How to Register for Italian Healthcare and Get Your Tessera Sanitaria

You've got your codice fiscale. You've sorted your permesso di soggiorno. Now comes healthcare, and this is the step that makes a real difference to daily life in Italy. Registering with the public health system gives you the same care as an Italian citizen. A family doctor, hospital treatment, subsidised medicine, specialist visits. Mostly free, sometimes for a small co-payment.

But it doesn't happen on its own. Nobody signs you up. You have to go and register, and the first question almost everyone asks is the same one. Do I have to pay for it? The honest answer is: it depends on why you're in Italy. Let me walk you through who pays, who doesn't, and exactly how to register.

What the SSN and tessera sanitaria actually are

The SSN, short for Servizio Sanitario Nazionale, is Italy's public health system. It's the equivalent of the NHS in the UK. Once you're registered, you get a family doctor and access to public hospitals and clinics.

The tessera sanitaria is the card that proves you're in the system. It's a plastic card, green on one side, that carries your codice fiscale and doubles as your European health card when you travel. You show it at the pharmacy, at the doctor, at the hospital. Getting the card is the goal, but the card is really just proof of the thing that matters, which is being registered with the SSN.

Healthcare in Italy is run locally, not from Rome. Your registration happens at your area's health authority, the ASL (Azienda Sanitaria Locale). One thing that trips people up: the name changes by region. In Lombardy it's the ATS, in Veneto it's the ULSS. Same job, different letters. If you're not sure, search "ASL" plus your town's name.

First question: do you pay?

There are two ways to register, and which one you fall into decides whether it's free.

Mandatory registration is free. If you're in Italy for work, for family reasons, for international protection, or if you're pregnant, fostering, or adopting, you register by right and you pay nothing. This covers most people who move here to live and work. If you have an employment contract, this is you. That's the free route.

Voluntary registration costs an annual fee. If you're here on a basis that isn't covered above, most commonly as a student, an au pair, or on an elective residence permit without working, you can still join the SSN, but you pay a yearly lump sum for the calendar year.

Here's the part to pay attention to. That voluntary fee changed a lot in 2024. For years students paid a small flat amount of about 150 euro. Under the 2024 reform it jumped to a flat fee of around 700 euro a year for students, and other voluntary categories pay more. Because this amount is set each year and can differ by category, don't take a fixed number as gospel. Confirm the current figure at your own ASL before you pay. If you're a student, private insurance can sometimes work out cheaper for a short stay, so it's worth comparing before you commit.

What to sort out before you go

Registration goes smoothly when you arrive with the right papers. You'll want:

• Your codice fiscale. You can't register without it. If you don't have one yet, start with how to get your codice fiscale in Italy.
• Your permesso di soggiorno if you're a non-EU citizen. The receipt from your permesso application (the ricevuta) is usually accepted while you wait for the card, so you don't have to delay. If you're unclear how the permit relates to your visa, we cover that in permesso di soggiorno vs visa.
• Proof of your address in Italy. Registering your residenza first is recommended but not always required. Many ASLs accept a self-declared address (domicilio) if you haven't completed residenza yet. This does vary by comune, so check locally.
• For voluntary registration, proof that you've paid the annual fee. You usually pay it on an F24 form at a bank, post office, or tabaccheria first, then bring the stamped receipt.
• For mandatory registration, your employment contract or recent pay slips.

Bring the originals and a photocopy of each. Italian offices love a photocopy.

The steps at the ASL

Once your documents are ready, the visit itself is short.

Find your local ASL office and look for the desk called Scelta e Revoca, which means "choice and revocation." That's where SSN registration and doctor selection happen. Some areas let you book an appointment online, others run on a ticket-and-queue system, so check yours and, if it's a walk-in, go early.

Hand over your documents. The clerk registers you in the system and then shows you a list of the family doctors (medico di base) taking new patients in your postal code. You pick one from the list. If you have kids, you pick a pediatrician for them too. It's worth asking around beforehand, other expats often know which local doctors speak English.

When it's done, the clerk hands you a paper certificate. Keep it safe. That paper is your proof of coverage and it works straight away, so you can book with your new doctor and get prescriptions immediately. You don't have to wait for the plastic card.

The tessera sanitaria itself arrives by post to your registered address a few weeks later. It's sent to the address held in the tax database, so if you've moved, make sure that address is current or the card goes to the wrong place.

The most common mistake is picking a doctor near your university or office instead of near your home. You'll visit your medico di base for sick notes, prescriptions, and check-ups, so convenience matters. The second mistake is forgetting to renew. Voluntary registration runs out on 31 December every year. Renew it in January so you don't end up with a gap in coverage.

A quick worked example

Say you arrive in October as a non-EU master's student. You get your codice fiscale, you submit your permesso application and keep the ricevuta. You're a student with no Italian job, so you're in the voluntary category. You check the current fee with your ASL, pay it on an F24 form, and bring the receipt. At the Scelta e Revoca desk you show your passport, codice fiscale, permesso receipt, address declaration, and fee receipt. You pick a GP near your flat, walk out with the paper certificate, and the card turns up a few weeks later. Then you renew the whole thing the following January.

Frequently asked questions

Do I have to pay for the tessera sanitaria?

It depends why you're in Italy. If you're here for work, family, or protection, registration is free. If you're a student, au pair, or on elective residence without working, you pay an annual voluntary fee. Confirm the current amount with your ASL.

Can I register with just the permesso receipt?

Usually yes. The ricevuta from your permesso application is normally accepted as temporary proof of legal stay, so you can register while you wait for the physical permit. Your registration may be issued short-term at first and extended once the permit arrives.

How long until I get the physical card?

You get a paper certificate the same day, which works immediately. The plastic tessera sanitaria arrives by post a few weeks later, sent to your registered address.

Do I need to register my residenza first?

It's recommended but often not required. Many ASLs accept a self-declared address if your residenza isn't done yet, though this varies by comune. Check with your local office before assuming either way.

What to do next

Registering with the SSN is usually the last of the big first steps, after the codice fiscale and the permesso. Once it's done, the core of your setup in Italy is complete. You have a tax code, the right to stay, and healthcare.

If you landed here before sorting the earlier pieces, work backwards. Start with how to get your codice fiscale in Italy, since you need it before anything else. And every term in this guide has its own plain-English page in the glossary if you want more detail on any single step.