Health insurance in Italy comes in two layers. The public Servizio Sanitario Nazionale (SSN), in place since 1978, covers hospital care, family doctors, specialist visits, tests, discounted medicines and ambulances for legal residents. Private insurance sits alongside it: for many newcomers it is a legal requirement for a visa or residence permit, and for many residents it is a way to see a specialist sooner or choose a private clinic.
This guide covers both: who can join the SSN and what it costs, when private cover is compulsory, how insurance works in practice in Puglia, and what to look for in a policy. For where to go when you need care, see public and private hospitals in Puglia. We checked it in October 2026. It is general information, not advice on any particular policy.
Public or private: which do you need?
- Working in Italy (employed or self-employed): you are enrolled in the SSN without charge. Private cover is optional.
- Elective residence and similar permits: you need private cover for the visa and permit, then you can usually join the SSN voluntarily for an annual fee.
- Short visits: travel medical insurance; compulsory only if you need a Schengen visa.
Public health insurance: the SSN
Healthcare in Italy is run by the regions, each through its own local health units (ASL), and funded mainly by taxes. All lawful residents, Italian or foreign, have access to the SSN, with services free or for a modest fee (ticket).
Mandatory (free) enrollment
Mandatory enrollment is both a right and an obligation. You register free of charge if you:
- Hold an employment agreement
- Work as a self-employed individual in Italy
- Belong to the family of an Italian citizen
- Belong to the family of a registered person
- Are currently unemployed, listed on employment registers, or participating in a professional training program.
Dependent family members with a valid residence permit are registered with the same rights as the main permit holder. Whether a spouse counts as a dependent depends on their own income and social security position, so confirm your case with the ASL.
Voluntary enrollment
Foreign nationals living legally in Italy for more than three months who are not entitled to mandatory enrollment must be insured against illness, injury and maternity, either with a private policy or by voluntary enrollment in the SSN. These groups can enroll voluntarily:
- Students and au pairs, including those with stays shorter than three months.
- Individuals with an elective residence permit who are not involved in any form of employment.
- Religious personnel.
- Diplomatic and consular staff from foreign missions operating within Italy.
- Employees of international organizations working in Italy.
- Foreign participants in volunteer programs.
- Parents aged 65 and older arriving in Italy for family-related reasons.
Holders of residence permits for medical treatment or tourism cannot enroll voluntarily.
What voluntary enrollment costs
Since 2024 voluntary enrollment costs at least €2,000 a year: 7.5% of income up to €20,658.28 and 4% on income above that, up to €51,645.69, based on total income in Italy and abroad in the previous year. It is paid by F24. Cover runs for the calendar year, January 1 to December 31, whatever the date you pay or your permit expires, and it cannot be split or backdated, so the fee is the same in January as in November. Students and au pairs have separate rates; ask your ASL for the current figure.
How to sign up
- Residency or permit first. You need residency or a valid permesso di soggiorno (the application receipt is usually enough). Many people buy short-term private cover for the permit application, then use the receipt to enroll.
- Pay (voluntary enrollment only). Ask the ASL for the exact amount and payment details, pay, and keep the receipt.
- Go to the ASL. Register at your Azienda Sanitaria Locale, usually without an appointment: take a number on arrival, and bring originals and photocopies.
- Choose a family doctor. Everyone on the SSN is assigned a medico di base, a general practitioner near home. Name your preferred doctor when you register.
Documents for SSN registration
Permesso di Soggiorno
Your permesso di soggiorno, or the receipt (ricevuta) showing you have applied and are waiting for the card.
Proof of Residency
If you’re an EU citizen without a Permesso di Soggiorno, you’ll need either your certificato di residenza or the residence application receipt from anagrafe (Vital Statistics Bureau).
But if you do have the Permesso di Soggiorno, then you can use a registered housing contract or a self-certified residency form ‘autocertificazione di residenza.’
Codice Fiscale
You need it for almost everything in Italy, including SSN registration. Once you are registered, you receive the tessera sanitaria, a health card that also serves as official proof of your tax code. Here is a guide on how to get your Codice Fiscale.
Proof of Identity
Your passport.
Proof of Payment
For voluntary enrollment, the receipt for the annual fee.
Proof of Income or Employment
The ASL may ask for a copy of your employment contract or a self-certification (autocertificazione) of your income. The forms are usually available at the ASL office.
Private health insurance: when it is a legal requirement
Short stays with a Schengen visa
Visitors who need a Schengen visa must show travel medical insurance valid across the Schengen Area for the whole trip, with cover of at least €30,000 for emergency treatment, hospital care and repatriation for medical reasons. Visitors who do not need a visa, such as US citizens on short trips, are not required to have it, although it is sensible.
Long stays and residence permits
For a national (type D) visa and the permesso di soggiorno (residence permit) that follows, consulates and the Questura ask for health cover in Italy for the length of the stay, unless you will be enrolled in the Servizio Sanitario Nazionale (SSN), the public health service. Typical cases are elective residence, the digital nomad visa and study. Each consulate publishes its own list of what the policy must cover, so read it before you buy.
Private insurance alongside the SSN
Once enrolled in the SSN, many residents keep a private policy as well, for faster specialist visits, private rooms or treatment abroad. Emergency care at a public pronto soccorso (ER) is available to everyone, insured or not.
Travel insurance or health insurance
Travel insurance is built for trips: emergencies, cancellation, lost luggage. It rarely covers routine care, chronic conditions or long stays, and may not satisfy a consulate for a long-stay visa. International private medical insurance is built for living somewhere: doctor visits, hospital stays, tests and, depending on the plan, outpatient care and medicines. Most plans exclude or limit pre-existing conditions, so read that section first.
How it works in Puglia
Direct billing is limited in Puglia. With an international policy, the usual pattern is to pay the clinic or hospital, then claim the money back. Some private clinics have agreements (convenzioni) with insurers and health funds: Casa di Cura Petrucciani in Lecce, for example, publishes the list it accepts. A public hospital will normally ask a patient without SSN cover to pay the standard fee and keep the receipts for the claim.
At the desk of a private clinic in Lecce the first question tends to be “convenzione?”, meaning which agreement covers you. It saves time to know the answer, and to have the policy number on your phone.
For a quick consultation in English, telemedicine services such as Doctors in Italy offer video visits and bill several international insurers directly. Check on their site whether they have a doctor near you in Puglia. Our list of English-speaking doctors in Lecce covers in-person options.
Choosing a policy
- Visa wording. If you need the policy for a visa or permit, check the consulate’s requirements line by line: minimum cover, validity in Italy for the whole stay, no deductible if they say so.
- Where you will be treated. Ask your preferred clinic which insurers it works with, and check the insurer’s own provider list for Puglia. Our guide to hospitals and clinics in Puglia lists the main facilities.
- Pre-existing conditions. Find out what is excluded, and for how long.
- Deductible and claims. A lower premium often means a higher excess. Ask how claims are filed, in which language, and how fast they are paid.
- Renewal. Check whether the insurer can refuse to renew, or raise the premium sharply with age.
International expat insurers active in Italy include Allianz Care, AXA Global Healthcare, Bupa Global and Cigna Global. Italian insurers such as Generali and UniSalute sell local plans, usually in Italian and often designed to sit alongside SSN cover. Compare quotes for the same level of cover, and keep the policy documents in the language a consulate or clinic can read.
Before you buy
Decide first whether you need the policy for a visa, for daily life, or both. Then check the consulate’s list, ask your nearest private clinic which insurers it deals with, and read the exclusions before the price.
If you live in or near Lecce, see our list of English-speaking doctors in Lecce.
