Tessera sanitaria: how a foreigner gets one in 2026

Iscrizione al SSN (Servizio Sanitario Nazionale) is enrollment in Italy's national health service, after which you get a tessera sanitaria and the right to a family doctor (medico di base), hospitals, tests, and ambulances almost like citizens. Below is how to enroll at the ASL, get a tessera sanitaria by the ricevuta, choose a medico di base, and avoid the typical traps. This is not legal advice but an overview based on community experience; categories, fees, and timelines change and depend on the region, so verify everything on salute.gov.it and at your local ASL.

How do you get the tessera sanitaria in Italy?

The tessera sanitaria is issued when you enroll in the SSN at your local ASL (ULSS in some regions). You usually bring a passport, the codice fiscale, the ricevuta or permesso and proof of address; for many permit types enrollment is mandatory and free, for the rest it is voluntary with a contribution. The plastic card arrives by post, and a paper temporary tessera works until then. You do not need to wait for the plastic permesso.

Where you enroll: the ASL, ULSS, and how to find your office

You enroll in the SSN at your local ASL (Azienda Sanitaria Locale). In some regions and provinces it is called ULSS - for example, in Padua. To find yours, the easiest way is to search Google or maps for "tessera sanitaria + your city" or "ASL/ULSS + city." Offices are distributed across districts and are not always located in your own town - sometimes the office you need is right inside a hospital (ospedale) or clinic.

Enrollment is usually free and without an appointment (walk-in): you take a ticket, wait in line, and register at the counter. In Turin participants said the whole procedure took literally 2-10 minutes - take a ticket, wait about 10 minutes, get the tessera. But some ASLs accept applications only online or by email, so it is best to check the procedure in advance on your ASL's website.

I moved on lavoro autonomo and was afraid I would have to pay for insurance. At the ASL they explained that I have mandatory enrollment and it is free - I brought a passport, the ricevuta, and the codice fiscale, and that was it. The family was registered free in the same way.

Can you get a tessera while waiting for the permesso

Yes - you do not need to wait for the plastic permesso di soggiorno. As soon as you have the ricevuta in hand (the postal receipt confirming you filed the residence-permit KIT/application), you can go to the ASL and get coverage. Many participants received a tessera as early as the day after sending the KIT. More on the filing itself - in the material on the KIT-postale for the permesso.

What the community brings to the ASL:

• the original passport and a copy of the first page (at some ASLs they additionally ask for a copy of the D visa);
• the original ricevuta and a copy of it plus the payment receipt;
• a copy of the codice fiscale;
• sometimes - proof of address (even a signed autocertificazione works) or a copy of the P.IVA.

The temporary tessera (provvisoria) is just an A4 or A6 sheet, it is issued right away, and it is already enough to use healthcare. The plastic card is printed not by the ASL but by the Agenzia delle Entrate (the tax agency) and mailed to your address, usually in about two weeks, and per some reports 15-20 days.

A useful detail at the form stage: according to the community, you can mark a language barrier (barriera linguistica) on it. Then at appointments the ASL provides a cultural-linguistic mediator (mediatore linguistico) free of charge, often by phone right during the visit - convenient while your Italian is weak. If you later go to a private doctor, you can also bring an interpreter, but at your own expense (reportedly around 15-25 euro per hour).

First read the law yourself to understand whether you are entitled to mandatory or voluntary enrollment - that is more reliable than what a particular clerk at the window claims. For the mandatory category, the basis is article 34 of the consolidated immigration law 286/98: paragraphs 1-2 - mandatory free enrollment, paragraph 3 - voluntary, with the purchase of insurance.

While the permesso is still in progress and you only hold the ricevuta, check the travel rules separately - see travel on the ricevuta: can you return.

What to do if the ASL refuses

A common problem: many ASLs mistakenly require residenza (registration) or a plastic permesso before issuing the tessera, even though this is not needed for the mandatory category. Community participants got the card time and again simply by going to a different window or a different office, sometimes citing article 34 of the law directly. The advice is the same - try a different window or a different ASL and find a competent staff member.

On lavoro autonomo (the mandatory category) at one ASL window they refused me, and at the next one a few minutes later they registered it without questions. The takeaway: persistence and switching clerks decide more here than the rules themselves.

