First steps in Italy
Moving: step-by-step plan - Codice Fiscale - Bank - Medicine SSN - SPID and CIE - Rent
Contents
- SSN vs private insurance: who gets what in 2026
- How to get a Tessera Sanitaria by residence permit type
- Tessera with ricevuta - before receiving the permesso
- Medico di base - the family doctor
- Real medical prices in 2026
- Emergency care and hospitalization
- DN vs LA: difference in healthcare
- Insurance for Visa D
- Children and family
- Conclusions and action plan
Healthcare in Italy is one of the most frequent topics in Russian-language emigration chats. Every day dozens of people ask: do you have to pay 2000 euros a year? When can you get a free doctor? Does the ambulance work for those who haven’t yet received the permesso?
This article gives concrete answers based on real experience of Russian-speaking immigrants in 2026, with prices, documents and community lifehacks.
1. SSN vs private insurance: who gets what in 2026
The main question: are you covered by the SSN (Servizio Sanitario Nazionale) — Italy’s national health service — or are you forced to pay for private insurance?
In 2026 the situation looks like this: access to the SSN depends on your residence permit type and whether you pay contributions to INPS (the Italian social security/pension system).
| 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) | Temporarily | Temporary tessera | 0 EUR |
Key principle: if you work officially in Italy and pay contributions to INPS, SSN coverage is mandatory for you and the Tessera Sanitaria is issued at no extra cost. If you don’t pay contributions (remote work, passive income), you must either pay the voluntary contribution or get private insurance.
Detailed guide on the topic
“I opened my partita last week and intend 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 everything’s fine and registered everything.”
- Experience of a member from Genoa (March 2026)
2. How to get a Tessera Sanitaria by residence permit type
Tessera Sanitaria (Italian health card) is the Italian public health insurance card. It is issued at your local ASL (Azienda Sanitaria Locale) and gives access to the entire public healthcare system.
Tessera Sanitaria is now combined with the Codice Fiscale card: your tax code is printed on the plastic. The green Codice Fiscale cards are no longer issued — the tessera is used instead.
Step 1. Gather documents
Basic package for LA (Lavoro Autonomo):
- Permesso di soggiorno (plastic card or ricevuta)
- Codice Fiscale (certificate from 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 register online; in Turin some offices accept walk-ins — take a ticket. Check your regional ASL website.
Step 3. Get a temporary tessera
On the spot you will be given 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 when registering the tessera or later — choose a family doctor (medico di base) from the list available at your ASL.
“In Turin it’s easiest at the ASL. No appointment, 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 while you’re there.”
- Experience of a member 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 where two offices refused and a third processed without issues.
3. Tessera with ricevuta - before receiving the permesso
One of the most important lifehacks of 2026: you can get a temporary Tessera Sanitaria even before you have the plastic permesso in hand. A ricevuta — the receipt confirming you’re waiting for fingerprint appointment for the first residence permit — is sufficient.
Ricevuta (ricevuta) is the paper confirming you applied for the permesso and are awaiting the fingerprint appointment. With this document you can already apply at the ASL.
A specific example from Milan (October 2025): they issued the tessera with two documents:
- Permesso (or ricevuta confirming waiting for fingerprints)
- Codice Fiscale
The temporary tessera in this case is issued for 6 months; after receiving the plastic permesso you must return to the ASL and extend it to match the residence permit’s expiration.
“By the way, the tessera should be issued to you even while waiting for the permesso; I’d 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 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 issued on a ricevuta gives access to a family doctor, planned visits and tests — i.e., full standard medical care, not just emergency care.
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, medical certificates and sick leaves.
As soon as you have the tessera — paper or plastic — you have the right to choose a family doctor at your ASL. This is free.
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)
- Go to register with the tessera and permesso
- Receive a patient card — from that moment you are registered
You can change doctor once a year or in special circumstances (moving to another area).
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 a gynecologist, and at the hospital they should do the screening. If the pregnancy is high-risk, they should write esenzione — and all medications 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 registered residence. If you temporarily moved to another region, emergency care is provided everywhere, but planned visits and family doctor services are only where you are registered.
5. Real medical prices in 2026
This is the most practical part of the article. With SSN and a tessera you don’t pay the full cost of a service — you pay only the ticket, a fixed co-payment set by the state.
Real 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 |
| Ambulance | Free | Free (by law) |
| Hospitalization | Free | Free (by law) |
| Oncology (after diagnosis) | Free for life | - |
| Prescription medicines | 0-3 EUR | Market price |
Category A medicines — essential drugs — are issued free or almost free on prescription from the medico di base. Category C medicines are paid. Before buying a drug, check with the doctor whether it can be obtained for free on prescription.
“Real 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 completely exempt from the ticket. These include children under 6, low-income pensioners, people with chronic diseases (with an esenzione code), pregnant women (for pregnancy-related services), and unemployed people with low income.
Be careful with unemployment exemptions: the community reported a case where an exemption was issued by mistake and 4 years later a fine of 194 euros arrived for 3 visits. If in doubt — it’s safer to pay the ticket than deal with issues later.
Waiting times for some specialists in 2026 can be very long. A dermatologist in a public clinic might have an appointment in September, an ophthalmologist in February. If you can’t wait, you can see the same specialist privately (intramoenia — a doctor seeing patients for a fee at the same hospital) or go to a private clinic.
