Health and SSN in Italy: tessera sanitaria

You can enroll in the SSN and get a tessera sanitaria on the ricevuta alone. How to pick a medico di base, what the ticket costs and the emergency numbers.

The tessera sanitaria in Italy is issued at your local ASL on the ricevuta for the KIT submission - with a passport and codice fiscale, without waiting for the plastic residence permit (per the community). It confirms your enrollment in the public SSN system (Servizio Sanitario Nazionale): from there you register with a family doctor (medico di base) and use hospitals and ambulances almost the same way citizens do. This is not legal or medical advice but an overview based on community experience; the procedure depends on the region and the grounds for your residence permit, so verify the details against Italy's official sources.

In brief: community data

Do not wait for the plastic permit: the tessera sanitaria is issued on the ricevuta for the KIT submission; at first a temporary paper one (tessera provvisoria) is given, the plastic comes later.
The ASL is a window-by-window quest: you are often refused the first time, but it works at another window, branch or by email; the codice fiscale must be linked to your address, otherwise the system does not see you.
What it costs: basic treatment in the SSN is free, for some tests and specialists you pay a ticket; an esenzione code (by illness, low ISEE or status) helps reduce it, while for residenza elettiva healthcare is paid (per the community).
The language barrier is solvable: mark barriera linguistica - the ASL provides a mediatore linguistico for free, often by phone right at the appointment.
Pregnancy: from roughly the 3rd month a permesso per cure mediche is arranged, a pregnant woman is not deported, and prenatal care and childbirth are covered for free even without documents.

The tessera sanitaria in brief

The tessera sanitaria is the card confirming your enrollment in the SSN (Servizio Sanitario Nazionale); it also serves as the plastic codice fiscale. You obtain it at your local ASL, and according to the community a passport, the codice fiscale and the ricevuta for the permesso application are enough - you do not need to wait for the plastic residence permit. After enrolling you choose a medico di base and use hospitals, tests and ambulances almost like citizens. Step by step, with the documents and who enrols for free, in the article how a foreigner gets the tessera sanitaria.

How it works in a nutshell

The SSN is the national health system, managed locally by regional ASL services (Azienda Sanitaria Locale). It is at the ASL that you enroll in the system, get the tessera sanitaria, and choose a family doctor. According to the community, the basic set of services (a visit to the medico di base, ambulance care, hospitals, prescriptions) is free or almost free for those enrolled in the SSN; for tests and specialists you usually pay a small co-payment (ticket).

The minimum guaranteed level of care is set at the national level (LEA - livelli essenziali di assistenza), and a state-regional agreement requires regions to apply the rules uniformly and not create differences in access to healthcare between territories. This is important to know if one ASL tells you one thing and a neighboring one says something else.

Do not wait for the plastic residence permit

The main thing the community repeats: to enroll in the SSN and get a tessera sanitaria, you do not need a finished plastic permesso. As soon as you have the ricevuta in hand (the postal receipt confirming you filed the permesso KIT), you can go to the ASL. They usually bring the original passport and ricevuta, a copy of the first page of the passport (sometimes a copy of the D visa), a copy of the codice fiscale, and a copy of the ricevuta with the payment slip.

At first they issue a temporary paper tessera (tessera provvisoria, a "polis" on an A4 or A6 sheet). According to the community, it is valid for 3 or 6 months from the date of registration at the questura; when the term is near its end, you get a fresh paper from the questura stating that the permesso is not ready yet, and the ASL extends coverage by another 3 months. Once the permesso is received, the tessera is issued for its full validity period, and the plastic card is mailed to your home address. The tax authority Agenzia delle Entrate prints and mails the plastic, not the ASL; the paper "polis" from the ASL works as a full substitute and can be used everywhere. In some regions, if you have an electronic carta d'identita (CIE), they issue only the paper - and that is enough.

Do not wait for the plastic residence permit. The day after the ricevuta arrived, we went to the ASL - my husband was enrolled and immediately registered with a doctor. A few days later he was already referred to an oncologist. If we had waited for the finished permesso, we would have lost weeks.