When it does not work in person, email/PEC helps. Several participants got a temporary tessera simply by sending the ASL a passport, codice fiscale, and ricevuta by mail - sometimes the same day: they were sent a sheet, which they only had to print and sign. One person in Sardinia, who was refused several times in person, got everything done by email in a single day.

In person, our ASL dug in: no residenza - no tessera. I wrote to their email with the passport, codice fiscale, and ricevuta attached - they sent the temporary card the same day, I printed and signed it. Do not fight at the counter, try email.

How long the temporary tessera is valid

The temporary tessera tied to the ricevuta is usually issued for 3 months, sometimes for 6. It can be extended by going back to the ASL with a fresh receipt from the questura confirming that the permesso is not ready yet. Once the permesso is received, the tessera is re-issued for the full validity period of the permit - be sure to go to the ASL again for this. Plastic cards, per reports, are valid for up to 5 years.

How to choose a medico di base or pediatrician

A family doctor (medico di base, and for children - a pediatra) is chosen at the same moment, at enrollment. You can name a specific doctor; if you do not, they will ask which gender of doctor you prefer and will try to find one closer to your address. The doctor is usually chosen for six months, then re-registered. Changing the registered doctor or pediatrician in many regions (for example, in Lombardy) can be done online in a couple of minutes - and not stand at the ASL for three hours. More - in the material on the medico di base.

An important nuance: according to the community, in Milan, with only a temporary tessera, they do not give registration with a family doctor - they register only insurance coverage, and the doctor is chosen later.

We did it this way: first a paper tessera for everyone, then at the counter we asked for a family doctor for the adults who knew English, and for the child - a separate pediatrician. We chose everything right at the ASL in one visit.

When my wife was found to have a serious diagnosis, after filing the KIT we were told to go straight to the ASL with our medical papers translated into Italian. She was registered with a family doctor the same day, and within a week they issued referrals to specialists, for tests, and to the disability commission.

Example: how to enroll in the SSN on the ricevuta

Below is a worked-through look at a single ASL visit. The values are synthetic, for illustration; the procedure and the list differ by region, verify them at your local ASL and on salute.gov.it. This is not legal advice.

A hypothetical case: "Yulia" moved on lavoro autonomo (the mandatory category), sent her KIT a couple of days ago and holds the ricevuta. This is what she brings to the ASL:

• the original passport and a copy of the first page (some ASLs also ask for a copy of the D visa);
• the original ricevuta and a copy of it plus the payment receipt;
• a copy of the codice fiscale;
• just in case - proof of address (a signed autocertificazione works) and a copy of the Partita IVA certificate as proof of the mandatory category.

How the visit usually goes: (1) find your office (ASL or ULSS, sometimes right inside a hospital); (2) take a ticket, wait in line - per the community it is all done at the counter in a few minutes; (3) if the window immediately quotes the voluntary fee (per the community around 2000 euro/year is named for adults - the amount is time-sensitive, verify the current one), Yulia shows the Partita IVA certificate and asks for free mandatory enrollment; (4) on the spot they issue a temporary tessera - just an A4/A6 sheet, and it is already enough to use healthcare; (5) she chooses a medico di base right there - you can name a specific doctor or ask for one closer to your address (for a child, a separate pediatra).

After that the plastic card is printed not by the ASL but by the Agenzia delle Entrate and mailed in about two weeks (per reports 15-20 days - verify the current details). The temporary tessera is usually issued for 3 months (sometimes 6); once the permesso is ready, the tessera is reissued for the term of the permit. It helps to mark a language barrier (barriera linguistica) at the form stage so that at appointments a mediatore linguistico is provided free of charge.

I came with a passport, the ricevuta and the codice fiscale, and just in case grabbed the Partita IVA certificate. At the window they first started talking about an annual fee - I showed the P.IVA, and they registered everything free as mandatory enrollment. The temporary tessera - an A4 sheet - was issued right away, and the plastic arrived by post about two weeks later.

We chose the family doctor right at the counter: for the adults we asked for a doctor who knew English, for the child - a separate pediatrician closer to home. We did it all in one visit, and the plastic simply arrived later by post.

