to get my medical certification for my driver’s license). I had liked her because she was not only a thorough doctor, but she also spoke excellent English). Fortunately, after a short call from the A.S.L. office, she accepted me as a patient. This was required also because she was not officially in my “locale”.

You can change your doctor of record later, but I’d advise doing your research ahead of time, and finding a doctor you like and who is willing to add you to his or her list of patients.

Fees and co-pays for Italian health care can vary by region.

I do not have a reference sheet on this, but when considering your area of residency, you might want to visit an A.S.L. office in the specific region to get information on coverage and fees. I’ve yet to find anything online that shows a comparison by region.

Prescription costs can vary based on your income bracket.

Until you establish permanent residency or until you qualify for Italian citizenship, be prepared to return to the A.S.L. office every January to sign up for another year of coverage and pay the fee. To be on the safe side, show up with the same documentation and declarations!

I’m happy to have full health coverage now in Italy. If I want expedited or specialized care for special circumstances I can consider paying additional fees or getting supplement insurance.

And, I still need to get a travel health policy for the States when I return there for visits.

And important update:

I have just gone through the process to get my carta di soggiorno – or my permanent residency, now that I have spousal rights through my civil union with an Italian citizen. Also, we are residents in Veneto, so the experience has been very different compared to Umbria. As part of an Italian family I am granted participation in the region’s health care services without charge and without having to renew it each year. It mirrors the validity of my carta di soggiorno, which is five years (I am allowed to apply for Italian citizenship in two years).

I hope sharing my experience is helpful as you navigate your way through this important “to do” item on your checklist. And, remember, these are only my opinions, based on my experience of getting Italian health care through the national and regional plans. They, in no way, should serve as a substitute for your own research and subsequent decisions based on the area in which you intend to reside.