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HEALTH

Which foreign residents have to pay for healthcare in Italy?

Italy's government wants to charge a €2,000 annual fee for some foreign nationals to register with the Italian national health service - but many already pay this much, or more. What are the rules and what would change under the plans?

Published: 17 October 2023 16:34 CEST
Updated: 19 October 2023 11:08 CEST
Who has to pay to access Italy's national health service?
Who has to pay to access Italy's national health service? Photo by Fred TANNEAU / AFP.

There was concern this week about new proposals from the Italian government to charge non-EU nationals higher fees to use Italy’s national health service (servizio sanitario nazionale, or SSN).

Under the 2024 budget plan, a €2,000 charge for registering with the health service would apply to “foreign residents who are citizens of countries that are not members of the European Union”, according to a statement published by the Italian economy and finance ministry (MEF) on Monday.

READ ALSO: What we know about Italy’s plan to charge non-EU residents €2,000 for healthcare

Italy’s health ministry later clarified that the 2,000-euro charge would not in fact apply to all non-EU nationals, but only to those who already pay an annual fee to use the SSN.

Though a number of questions about the proposal remain, this still appears to mean a steep cost increase for many of Italy’s international residents who are not eligible for free healthcare.

Who will the new rules apply to?

For many foreign nationals resident in Italy, enrolling with Italy’s SSN means paying an annual registration fee under what’s called ‘voluntary’ registration.

For others, registration is deemed ‘mandatory’ and is therefore free, and healthcare services are then paid for at the same rates as for Italian nationals.

“The rule contained in the 2024 budget refers to specific categories, not entitled to compulsory registration, who can voluntarily register with the SSN through the payment of an annual flat-rate contribution,” the health ministry stated.

“The rule is limited to updating the stipulated lump-sum contribution,” it said, suggesting that the new charge would replace existing fees.

Registration fees could therefore increase for people who are now paying a rate below €2,000 a year – though it remains unclear whether it could also be revised down for those who are already paying more.

Who can currently register for free?

Certain people are entitled to iscrizione obbligatoria, ‘mandatory registration’ or ‘registration by right’, in the national health service, which means you can register with the SSN for free.

Iscrizione obbligatoria applies to the following categories, according to current health ministry guidelines:

  • Residents who have a regular ongoing contract with an Italian employer, are self-employed, or are registered on Italy’s unemployment lists (liste di collocamento).
  • People who are waiting for their residency permit to be issued on the basis of employment or family reasons.
  • People who are waiting for their residency permit to be renewed on the basis of employment or self-employment, for family reasons, for asylum, for subsidiary protection, ‘special cases’, or special protection; for medical treatment, for those waiting to adopt or foster children, and for those in the process of acquiring citizenship.
  • All minors, including unaccompanied foreign minors, regardless of their legal basis in Italy.

The health ministry’s statement indicates that people in these categories would continue to be able to register with the SSN for free even if the €2,000 charge remains in the final draft of the budget law.

Who needs to pay to register?

Anyone who doesn’t fall into any of the categories listed above can opt in to the SSN through iscrizione volontaria, or voluntary registration.

This includes pensioners on elective residence visas, diplomatic and consular staff working for foreign governments, employees of international organisations, volunteer workers, and people over the age of 65 in Italy for family reunification reasons (who arrived after November 5th, 2008).

People in this situation must pay a fee of at least €387.34, rising to as high as €2,788.87 based on income calculations.

However foreign students in Italy who have no income besides scholarships or financial aid provided by Italian public institutions pay a flat fee of €149.77, while au pairs pay €219.49.

The MEF said in its statement on Monday that students and au pairs would continue to pay a discounted fee, without giving further details.

The registration is valid for the calendar year starting on January 1st and running to December 31st, regardless of when the payment is made.

If the rule is included in the final draft of the budget, it’s people who fall into this ‘voluntary registration’ category who would pay the €2,000 charge.

Member comments

  1. Replying to paying into health service. I am copying an email received regarding the EU declaration protecting rights for those that had residency before

    It won’t let me copy the text. So will try and summarise… if resident in Italy before Brexit. You are classified as having permanent residency after 5 years. That means article 23 of the withdrawal agreement and article 24 of the directive 2004/38 apply.

    It therefore follows that, as permanent residents, you should be entitled to access the Italian public healthcare system free of charge under the same conditions which apply to Italian nationals (referred to as compulsory affiliation ).

    Hope this helps and you can update the topic to share

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For members

TAXES

How much should you pay your Italian accountant to do your taxes?

Italian taxes are notoriously difficult to navigate and even trickier to deal with yourself, meaning you may want to turn to a 'commercialista' for help. But how much should you pay for their services?