Why it is important to link the codice fiscale to the address

The codice fiscale must be correctly linked to your Italian address in the tax system - otherwise the ASL "does not see" you and may refuse a tessera (or the plastic simply will not arrive). This is fixed at the Agenzia delle Entrate: you book an appuntamento online or through the app and ask to link the code to your address/domicilio. A code obtained abroad through the consulate sometimes shows up in the ASL software as invalid and requires activation; opening a Partita IVA also usually "surfaces" the data. To calculate and break down your code letter by letter, use the tool:

A separate trap is a prefix mismatch. For people from Russia, the code sometimes gets the prefix 135 in one office and 154 in another; the wrong code on a tessera once disrupted a second vaccination (the codes did not match), and fixing it took the ASL administrator doing it by hand. Stating "RUS" versus "USSR/SUN" as the place of birth in the KIT can cascade into a wrong codice and wrong data in the permesso, carta d'identita, and tessera. On the first steps with the code and registration - in the article codice fiscale and residenza.

I got stuck in a bureaucratic loop: the ASL points to the tax office, the tax office to the ASL, and the plastic card still does not arrive. Meanwhile I already have residenza, a paper tessera, and a carta d'identita. Where to complain on the merits - I never found, there is no clear authority.

Mandatory and voluntary enrollment: the difference

According to the community, there are two forms of enrollment in the SSN.

• Mandatory (iscrizione obbligatoria). Available to holders of a residence permit on a number of grounds - employment, self-employment (lavoro autonomo), waiting for employment, family grounds, asylum. The tessera is free, and family members are covered free in the same way, including those who arrived through reunification. The right to the SSN is not interrupted even during the wait for permit renewal - these are the norms of the consolidated immigration law.
• Voluntary (iscrizione volontaria). For grounds without mandatory enrollment (for example, part of residenza elettiva, pensioners, some elderly people through reunification, students). In that case you pay an annual fee to the SSN or take out private insurance.

According to the community, for adult non-EU citizens a new flat fee of around 2000 euro per year is quoted - it replaced the former income-linked payment (a range of roughly 387.34 to 2788.87 euro). The student fee rose to 700 euro (previously 149.77), and for Au Pairs - to 1200 euro (previously 219.49). An important detail: the voluntary fee always expires in December of the current year, no matter which month you enroll. For residenza elettiva, participants quoted other amounts too - around 400 or 350 euro per year (opinions differed), and a minimum private insurance package - around 900 euro per year. All figures are time-sensitive - verify the current details at the ASL. Do not guess which form applies to your permit, verify it on salute.gov.it.

A big source of confusion in the chats is whether this 2000 euro fee is charged per person or for the whole family. According to the community, the answer depends on exactly how your ASL "sees" you: if you are registered as a family member of an EU citizen (familiare UE) and must be listed "in carico," the amount may be requested separately for each person who cannot be registered to the working family member. So keep proof of the mandatory category on hand: several participants showed a fresh Partita IVA certificate or digital-nomad registration at the window - and the staff member immediately changed the requested 2000 euro to free mandatory enrollment. Do not leave the ASL after the first amount quoted, if you have grounds for the mandatory category.

At the ASL window they quoted me 2000 euro a year right off the bat - the clerk did not even know what a digital nomad was. In broken Italian I showed a photo of the Partita IVA certificate I had opened a week earlier. She asked me to send a copy to the email - and calmly registered it for free. Have the document on hand, it makes the difference.

Refusal of free enrollment for digital nomads

Officially: for the digital nomad visa the consulate requires health insurance for medical care and hospital admission valid in Italy for the whole stay (esteri.it, decree of 29.02.2024). The Agenzia delle Entrate says that foreigners with a permesso of more than three months who are not in the mandatory categories may enroll in the SSN voluntarily for an annual contribution, and that enrollment normally lasts as long as the permesso (agenziaentrate.gov.it). Which category an ASL puts a digital nomad permesso in, these pages do not say (checked 25.09.2026) - and the answers in the chats differ.

The chats hold 20 messages about the tessera for digital nomads from February 2025 to July 2026, plus the replies in the same threads. Reports with an outcome:

In total 3 free (2 of them with an open Partita IVA) and 5 refusals or demands to pay. One more reply (07.2026) retold a case where an employed digital nomad without a Partita IVA got the tessera. The advice that recurs in the same threads: go in person with the Partita IVA certificate and proof of contributions, and try again after a refusal - the outcome depends on the particular ASL.

