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AMERICANS IN ITALY

Americans in Italy: Healthcare fees and what Italian hospitals are really like

Which US residents in Italy could face a €2,000 healthcare fee under government proposals and what standard of care can you expect at Italian hospitals? Find out in our latest Americans in Italy newsletter.

Milan's Raffaele hospital. Italy is home to some highly-rated healthcare facilites - but how good is public healthcare in general?
Milan's Raffaele hospital. Italy is home to some highly-rated healthcare facilites - but how good is public healthcare in general? (Photo by Miguel MEDINA / AFP)

Welcome to our regular look at everything you need to know about life in Italy for The Local’s readers from the US. This newsletter is published monthly and you can receive it directly to your inbox before we publish by going to newsletter preferences in ‘My Account’ or following the instructions in the newsletter box below.

Many of our international readers were dismayed to learn recently of Italy’s plans to introduce a €2,000 annual fee for non-EU residents to access the country’s national health service.

The health ministry later clarified that the rule would only apply to certain categories of foreign residents, which would include people in Italy on an elective residency visa (the majority of whom are pensioners), staff of non-Italian companies or organisations, and diplomatic or consular employees.

For these people however, which include many of The Local’s readers, this could mean a steep increase in the annual registration fee.

“Paying €2,000 a year would surely mean that we would expect better healthcare, but this is not a given,” American reader Jill Holmden told The Local.

“It seems unfair to retrospectively impose this cost on people already living here.”

The proposal was included in the first draft of Italy’s 2024 budget, which is subject to further changes before being finalised by the end of the year. Learn more about the government’s current plans in the article below:

Who would be affected by Italy’s plan to charge €2,000 a year for healthcare?

If you want to join a gym in Italy, you may have to get a medical check up first.Italy’s government wants to introduce a €2,000 healthcare fee for some foreign residents. Photo by Ina FASSBENDER / AFP.

Whether or not the €2,000 fee is applied in the future, US readers will be relieved to hear that urgent care is always free in Italy.

Here’s one account from the archives of a US citizen in the Le Marche region who wrote about his positive experience accessing emergency services without health insurance when he began having trouble breathing.

“At one point a person with a clipboard came into the treatment room and I figured she was doing an insurance check. The doctor shooed her off, saying it was clearly an emergency,” he writes.

‘How I ended up in hospital in Italy – without health insurance’

Many American nationals who have used Italian healthcare tell us that, in contrast to US hospitals, they feel in Italy more money is spent on technology than niceties.

In a recent survey, we asked for your view on the quality of care you received in the Italian health system, and many rated it very highly. 

“Excellent levels of world-class expertise” is how 83-year-old Florence resident Stephen Jenkins summed up his view of Italy’s medical services.

But many also said there is a general lack of comfort when it comes to facilities.

“You need to bring your own towels and cutlery but there are no facilities to wash or hang dry them,” noted Willem-Jan Kuiper in Le Marche.

And if bedside manner is important, you may find Italy’s hospitals somewhat lacking.

“Do not expect any sort of good bedside manner or customer service,” said 42-year-old Laura Andersen in Veneto.

‘Very professional but underequipped’: What readers think of Italy’s hospitals

Have your say: If you’d like to share your opinion or tell us about an experience you’ve had while living in Italy, please leave a comment below this article or get in touch by email.

And if you have any advice for other American readers who are considering moving to Italy, or questions of your own, you can add them to our ongoing survey here.

Thanks for reading and please get in touch with us by email if you have any feedback on this newsletter.

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AMERICANS IN ITALY

Americans in Italy: Lowering your freelance tax bill and driving test tips

How can you lower your social security bill as an American freelancer in Italy and what should you know before taking the Italian driving test? Find out in our latest Americans in Italy newsletter.

Americans in Italy: Lowering your freelance tax bill and driving test tips

Welcome to our regular look at everything you need to know about life in Italy for The Local’s readers from the US. This newsletter is published monthly and you can receive it directly to your inbox before we publish by going to newsletter preferences in ‘My Account’ or following the instructions in the newsletter box below.

Freelancing is an attractive option for those seeking the freedom and flexibility of working for themselves.

In Italy, this may occasionally also be the only viable route as many companies are unable (or unwilling) to pay high employee taxes, and instead only work with self-employed contractors.

Generally speaking, freelancers in Italy pay two main types of tax: income tax and social security contributions to INPS.

Under the ‘ordinary regime’ (regime ordinario), you’ll pay Italy’s standard income tax IRPEF, which ranges from 23 to 43 percent of your taxable income depending on your earnings. But if you qualify for Italy’s popular ‘flat-tax regime’, you’ll pay five percent of your taxable income for the first five years and 15 percent from there on out.

As for social security, freelancers who are not enrolled in a professional association must pay into a state benefits scheme called gestione separata (literally ‘separate management’), with contributions set at 33 percent

But a special Italy-US bilateral agreement aimed at mitigating the effects of citizenship-based taxation means that American freelancers can significantly lower their tax bills by paying social security in the US instead of Italy.

Here’s how you can take advantage of it. 

How to lower your social security bill as an American freelancer in Italy

Driving is often a necessity in Italy as, outside of large urban areas, many parts of the country lack adequate public transport services.

But this can be tricky for holders of non-EU licences as Italian rules state that they can drive on national roads for a maximum of one year from acquiring residency.

After that, they need to exchange their non-EU licence for an Italian licence or, if that’s not possible, take an Italian driving test in order to get one.

As, barring diplomatic staff and their family members, the US doesn’t currently have a bilateral licence exchange agreement with Rome, American nationals living in Italy must get an Italian licence to continue legally driving in the country following the one-year window.

But passing Italy’s driving test can be a major challenge, not least because the theory quiz requires a significant amount of technical knowledge and cannot be taken in English

US citizen Barbara Giuliano Di Fabio told us how she managed to get her own Italian driver’s licence, sharing her best tips for fellow Americans looking to do the same. 

‘I felt like a rookie’: How one American finally got her Italian driver’s licence

While the theory quiz is generally regarded as the most daunting part of Italy’s driving test, that doesn’t mean that the road exam is without challenges. 

Driving a manual car (macchina con cambio manuale) after you’ve driven automatic transmission vehicles (macchine con cambio automatico) all your life can be one of them.

But can you only take Italy’s practical driving test if you drive a car with a manual gearbox or is there an option for automatic vehicles?

Can you only take Italy’s practical driving test if you drive a manual car?

Have your say: If you’d like to share your opinion or tell us about an experience you’ve had while living in Italy, please leave a comment below this article or get in touch by email.

And if you have any advice for other American readers who are considering moving to Italy, or questions of your own, you can add them to our ongoing survey here.

Thanks for reading and please get in touch with us by email if you have any feedback on this newsletter.

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