First steps in Italy
Moving: step-by-step plan - Codice Fiscale - Bank - Healthcare SSN - SPID and CIE - Renting
Contents
- SSN vs private insurance: who gets what in 2026
- How to get the Tessera Sanitaria by residence permit type
- Tessera with ricevuta – before getting the permesso
- Medico di base – the family doctor
- Actual healthcare prices in 2026
- Emergency services and hospitalization
- DN vs LA: difference in healthcare
- Insurance for a D visa
- Children and family
- Conclusions and action plan
Healthcare in Italy is one of the most frequent topics in Russian-speaking emigration chats. Every day dozens of people ask: do I need to pay 2000 euros a year? When can you get a free doctor? Does emergency care work for those who haven’t received the permesso yet?
This article gives concrete answers based on the real experience of Russian-speaking immigrants in 2026, with prices, documents and community life-hacks.
Healthcare in Italy: SSN vs private insurance in 2026
Main question: are you entering the SSN (Servizio Sanitario Nazionale) — Italy’s public health system — or are you forced to pay for private insurance?
In 2026 the situation looks like this: access to the SSN depends on your type of residence permit and whether you pay contributions to INPS (the Italian social security agency).
| Category | SSN | Tessera Sanitaria | Cost |
|---|---|---|---|
| LA residence permit with INPS | Yes – mandatory | Free | 0 EUR |
| LA residence permit without INPS | Only voluntarily | Paid | ~2,000 EUR/year |
| DN residence permit | Depends on the province | Paid or free | 0–2,000 EUR/year |
| Student residence permit | Voluntary | Paid | ~700 EUR/year |
| Family members of LA | Yes | Free | 0 EUR |
| Ricevuta (without permesso) | Temporary | Temporary tessera | 0 EUR |
Key principle: if you work officially in Italy and pay INPS contributions, SSN coverage is mandatory and the tessera is issued at no extra cost. If you do not pay contributions (remote work, passive income), you either need to pay the voluntary contribution or take out private insurance.
Detailed guide on the topic
“I opened a partita a week ago and I’m going to pay taxes for 2026, I showed her a photo of the partita certificate. She asked me to send a copy by email, and said that then tutto bene and she issued everything.”
- Experience of a participant from Genoa (March 2026)
2. How to get the Tessera Sanitaria by residence permit type
Tessera Sanitaria is the card of Italy’s public health insurance. It is issued at your local ASL (Azienda Sanitaria Locale) and gives access to the entire public health system.
Tessera Sanitaria is now unified with the Codice Fiscale card: your tax code is printed on the plastic. The green Codice Fiscale cards are no longer issued — tessera is issued instead.
Step 1. Gather documents
Basic package for LA (Lavoro Autonomo):
- Permesso di soggiorno (plastic card or ricevuta)
- Codice Fiscale (certificate from the Agenzia delle Entrate)
- Passport
- Proof of address (autocertificazione di residenza or a letter from the comune)
- INPS documents: partita IVA certificate or employment contract
Step 2. Register at the ASL in your place of residence
Each region and even each ASL office has its own requirements. In Milan you can book online, in Turin some offices accept people without an appointment — you need to take a ticket. Check your regional ASL website.
Step 3. Get a temporary tessera
On the spot they will give you a paper tessera (A4 sheet or folded form). The plastic card will arrive by mail within 20 days. Sometimes 2–3 copies arrive — that’s normal, use any of them.
Step 4. Choose a medico di base
Either immediately when issuing the tessera or later — choose a family doctor from the list available at your ASL.
“In Turin it’s easiest at the ASL. No appointment, you just come, take a ticket and get everything in 5 minutes. Part of it they give you at the window, the other part they send to your email right in front of you.”
- Experience of a participant from Turin (August 2025)
Different ASL offices in the same city may require different documents and interpret rules differently. If one office refused — try another. The community has repeatedly described cases when two offices refused, and the third processed everything without problems.
3. Tessera with ricevuta — before getting the permesso
One of the most important life-hacks of 2026: you can get a temporary Tessera Sanitaria even before you have the plastic permesso di soggiorno in hand. A ricevuta — the receipt confirming you are waiting for fingerprint appointment for the first residence permit — is enough.
Ricevuta (receipt) is the paper confirming that you applied for the permesso and are waiting to be called for fingerprints. With this document you can already apply to the ASL.