How much treatment costs with a tessera

After enrollment, healthcare is not entirely free, but it is cheap:

• a specialist visit with a tessera costs about 20 euro (that is the ticket);
• tests are paid for partly - one participant paid about 45% of the cost through the ticket;
• medicines on your doctor's prescription are sold at any pharmacy at 70-80% less than the retail price.

An important exception is teeth: fillings, crowns, implants and braces are almost never covered by the tessera for an adult, you pay a private dentist for them - more in the article on dental care.

The co-payment exemption code (esenzione) is obtained at the ASL - by low income (ISEE), refugee status, or a number of illnesses (diabetes, dialysis, oncology are assigned automatically). Always check that the doctor's prescriptions carry your esenzione code.

According to the community, the income exemption (esenzione per reddito) starts at a threshold of around 8500 euro per year - below it, basic access to healthcare goes without a ticket; verify the exact figure and formula at the ASL, it is time-sensitive. There is also an exemption for unemployment: for one participant, when choosing a doctor, the ASL staff member themselves pointed out that, due to job loss, both the applicant and all their dependents are exempt from the ticket. Ask about your case right at the window - such benefits are not always announced.

When my husband lost his job during COVID and we moved, at the ASL, when choosing a family doctor, the staff member said on their own: you are entitled to the unemployment benefit, neither you nor your dependent children pay the ticket. We would never have found out about it ourselves - ask about esenzione when you enroll.

There is also a tax bonus: medical expenses, prescription medicines, and, for example, contact lenses bought by presenting the tessera reduce your tax - 19% is refunded on the amount above 129 euro spent on medical services and medicines; this is claimed when filing the 730 return. To estimate taxes and the forfettario regime, the material on the forfettario and taxes is handy.

A single paper tessera valid for 6 months was enough for us to get free full chemotherapy, an MRI, and a PET, take-home medicines, and even to register disability with payments. Everything moved fast. For serious cases the system turned out to be very decent.

Ambulance care without a tessera and important caveats

Emergency care is provided even without a tessera: ambulances and pronto soccorso (the emergency department) treat regardless of documents. Pregnant women are registered with a doctor and given free care and coverage even with no documents at all (they cannot be expelled); after presenting a certificate of pregnancy at the ASL, coverage follows automatically. Emergency numbers: 118 (medical ambulance), 112 (carabinieri / the general EU number), 113 (police).

If you still have no residence permit at all or are only waiting for it, basic and emergency care is available through the STP/ENI codes - more in the article on emergency care and STP/ENI.

Opinions about quality differ sharply in our chats. Some praise the system as excellent and reliable, especially for oncology and childbirth. Others are angry: you wait months for a non-urgent specialist and end up going privately (around 100-160 euro per visit). The farther south, the worse the organization, while in big hubs like Turin there are huge queues.

It is hard for those used to "tests just in case": an Italian doctor will not order anything extra and will not prescribe a medicine simply on demand. At first this annoyed me, but then I understood - it is evidence-based medicine, and that is right.

The tessera as a codice fiscale card and where it is asked for

The tessera sanitaria is combined with the codice fiscale card: it has your codice fiscale and a barcode printed on it. It is asked for at pharmacies, at the post office, when topping up Mooney and cigarette machines, when opening Revolut, and so on. Technically only the codice fiscale number is needed, so a separate plastic codice fiscale card from the Agenzia delle Entrate works too.

We hit the classic residenza loop: to pay rent and get registration (and with it a carta d'identita and tessera), you need a bank account, but Revolut and some services do not open an account without a tessera. We untangled it through a paper tessera by the ricevuta - and only then the account.

Without a tessera you cannot view online test results unless you have SPID or CIE/CNS; the tessera itself can serve as a CNS for some logins, but it sometimes requires a card reader and a PIN. How to get SPID - in the material on SPID.

