A dual system: public and private
For high-net-worth (Hnw) individuals considering retirement in Italy, healthcare is often one of the first questions to arise. The country offers a dual system: the Servizio Sanitario Nazionale (Ssn), Italy’s universal public healthcare, and a well-developed private sector with hospitals and clinics throughout the country.
The Ssn covers Gp visits, hospital treatment, emergency care, and most prescriptions at very low cost, while private providers offer shorter waiting times, English-speaking staff, and greater comfort. Deciding how to structure healthcare is therefore not a matter of “access”—all legal residents can obtain it—but rather a question of cost, location, and lifestyle expectations.
Public coverage: when it is free, and when it is not
Cost: the S1 form vs voluntary contributions
For retirees moving from the Eu, Eea, Switzerland, or the Uk, the most important determinant is whether they qualify for an S1 form. This form is available to individuals receiving a state pension from their home country, and entitles them to register with the Italian Ssn at no cost. In practice, this means comprehensive coverage—doctor visits, hospital care, prescriptions—without paying insurance premiums.
It’s worth noting, however, that care is not entirely free at the point of use. Like Italian citizens, patients usually pay a small co-payment (known as a “ticket”) each time they access certain non-emergency services, such as specialist visits, diagnostic tests, or prescriptions.
For clients in this category, enrolling in the Ssn is almost always advisable: it provides robust coverage at virtually no expense.
By contrast, retirees who do not qualify for the S1—for example, Americans or Canadians on elective residence permits, or early retirees from Europe not yet drawing a state pension—must pay an annual contribution to join the Ssn. The contribution ranges from €2,000 to approximately €2,800 per person, per year, depending on income. It must be renewed each January, and registration is individual (spouses must each register separately).
Unlike some countries, Italy applies a flat fee rather than age-based pricing, which can be attractive for older retirees compared to private international insurance. However, coverage is valid only within Italy. For international travel or for clients maintaining ties in multiple jurisdictions, supplementary private coverage is usually required.
As a reminder, in Italy public hospitals are obliged to provide emergency services to anyone in need, regardless of nationality or insurance status, but for those not covered (either through S1 or through payment), a payment will be required upon discharge.
Location: the regional divide
Cost is not the only factor. The quality and efficiency of the public system varies significantly across regions. In Northern Italy—Lombardy, Veneto, Emilia-Romagna—public hospitals are modern, well-staffed, and wait times are relatively short. For retirees living in these areas, combining Ssn access with selective private coverage can provide both security and flexibility.
In Southern regions such as Calabria or parts of Sicily, the picture can be more challenging. Infrastructure is often older, staff shortages more common, and waiting times for non-urgent procedures considerably longer. In these areas, many retirees—particularly Hnw clients—prefer to rely primarily on private coverage, using the Ssn mainly for emergencies.
Why private insurance remains relevant
Even retirees entitled to free public coverage through the Ssn often choose to maintain private insurance. The reasons include:
- Speed and convenience: Shorter waiting times for specialist appointments or elective surgery.
- Choice of providers: Freedom to select preferred doctors and hospitals.
- Language and comfort: English-speaking staff and international-standard clinics, especially important for clients less confident in Italian.
- Services not fully covered by the Ssn: Dental, optical, and certain elective procedures.
- International mobility: Coverage for healthcare outside Italy, particularly relevant for retirees who split their time between countries.
Premiums vary widely depending on age, health condition, and whether policies are purely Italian or global. Comprehensive international policies can become expensive for older retirees, but more targeted coverage—complementing the Ssn—can offer good value.
We spoke with Maximilian Eisendle, who – together with his sister Isabel Eisendle – leads the family-run broker Eisendle Insurance in its fourth generation (established 1908), providing English-speaking insurance consultancy for local and international clients.
Eisendle clarifies that private health insurance generally falls into two categories: policies with lifelong entitlement and policies that can be terminated also by the insurance company.
He strongly recommends choosing policies with lifelong entitlement, as their cover remains guaranteed even in advanced age or in the event of diagnosed illnesses. Typical annual premiums range from €2,000 to €4,000, depending on age and the quality and features of the selected plan.
Eisendle also emphasise that, even for those covered privately, coverage through Ssn is always recommended, given medical emergencies are usually handled in public hospitals, which are generally better equipped with Er facilities.
What advisors should consider
For wealth managers, family offices, and private bankers assisting clients with relocation, healthcare should be treated as an integral part of the move—alongside tax residency, estate planning, and lifestyle choices. Key points include:
• Clarify S1 eligibility: This determines whether Ssn access is free or requires contributions.
• Evaluate regional healthcare standards: The choice of residence in Italy has a direct impact on quality and accessibility.
• Bridge the first year: Some retirees may face a gap between arrival and Ssn registration; temporary private coverage is essential.
• Coordinate healthcare and tax residency: Enrolment in the Ssn is linked to residency status, which in turn has tax implications.
• Balance Ssn with private coverage: For most Hnw retirees, the optimal solution is not “public or private,” but a tailored combination of the two. Eisendle Insurance recommends combining private insurance with the Ssn, to better combine the convenience of former with the ongoing access of the latter, especially for emergency care.
Conclusion
Italy’s healthcare system is one of the reasons the country consistently ranks high as a retirement destination. Yet for foreign retirees—particularly Hnw individuals—the decision is not automatic. When Ssn access is free via the S1 form, registration is a clear advantage. When it requires contributions, or when clients settle in regions with less reliable public services, the case for private insurance becomes stronger.
For advisors, the opportunity is to guide clients through these nuances: aligning healthcare choices with tax, lifestyle, and legacy planning. Those who anticipate both the bureaucratic requirements and the practical realities will help their clients enjoy not only Italy’s culture and climate, but also the peace of mind that comes from a well-structured healthcare strategy.