A concrete example from Milan (October 2025): the tessera was issued with two documents:
- Permesso (or ricevuta confirming waiting for fingerprints)
- Codice Fiscale
In this case the temporary tessera is issued for 6 months; after receiving the plastic permesso you need to return to the ASL and extend it until the end of the residence permit validity.
“By the way, the tessera should be granted to you while waiting for the permesso, I would recommend going to the ASL.”
- Experience of a community member (December 2025)
- ✓Ricevuta confirming waiting for fingerprints
With the post office stamp and date
- ✓Codice Fiscale
Certificate from the Agenzia delle Entrate
- ✓Passport
- ✓Proof of address in Italy
Rental contract or ospitalità from the owner
- ✕Plastic permesso
Not required for the initial tessera
- ✕Residence registration
Not always required — depends on the ASL
The tessera by ricevuta gives access to a family doctor, planned visits and tests — i.e. to standard medical care, not only emergencies.
4. Medico di base — the family doctor
Medico di base (family doctor, general practitioner) is the central figure in the Italian healthcare system. Through them you get referrals to specialists, prescriptions, certificates and sick notes.
As soon as you have a tessera — paper or plastic — you have the right to choose a family doctor in your ASL. This is free of charge.
How to register with a medico di base
- Get the list of doctors at your ASL (usually available online or at reception)
- Check whether the doctor is accepting new patients (sono in lista aperta)
- Come to register with the tessera and the permesso
- Receive the patient card — from this moment you are registered
You can change doctors once a year or in special circumstances (moving to another district).
The family doctor issues referrals (impegnativa) to specialists: gynecologist, endocrinologist, ENT, ophthalmologist. With a referral you book through the CUP system (booking center) and pay only the ticket — a small fixed co-payment.
“Ask the medico di base to give you a referral to the gynecologist, and the hospital should do that screening. If the pregnancy is high-risk, they should write an esenzione — and all medicines and appointments will be free.”
- Experience of a community member (November 2025)
You can view your medico di base and your medical history in the Fascicolo Sanitario Elettronico (FSE) — the electronic health record accessible via SPID.
Important: the tessera remains valid for the region of your residence. If you temporarily move to another region, you will receive emergency care everywhere, but planned visits and the family doctor service are only by place of registration.
5. Actual healthcare prices in 2026
This is the most practical part of the article. In the SSN system with a tessera you don’t pay the full cost of the service, only the ticket — a fixed co-payment set by the state.
Actual prices with an SSN tessera (ticket) in 2026
| Service | SSN ticket | Without tessera (private) |
|---|---|---|
| ENT consultation | 12 EUR | 80–150 EUR |
| Gynecologist consultation | 25 EUR | 80–120 EUR |
| Endocrinologist + tests | 22 EUR | 100–200 EUR |
| Dermatologist | 15–25 EUR | 80–130 EUR |
| Ophthalmologist | 15–20 EUR | 60–100 EUR |
| Ultrasound (ecografia) | 20–35 EUR | 80–150 EUR |
| Blood tests | 10–25 EUR | 50–100 EUR |
| Emergency care | Free | Free (by law) |
| Hospitalization | Free | Free (by law) |
| Oncology (after diagnosis) | Free for life | - |
| Prescription drugs | 0–3 EUR | Market price |
Category A drugs — life-saving medications — are issued free or almost free on a prescription from the medico di base. Category C drugs are paid. Before buying a medicine, check with the doctor whether it can be obtained free on prescription.
“Actual prices with the tessera: ENT – 12 euros, gynecologist – 25 euros, endocrinologist with tests – 22 euros. This is not a joke — public healthcare in Italy really works and is really affordable.”
- Summary from community experience analysis 2026
Important caveat: some privileged categories are fully exempt from the ticket. These include children under 6, pensioners with low income, people with chronic diseases (with an esenzione code), pregnant women (for pregnancy-related services), unemployed people with low income.
Be careful with unemployment exemptions: the community described a case where an exemption was issued by mistake, and four years later a fine of 194 euros arrived for 3 visits. If in doubt — it’s better to pay the ticket than deal with the fallout later.
Waiting lists for some specialists in 2026 can be very long. Dermatology in a public clinic — appointments for September, ophthalmology — for February. If you cannot wait, you can see the same specialist privately (intramoenia — the doctor works in the same hospital but for pay) or go to a private clinic.
6. Emergency services and hospitalization
Emergency services (Pronto Soccorso, number 118) and hospitalization in Italy are free for everyone on the country’s territory — regardless of having a tessera, residence permit, or insurance.