6. Ambulance and hospitalization
Ambulance (Pronto Soccorso, number 118) and hospitalization in Italy are free for everyone on Italian territory — regardless of tessera, residence permit or insurance.
This is one of the key principles of Italian healthcare: no one is refused emergency care. If you call an ambulance or present to Pronto Soccorso with a real emergency — treatment is free.
- ✓Ambulance call (118)
- ✓Admission to Pronto Soccorso
In emergency situations
- ✓Hospitalization
For any duration
- ✓Emergency surgeries
- ✓Childbirth in a public maternity hospital
- ✓Emergency care for pregnant women
- ✓Oncology treatment
After diagnosis — free for life
“If the pregnancy is high-risk, they must note it (gravidanza alto rischio / esenzione) — and all medicines and appointments will be free.”
- Experience of a participant from Milan (November 2025)
Regarding oncology: an oncological diagnosis entitles you to an esenzione code, after which all services, tests and medicines related to oncology become free for life — regardless of your immigration status or tessera.
Triage coding at Pronto Soccorso: white code — non-urgent (may be chargeable or involve very long waits), green — medium urgency, yellow — urgent, red — emergency. For green and above — treatment is provided without payment.
7. DN vs LA: difference in healthcare
This is one of the hottest topics in the 2026 community. The difference between holders of the 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 |
| Province stance | Uniform: pays INPS = free | Varies: some issue it, some don’t |
| Family members | Covered for free | Questionable |
| Private insurance | Only needed without INPS | Often the only option |
DN holders in 2026 face inconsistent ASL policies. In one province they issue tessera for free if you have a partita IVA, in another they demand 2000 euros even if you pay INPS contributions. If you’re DN — check the position of your ASL specifically 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 come, I opened a partita a week ago and intend to pay taxes for 2026. She asked me to send a copy of the partita certificate and said — tutto bene — and registered everything.”
- Experience of a participant from Genoa (March 2026)
“In Turin they issued free tessera for DN, but in Genoa they wrote an official letter saying that despite contributions, the tessera is paid.”
- Experience from the chat (February 2026)
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 per family, not per person) or private insurance.
Private insurance in Italy in 2026: major players — Allianz, Unipol, WayItaly (Weinitaly). Cost — from 1500 to 2500 EUR per adult per year. Family packages — from 2800 EUR. Important: most private insurances do not include ambulance services and do not give discounts on medicines, unlike the public system.
8. Insurance for Visa D
To obtain a Visa D (long-stay national 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 Visa D must cover the entire visa period, include emergency medical care throughout the Schengen area, and have coverage of at least 30,000 euros.
Options for insurance for Visa D in 2026
-
Private international insurance (WayItaly/Weinitaly, AXA, Allianz Travel) — from 345 euros per adult per year. This is minimum emergency insurance suitable for the visa, but it does not replace the tessera for everyday life.
-
Voluntary contribution to the SSN — if you are already in Italy and received 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 from WayItaly, it costs about 345 euros per year. It’s emergency insurance; with it they registered him at the comune. But you still need to pay the voluntary SSN contribution for normal life.”
- Experience from the chat (February 2026)
Visa D insurance and Tessera Sanitaria are different things. Insurance is needed to obtain and renew the visa. Tessera is for everyday use of the healthcare system. For comfortable living you need both (or LA with SSN, where the tessera is already included).
After obtaining the residence permit and tessera through the SSN, the need for separate insurance disappears — the SSN itself is a full 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 emergency treatment
- ✓Planned pediatric check-ups are free
- ✕Dentistry
Practically not included in the SSN (only basic cases)
- ✕Orthodontics
Not covered by SSN
“There is a tessera sanitaria and the child has a family doctor; they gave it last week. But nothing dental is included in the insurance, right?”
- Question from the chat (October 2025)
Yes, dentistry for adults is almost entirely outside the public system. Children up to 14 in some regions receive basic dental care via the ASL, but orthodontics and complex treatments 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 permessi for family reunification (permesso per ricongiungimento familiare).
Detailed guide on the topic
“Tessera sanitaria is issued by the ASL — contact them if the permit type of the person you joined allows the family to get tessera for family members.”
- Advice from the community (July 2025)
Student tessera: students studying at Italian universities can get a tessera through the SSN for ~700 euros per year. This is significantly cheaper than the standard voluntary contribution of 2000 euros. Family members of a student — questionable: most often they need separate insurance.
Pregnancy: 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.
Main conclusions
-
LA with INPS = free tessera and full access to the SSN. Open a partita, 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 on a ricevuta works. Don’t wait for the plastic permesso — with a ricevuta you can 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.
-
Real 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 the neighboring office may accept the same documents without questions.
Action steps when moving to Italy in 2026
Get a Codice Fiscale
Contact Agenzia delle Entrate
Apply for the residence permit
Obtain a ricevuta (receipt of application)
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 receiving the permesso
After getting the permesso — go to the ASL to replace the temporary tessera
Activate SPID
For access to the Fascicolo Sanitario Elettronico
Book planned appointments through CUP
The booking system for specialists and tests
For DN - check your ASL’s position
Rules may differ by 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 could 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
Related articles
Lavoro Autonomo 2026 - A residence permit that gives access to free healthcare via INPS
Digital Nomad visa 2026 - DN and healthcare: private insurance is required
Forfettario 2026 - INPS contributions grant the right to public insurance
Codice Fiscale 2026 - needed to get the tessera at ASL