Veronika, communitypersonal opinion

Cancer, chemo, examinations, medicines - everything was done completely free on an ordinary paper tessera valid for 6 months. The day before the appointment they even called to remind us which documents to bring. I did not expect such treatment.

Timur, communitypersonal opinion

Where the ricevuta comes from and how to hand in the form at the post office is covered in the article on the kit permesso and filing the kit.

The ASL in practice: a quest through the windows

Practice at the ASL varies greatly from city to city and even from window to window. According to the community, many people are refused the first time (they are told to wait for the permesso or residenza), but it works out at a different window, at a different ASL, or by email: some send a temporary tessera by letter the same day, if you attach a passport, codice fiscale, and ricevuta. In some places (for example, in Turin) they assign a family doctor and enroll you in the system even without a finished permesso, but the queues are huge - one participant waited for the card for about 4 months.

An important technical detail: the codice fiscale must be valid and linked to your Italian address, otherwise the ASL will not see you in the system. If the address is not linked, it is "activated" (linked to the domicilio) at the Agenzia delle Entrate. According to the community, the chain looks like this: ricevuta, grounds for residenza (a lease, etc.), registration/residenza, carta d'identita, tessera sanitaria. More on the codice fiscale and linking the address - in the article on the codice fiscale and residenza.

Getting a tessera is a quest: at one window they refused, at the next one they issued it, and acquaintances of ours resolved it entirely by letter to the ASL. It all comes down to persistence and whether you happen to get a competent staff member. No two cities are ever the same.

Larisa, communitypersonal opinion

A common, expensive mistake is the wrong code in the codice fiscale. For one client the code (135 instead of 154, for example) quietly broke both a vaccination appointment and an attempt to get a driver's license. Check that the code on your tessera matches everywhere before it "goes off." And do not take an STP if your grounds entitle you to a real tessera: an STP, when misapplied, can be canceled - for example when you end up in the hospital.

immigration consultantpersonal opinion

How much it costs

According to the community, basic treatment in the SSN is free. Medicines prescribed by your doctor cost 70-80% less than retail, and some are free or symbolic (around 2 euro). For certain tests you pay a co-payment (ticket): one participant paid about 45% of the cost for blood and ultrasound through the ticket. An exemption code (esenzione ticket) from the ASL helps reduce the ticket - by illness, low ISEE, or status; for diabetes, dialysis, and oncology the exemption is assigned automatically. According to the community, there is also an exemption for unemployment: for one family, when choosing a doctor, the ASL staff member themselves suggested that, due to job loss, neither the applicant nor their dependents pay the ticket. An income threshold for an exemption was also mentioned - around 8500 euro per year: this is the esenzione per reddito threshold (by income and category, set by the ASL), not the assegno sociale; the specific figures and conditions are time-sensitive, verify the current details at the ASL. In addition, 19% of medical expenses above 129 euro can be recovered through the 730 tax return.

For the residenza elettiva grounds, SSN healthcare is not free, it is purchased. The community quoted various and contradictory figures (on the order of a few hundred euro per year, while for some it was substantially more, calculated from income), so go not by a specific number but by the fact that it is paid and verify the current details at the ASL and on salute.gov.it. Children from age 14, according to the community, are covered free under a parent's policy.

Emergency care, specialists, and pregnancy

In an emergency people go to pronto soccorso (the emergency department) or call an ambulance. In a real life-threatening situation, care is provided immediately and without a tessera sanitaria. For specialists the queue is sorted by urgency: a doctor's "urgent" note (within 72 hours) speeds up the appointment, while non-urgent cases may wait for months - or pay privately. According to the community, waiting time in the emergency department varies: from about 20 minutes in a small town to 2-3 hours in busy city hospitals. The details are in the article on emergency care and STP/ENI.