Related articles

• Medico di base: choosing and changing the family doctor - how to register and change the doctor.
• Dental care in Italy: prices and insurance - which dental treatment stays outside the SSN and what it costs.
• Emergency care and the STP/ENI codes - healthcare without a residence permit and ambulances.
• Codice fiscale and residenza - linking the code to the address.
• KIT-postale for the permesso - the filing and the ricevuta you take to the ASL.
• SPID - digital identity - logging into online services and test results.
• Family reunification - free coverage of family members in the SSN.
• ASL catalog by region - how to find your ASL office for enrollment and getting the tessera.
• Insurance for the visa D to Italy 2026: SSN - what to cover yourself with in the first year before SSN enrollment.

Official sources

• Ministero della Salute - the SSN, foreigners' rights to medical care, LEA, esenzione
• Agenzia delle Entrate - the tessera sanitaria, the codice fiscale, linking to the address
• Agenzia delle Entrate: iscrizione al SSN - how long enrollment lasts and voluntary enrollment for a contribution (checked 25.09.2026)
• esteri.it: digital nomad visa - the insurance requirement for the whole stay (checked 25.09.2026)
• Portale Immigrazione - filing the KIT and the permesso status
• SPID - digital identity for online test results
• the local ASL/ULSS website - SSN enrollment, the list of documents, and choosing a medico di base

Frequently asked questions

Can you get a tessera sanitaria before the plastic permesso?

According to the community, yes: SSN enrollment does not wait for the plastic permesso. As soon as you have the ricevuta in hand (the postal receipt confirming you filed the residence-permit KIT), you can go to the ASL and get coverage. Many people received a temporary tessera as early as the day after sending the KIT. The procedure differs by region - check with your local ASL and on portaleimmigrazione.it. This is not legal advice.

Is the tessera sanitaria paid or free?

According to the community, for holders of a residence permit on grounds with mandatory enrollment (l'iscrizione obbligatoria, which includes lavoro autonomo) the tessera is free, and family members are covered free in the same way, including those who arrived through reunification. For grounds without mandatory enrollment, you apply for voluntary enrollment for an annual fee. Verify the category for your permit on salute.gov.it. This is not legal advice.

What do you do if the ASL refuses, citing the lack of residenza or the plastic card?

According to the community, many ASLs mistakenly require residenza or a plastic permesso even for the mandatory category. People got the tessera by going to a different window or a different ASL office, sometimes citing article 34 of the consolidated immigration law. The community advice is to try a different window or a different ASL and find a competent staff member.

Where does the plastic card come from and how long is the wait?

According to the community, the temporary tessera (an A4/A6 sheet) is issued at the ASL right away, and the plastic is printed and mailed by the Agenzia delle Entrate (the tax agency), usually in about two weeks, and per some reports 15-20 days. The ASL does not print or mail the plastic. Verify the current exact timelines.

How do you choose or change your family doctor (medico di base)?

According to the community, the doctor is chosen right at enrollment at the ASL: you can name a specific doctor, otherwise they will ask about a man or a woman and pick one closer to your address. The doctor is usually chosen for six months, then re-registered. In many regions changing the doctor or pediatrician is done online in minutes. This is not legal advice.

Is the voluntary 2000 euro fee charged per person or for the whole family?

According to the community, it depends on how the ASL registers you. If you fall into the mandatory category (for example, lavoro autonomo or a digital nomad with an open Partita IVA), enrollment is free, and keeping a P.IVA certificate or digital-nomad registration on hand helps: participants showed it at the window, and the requested 2000 euro was replaced with free mandatory enrollment. But if you are registered as a family member of an EU citizen, the amount may be requested for each person who cannot be registered in carico to the working family member. Verify the category for your permit on salute.gov.it and at the ASL. This is not legal advice.

Related materials - Healthcare and the SSN

• Health and SSN in Italy: tessera sanitaria
• Medico di base in Italy: how to register
• Italy ambulance number: 118, pronto soccorso
• Insurance for the visa D to Italy 2026: SSN

Next stepPrintable modulesFill a short form and print a ready Italian document: autocertificazione, ospitalita, conto di base.

Documents for this topic

• Registry of Russian-speaking Doctors and Medical Specialists in Italy (updated May 2025)
• State-Regional Agreement on Medical Assistance to Foreigners in Italy (2012, Rep. N 255/CSR)
• Mod. APR/4 and APR057: residenza change checklist