Healthcare in Italy: the ticket, the classes and the exemptions
GP and hospital are free, for specialist and diagnostics you pay the ticket of at most € 36.15 per prescription — and the priority class on that prescription determines, bindingly, how long you may wait. Whoever knows the classes, the exemptions and the intramoenia route gets out of the Italian system what is in it.
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Written and checked by Auke on , against the sources at the bottom. Is something no longer right? Report it below and I'll fix it.
On paper the Italian healthcare system is one of the most accessible in Europe:
- no premium;
- no excess;
- free GP.
In practice it revolves around three things no counter explains: the ticket (the co-payment), the classes and the exemptions. And around one amount you must know in advance if you do not work and have no S1, the form with which you take your Dutch healthcare entitlement along: voluntary enrolment costs at least € 2,000 a year.
Access: ASL, GP and the tessera
Your right to care runs through your residenza, your registration as a resident. With it you enrol with the ASL of your district, the regional health service. Who comes in how:
- Employees and the self-employed are enrolled compulsorily and free of charge, on a par with Italians.
- Anyone who becomes involuntarily unemployed after less than a year of work keeps the enrolment for another year. After more than a year of work you keep it for as long as the unemployment lasts.
- Dutch pensioners come in with the S1 form from the CAK.
- Whoever does not work and has no S1 chooses between a private policy and voluntary enrolment.
The premium for voluntary enrolment is based on your income of the previous year, in Italy and beyond:
| Income last year | Premium for voluntary enrolment (per calendar year, not divisible) |
|---|---|
| up to € 31,924 | the minimum of € 2,000 |
| € 31,925 to € 51,645.68 | € 2,000 plus 4% of the income above € 31,925 |
| € 51,645.69 and above | the maximum of € 2,788.87 |
That minimum has doubled since 2024, which many sites don't yet know.
At enrolment you choose your medico di base, your GP: free, freely changeable, and the gatekeeper for everything after. The tessera sanitaria that follows is three things in one: health card, codice fiscale (your Italian tax number) and European health card.
If you leave before your AOW age, watch the date. The CAK route is expected to be open from 1 November 2026 only to new registrants with a statutory benefit: AOW, Anw, WAO, WIA or Wajong.
Anyone bringing only an early-retirement pension, an RVU payment or an early occupational pension then falls outside it. They land in the table above until AOW age: a private policy or voluntary enrolment. Anyone already a CAK client keeps their rights. What exactly changes, and what you can do now.
The ticket: at most € 36.15 — and the myth of the tenners
GP and hospital admission cost nothing. For specialist care and diagnostics you pay per prescription the ticket: capped nationally at € 36.15, lower in many regions.
The € 10 "superticket" that older sites still add to every consultation has been abolished nationally since 1 September 2020.
Medicines in class A are in principle free. You do pay a regional ticket of a few euros per prescription, and the price difference if you choose a brand where a generic exists.
The exemptions: who pays no ticket?
The exemptions are generous and worth applying for; the code goes on every prescription.
| Code | Who | Family income limit |
|---|---|---|
| E01 | children under six and everyone over 65 | under € 36,151.98 |
| E02 | unemployed people who previously worked, and their dependants | under € 8,263.31, raised to € 11,362.05 with a dependent partner and € 516.46 per child |
| E03 | recipients of a social pension and their dependants | — |
| E04 | over-60s on a minimum pension and their dependants | under € 8,263.31, with the same increases |
There are also separate exemptions for chronic conditions and pregnancy.
For a Dutch couple with AOW and a modest pension, E01 is the code to request at the ASL. If you are over 65 and the family income is under the limit, the ticket lapses.
The classes: learn to read the prescription
Every specialist prescription carries a priority class. It is not advice but a binding deadline:
- U means within 72 hours;
- B within 10 days;
- D within 30 days (tests 60);
- P within 120 days.
Ask your GP which class he fills in. It literally determines your place in the queue.
If the public diary does fill up (in the South and with popular specialisms it happens), there is the intramoenia route. You then see the same hospital specialist, outside the waiting list, at a private rate of roughly a hundred euros.
For the emergency department a national count of five codes has applied since 2019. With code 5 (white, not urgent) you pay a small ticket in most regions: the soft brake on improper emergency visits.
Major financial health risks this system does not have. Whoever knows the classes also knows the waiting times.
The premium for voluntary enrolment applies per calendar year and is not divisible. Whoever arrives in November and enrols pays the full amount for that year and again in January. For anyone coming without an S1 the arrival date is therefore worth € 2,000 — take it into the planning of your target date.
In Vertrekklaar this is phase 5 of 5 of the journey: the same steps, but on your situation — in your order, tickable, and with the deadlines watched. See the whole journey to Italy.
What this rests on
The facts in this article come from these official pages. Rules change. When in doubt, go by the source, not this article.
- ASL Roma 1 — healthcare for EU citizens per profile, and voluntary enrolment with the minimum premium of € 2,000 — aslroma1.it
- Regione Puglia — abolition of the € 10 superticket — regione.puglia.it
- Emilia-Romagna — exemptions vademecum: the € 36.15 ticket and the income thresholds — salute.regione.emilia-romagna.it
- Ministero della Salute — the national triage guideline — simeup.it
- CAK — emigrating with early retirement, the expected change from 1 November 2026 — hetcak.nl
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