This is one of the key principles of Italian healthcare: nobody will be refused emergency care. If you call an ambulance or attend Pronto Soccorso with a genuine emergency — treatment is free.
- ✓Calling an ambulance (118)
- ✓Admission to Pronto Soccorso
In an emergency
- ✓Hospitalization
For any duration
- ✓Operations for emergency indications
- ✓Childbirth in a public maternity ward
- ✓Emergency care for pregnant women
- ✓Oncology treatment
After diagnosis — free for life
“If the pregnancy is high-risk, they should write it down (gravidanza alto rischio / esenzione) — and all medicines and appointments will be free.”
- Experience of a participant from Milan (November 2025)
Regarding oncology: a diagnosis of cancer gives the right to an esenzione code, after which all oncology-related services, tests and medicines become free for life — regardless of your immigration status or possession of a tessera.
Pronto Soccorso triage coding: white code — non-urgent (may be paid or involve very long waits), green — medium urgency, yellow — urgent, red — emergency. For green and above — treatment is provided without charge.
7. DN vs LA: difference in healthcare
This is one of the most heated questions in the 2026 community. The difference between holders of a Digital Nomad (DN) residence permit and Lavoro Autonomo (LA) in terms of healthcare is fundamental.
| Criterion | LA residence permit | DN residence permit |
|---|---|---|
| INPS contributions | Mandatory (P.IVA + taxes) | Not always (depends on income) |
| Tessera Sanitaria | Free via SSN | Often 2,000 EUR/year |
| Provincial stance | Unified: pays INPS = free | Varies: some issue, some do not |
| Family members | Covered free | Questionable |
| Private insurance | Needed only without INPS | Often the only option |
DN holders in 2026 face inconsistent ASL policies. In one province they issue a tessera free with a partita IVA, in another they require 2000 euros even with INPS contributions. If you are DN — check the position of your specific ASL before moving.
“In Genoa at ASL3 the lady at the window first said — 2000 euros from you. I in my broken Italian started saying how so, I opened a partita a week ago and I’m going to pay taxes for 2026. She asked to send a copy of the partita certificate and said — tutto bene — and processed everything.”
- Experience of a participant from Genoa (March 2026)
“In Turin they issued for DN free, but in Genoa they wrote an official letter that despite contributions, the tessera is still paid.”
- Experience from the chat (February 2026)
The key takeaway for DN in 2026: having a partita IVA and actually paying INPS contributions is your main argument. If the first ASL refused — go to another office. If refused everywhere — consider the voluntary contribution (~2000 EUR/year for the family, not per person) or private insurance.
Private insurance in Italy in 2026: major players — Allianz, Unipol, WayItaly (Weinitaly). Cost — from 1,500 to 2,500 EUR per adult per year. Family packages — from 2,800 EUR. Important: most private insurances do not include emergency care and do not give discounts on medicines, unlike the public system.
8. Insurance for a D visa
To obtain a D visa (national long-stay visa for Italy) you must provide proof of medical insurance. In 2026 this is one of the mandatory documents in the application package.
Insurance for a D visa must cover the entire visa period, include emergency medical assistance throughout the Schengen area, and the coverage amount must be at least 30,000 euros.
Options for D visa insurance in 2026
-
Private international insurance (WayItaly/Weinitaly, AXA, Allianz Travel) — from 345 EUR per adult per year. This is an emergency-only policy suitable for the visa, but it does not replace the tessera for life in Italy.
-
Voluntary contribution to the SSN — if you are already in Italy and obtained a paid tessera, this document is accepted by the questura as proof of insurance when renewing.
-
Corporate insurance from an employer — if you work officially for a foreign company, sometimes it covers Europe.
“They bought my husband insurance in WayItaly, it costs about 345 euros per year. It’s an emergency insurance, with it they registered him in the comune. But you need to pay the voluntary contribution to the Tessera Sanitaria for normal life.”
- Experience from the chat (February 2026)
Visa D insurance and the Tessera Sanitaria are different things. Insurance is needed to obtain and renew the visa. The tessera is for everyday use of the healthcare system. For comfortable living you need both (or LA with SSN, where tessera is already included).
After obtaining a residence permit and a tessera through the SSN, the need for separate insurance disappears — the SSN itself provides comprehensive medical coverage. The questura accepts the SSN tessera as proof of insurance.