A specialist appointment goes through the hospital CUP (Centro Unico Prenotazione); if your city does not have the doctor you need, they will offer a neighboring one (also with a ticket payment). According to the community, you can book a CUP appointment not only in person at a window marked "CUP," but also by phone through the regional numero verde, and in a number of regions - right at the pharmacy (where at the counter they also tell you where to go with the referral). Where pharmacies do not perform the CUP role (reportedly, for example, in Abruzzo), they book only through the ASL or hospital - verify the procedure in your region. Results are obtained online via SPID or CIE or picked up at a hospital window. Most medicines in Italy (except fever reducers) are dispensed on a prescription from the medico di base - the prescription lowers the price and lets you buy at any pharmacy.

One more nuance that instructions rarely mention: when enrolling in the SSN you can mark a language barrier (barriera linguistica) on the form. According to the community, the ASL then provides for the appointment a cultural-linguistic mediator (mediatore linguistico) free of charge - often by phone right during the visit; if you go to a private doctor, you can also bring an interpreter, but at your own expense (reportedly around 15-25 euro per hour). This removes the fear of the first visit, when neither you nor the doctor really speak the same language.

I was afraid to go to the doctor because of the language, and for nothing. The doctor did not speak English, but at the ASL, right in front of me, they dialed an interpreter by phone, and we discussed the entire appointment through them - for free. It turned out that on the form I just had to mark the language barrier.

Vlada, communitypersonal opinion

I was booked to the ENT not at the ASL and not online, but at a pharmacy: I bought a medicine, asked at the counter - and they sent me to the second floor to book by referral. The appointment came up for the nearest date, and I paid only a ticket of about 20 euro. For us the pharmacy really works as a booking point.

Snezhana, communitypersonal opinion

A separate topic is pregnancy. According to the community, from the 3rd month you can get a residence permit on medical grounds (permesso di soggiorno per cure mediche) for the duration of the pregnancy and 6 months after the birth; a pregnant woman is not deported, is registered with a doctor, and is treated free even without documents (you bring a certificate of pregnancy to the ASL), and prenatal care and delivery are covered.

The split in the chats is real. Those who in Moscow or St. Petersburg could afford private clinics rate Russian medicine higher. But for a person on an ordinary salary Italy is better, and the human attitude here is incomparable - I am no longer afraid to go to the doctor.

Oksana, communitypersonal opinion

Italian doctors do not prescribe "just in case" and do not send you chasing tests you found yourself on the internet. Some people find that annoying, but to me it seems sensible: they treat by evidence-based medicine, not overtreat, as used to happen back home.

Gleb, communitypersonal opinion

Pediatrics here is a level above what we had. In Italy everything is to the point, fast, and without excess, while in Moscow almost every visit produced a referral or prescription without any real basis. They transferred my child's vaccinations from the Russian certificate right at the ASL: they translated it on the spot, entered it in the database, and scheduled the missing ones.

Maryana, communitypersonal opinion

We arranged my son's vaccinations not with the pediatrician but at a separate vaccination center - it varies by city, in some places the ASL does it. I translated our certificate in advance, the nurses checked it, entered it into the database, issued an Italian vaccination card for school, and right away gave us a booking for the missing doses. We managed it in literally one visit.

Zhanna, communitypersonal opinion

Articles in this section

SSN enrollment and the tessera sanitaria - who enrolls mandatorily and who voluntarily for a fee, how to get the tessera sanitaria through the ASL, and what the STP and ENI codes briefly mean.
Medico di base: the family doctor - how to choose and change your family doctor, how to register a child with a pediatrician (pediatra di libera scelta), and what the doctor does free of charge.
Emergency care, guardia medica, and STP/ENI - what 118 and pronto soccorso are, where to call at night and on weekends, and what care is available to those who still have no residence permit or are waiting for it to be issued.
Disability status in Italy for foreigners - the INPS invalidita civile commission, the patronato, what a recognized percentage gives and how the benefit differs from a pension.
Medicine analogs in Italian pharmacies - how to find a substitute by active ingredient, what is sold without a prescription and where to ask the pharmacist.
Pregnancy and childbirth in Italy - the consultorio, the STP code, the permesso per cure mediche and free prenatal care in a public hospital.
Dental care in Italy: prices and insurance - why dentistry is almost always outside the SSN, community price benchmarks and how to save.
Finding a Russian-speaking doctor in Italy - where to look for a doctor who speaks your language and how to check them in the ordine dei medici register.
Moving to Italy with cancer: SSN and STP - treatment under the SSN after the permit, what is available before it and how not to lose time.
Insurance for the visa D and the first year - which policy the visa needs, how to cover the first months before the tessera sanitaria and when insurance is still needed.
ASL catalog by city - addresses and the SSN enrollment procedure in your region.