Published: 18 September 2024 12:42 CEST
How much should you pay your Italian accountant to do your taxes?

If you ask someone in Italy who a commercialista is, you may get several different answers: accountant, consultant, financial advisor or administrator.

In fact, they can be all of these at once as, along with the patronati, they’re residents’ first port of call when dealing with the complex bureaucratic processes surrounding almost anything official in the country.

Commercialisti are also the people who can file and submit your yearly tax returns for you. 

If you live in Italy or generate income in the country, you’ll likely need to file your taxes once a year during the so-called dichiarazione dei redditi (‘income declaration’). 

Unlike in other European countries, where it’s fairly easy for taxpayers to file tax returns independently, doing this can be very tricky in Italy, not least because of the complicated language being used. 

And mistakes can cost you dearly as the Italian taxman could charge you hundreds or even thousands of euros if you submit late, forget some details or enter the wrong information.

That’s why many around Italy choose to hire a commercialista. But how much should you pay for their services?

Overview

Commercialista fees can vary greatly depending on the type of services you need and the complexity of your financial situation.

If you’re an employee with a single source of income and are seeking help with filing taxes, or claiming tax deductions or incentives, fees will be on the low end of the spectrum. 

But if you have multiple sources of income, or have foreign income or assets and are subject to taxation in multiple countries, the commercialista will need expertise in international tax law, which may significantly raise costs.

READ ALSO: The Italian tax calendar for 2024: Which taxes are due when?

If you are a freelancer or the owner of a small business, you may need monthly consulting and regular services such as bookkeeping and VAT reporting. In this case, services may be bundled in an annual package. 

Finally, if you own a large business or corporation, you may need to hire more than one commercialista to deal with payroll management, VAT declarations, and corporate tax filings. 

Please note that the cost of a commercialista can also vary by region as prices tend to be higher in large metropolitan areas such as Milan or Rome, while you may find particularly advantageous rates in small towns and less populated areas around the country. 

Annual tax returns

According to financial advice platform Fiscozen, income tax filing services generally start at €120 but can rise to over €700 depending on your personal situation.

Generally speaking, tax filing fees are higher if you’re a VAT number holder (or partita Iva) as this entails more work on the part of the commercialista (think of all the invoices issued and claimable VAT detractions) compared to an employed individual or pensioner.

Paying taxes

Most types of taxes in Italy (from income to property taxes to waste collection charges) must be paid by completing and submitting form F24 (modello F24) with Italy’s tax office.  

A commercialista can do this for you, with services costing between €15 and €30 per form, according to online investment advisor Moneyfarm. 

Registering a new business

Freelancers and business owners in Italy are required to register with Italy’s tax office by getting a VAT number (known as partita Iva). 

If you’re starting out as a freelancer, hiring a commercialista to get your personal VAT number and set up an electronic invoicing system on your behalf will cost you €150 on average, according to Fiscozen.

Fees will be higher if you’re starting a new business as this generally involves more paperwork and compliance with a number of tax requirements. 

In this case, a commercialista’s services may cost anything between €300 and €500, though you’ll also have to factor in the payment of a number of taxes (including up to €200 for the Certified Start of Business Report, or SCIA). 

‘Year-long administration’

As mentioned earlier, if you are a freelancer or a business owner, you may need monthly consulting services, as well as regular bookkeeping, VAT reporting and – if you have employees – payroll management. 

In this case, commercialista services may be bundled in a gestione annuale (‘year-long administration’) package. 

According to Fiscozen, a 12-month package for freelancers operating under Italy’s flat tax scheme costs €60 a month on average (€720 a year). 

But costs can be much higher for freelancers working under the so-called regime ordinario (‘ordinary regime’) and business owners. 

In this case, you may pay anything from €2,000 to €4,000 a year depending on: number of clients, business size and number of employees (if applicable).

How can I find a commercialista?

All commercialisti in Italy must be registered with national association CNCDEC (Consiglio Nazionale dei Dottori Commercialisti e degli Esperti Contabili). 

The association’s website gives you the option to look for registered professionals in your area (see an example via the screen grab below).

A screen grab of the search tool on Italy's national 'commercialisti' association's website

A screen grab of the search tool on Italy’s national ‘commercialisti’ association’s website. Source: Consiglio Nazionale dei Commercialisti

As with most things in Italy however, word of mouth is key, so make sure to ask friends and family for recommendations if you can.

Alternatively, online forums and message boards for foreign nationals in Italy often share names of professionals that are particularly experienced in international tax law.

Finally, you can also find a list of commercialisti working in your area in Italy’s pagine gialle (Yellow Pages). 

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