9. Children and family
Children of immigrants in Italy have special rights in the healthcare system. In 2026 the situation is as follows:
Children attached to the family of an LA holder with SSN receive a tessera for free and are registered with a pediatrician (pediatra di libera scelta) instead of an adult medico di base.
- ✓Free pediatric care
For children up to 14 years
- ✓Free vaccinations
According to the national schedule
- ✓Free treatment in emergencies
- ✓Planned pediatric check-ups for free
- ✕Dentistry
Practically not included in the SSN (only basic cases)
- ✕Orthodontics
Not covered by SSN
“The Tessera Sanitaria issued, and the child has a family doctor, they gave it last week. But dental care is not included in the insurance, right?”
- Question from the chat (October 2025)
Yes, dental care for adults is practically completely outside the public system. Children under 14 in some regions receive basic dental care through ASL, but orthodontics and complex treatment are paid everywhere.
Family members of an LA holder: spouse and children living together with the LA holder can be attached to their tessera and receive their own tessere for free. For this you need to come to the ASL as a family with the permesso for family reunification.
Detailed guide on the topic
“Tessera Sanitaria is issued by the ASL, contact them if the permit type of the person you joined allows getting a tessera for the family.”
- Advice from the community (July 2025)
Student tessera: students studying at Italian universities can obtain a tessera through the SSN for ~700 EUR per year. This is significantly cheaper than the standard voluntary contribution of 2000 EUR. Family members of a student — questionable: most often they need separate insurance.
Pregnancy: a special case. Pregnant women with a tessera receive all pregnancy-related services free (or with a minimal ticket). For high-risk pregnancies an esenzione code is issued, which exempts from any payments for medical services related to the pregnancy.
10. Conclusions and action plan
In 2026 Italy’s public healthcare remains one of the best in Europe — provided you know how to enter it. For Russian-speaking immigrants the main thing is to understand your status and take the right first steps.
Key takeaways
-
LA with INPS = free tessera and full SSN access. Open a partita IVA, pay taxes — go to the ASL and demand a free tessera.
-
DN = depends on the province. In 2026 different ASLs have different rules. Look for confirmed cases in your city.
-
Tessera via ricevuta works. Don’t wait for the plastic permesso — with the ricevuta you can already get a temporary tessera and choose a family doctor.
-
Ambulance and hospitalization — always free. Regardless of your status and documents.
-
Oncology — free for life after diagnosis. One of the strong arguments for legal status in Italy.
-
Actual prices with the tessera are very low. ENT 12 euros, gynecologist 25 euros — this is the reality of Italian healthcare in 2026.
-
If one ASL refused — go to another. Italian bureaucracy is inconsistent, and a neighboring office may accept the same documents without questions.
Order of actions when moving to Italy in 2026
Get a Codice Fiscale
Contact the Agenzia delle Entrate
Apply for the residence permit
Get the ricevuta (receipt of waiting)
Go to the ASL with the ricevuta
Get a temporary Tessera Sanitaria
Choose a medico di base
The family doctor is assigned through the ASL
Update the tessera after the permesso
After receiving the permesso — go to the ASL to replace the temporary tessera
Activate SPID
For access to the Fascicolo Sanitario Elettronico
Book planned appointments via CUP
System for booking specialists and tests
For DN — check the position of your ASL
Rules can differ depending on the region
“I recommend going to the ASL, choosing a family doctor and getting a temporary Tessera Sanitaria there. After that the tax office should automatically send the plastic card.”
- Advice from the community (December 2025)
“After I got the tessera, I was able to choose a doctor, book specialists and start living normally. The main thing is not to give up if the first ASL refuses.”
- Experience of a community member
Frequently Asked Questions (FAQ)
How much money is needed to move to Italy?
Minimum 10,000–15,000 EUR for the first 3 months: rent, deposit, insurance, food. Better to have a 6-month buffer.
Do you need to know Italian to move?
Not mandatory for the visa. For life — highly recommended. Without the language the first year will be hard.
Can you move with a pet?
Yes, you need a veterinary passport, a microchip, and a rabies vaccination at least 21 days before departure.
Related articles: Italy, residence permits and taxes
Description of the "Visas to Italy" category - Pregnancy and childbirth in Italy 2026 - Codice Fiscale in Italy 2026 - INPS and pensions in Italy 2026 - Family reunification in Italy 2026 - Can you leave Italy with a ricevuta 2026