First steps after arrival - codice fiscale, residenza, the permesso KIT, and the sequence of actions after which the path to the ASL and the tessera sanitaria opens.
Codice fiscale, residenza, and the tessera sanitaria - why the codice fiscale must be linked to the address, otherwise the ASL will not see you in the system.
Digital identity: SPID and CIE - what people use to obtain test results online and confirm their identity in hospital services.
Money and taxes in Italy - the ticket, esenzione by ISEE, and recovering 19% of medical expenses through the 730 return.
Additional document samples and reference materials - in the Library section.
Kit permesso: filing the kit in 8 days - where the ricevuta you take to the ASL comes from.

Official sources

Ministero della Salute - public healthcare, the SSN, LEA, foreigners' rights to medical care, STP and ENI
Agenzia delle Entrate - the tessera sanitaria, printing and mailing of the plastic card, the codice fiscale, and linking it to the address
Ministero dell'Interno and portaleimmigrazione.it - the permesso di soggiorno, the ricevuta, and the status on the basis of which the ASL enrolls you in the SSN
the local ASL website for your region - SSN enrollment, choosing a medico di base, and ticket rates in practice

Frequently asked questions

Do you need private insurance in Italy if you have a residence permit?

According to the community, for most residence-permit grounds people enroll in public healthcare (the SSN) through the ASL after the move, and private insurance is usually only needed at the visa stage and during the first few weeks. Verify the exact requirements for your type of permit on salute.gov.it and at your local ASL. This is not legal advice.

Where do you start if you have just arrived?

Community experience suggests this order: codice fiscale, then SSN enrollment and getting the tessera sanitaria through the ASL, then choosing a medico di base. Details are in the articles of this section and in the article on the codice fiscale and residenza.

Can you get a tessera sanitaria without a finished plastic residence permit?

According to the community, yes: as soon as you have the ricevuta in hand (the postal receipt confirming you filed the permesso KIT), you can go to the ASL. They usually ask for the original passport, the original ricevuta, a copy of the first page of the passport, a copy of the codice fiscale, and a copy of the ricevuta with the payment slip. At first they issue a temporary paper tessera (tessera provvisoria); the plastic card comes later. Practice varies by city - verify the current details at your ASL.

What do you do in an emergency without a tessera sanitaria?

In a real life-threatening situation go to pronto soccorso (the emergency department) or call an ambulance - emergency care is provided immediately and without a tessera sanitaria. According to the community, waiting times in the emergency department vary: from minutes in a small town to several hours in busy city hospitals. More in the article on emergency care.

How much do treatment and medicines cost for those enrolled in the SSN?

According to the community, basic treatment in the SSN is free; medicines on a doctor's prescription cost noticeably less than retail, and some are free or symbolic. For certain tests and specialists you pay a co-payment (ticket). An exemption code (esenzione) from the ASL by illness, low ISEE, or status helps reduce it. Verify specific amounts and conditions on salute.gov.it and at the ASL.

What do you do if you do not speak Italian and the doctor does not speak English?

According to the community, when enrolling in the SSN you can mark a language barrier (barriera linguistica) on the form - then the ASL provides a cultural-linguistic mediator (mediatore linguistico) for the appointment free of charge, often by phone right during the visit. You can also bring an interpreter to a private doctor, but at your own expense (reportedly around 15-25 euro per hour). The procedure differs by region - check with your local ASL. This is not medical or legal advice.

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