Healthcare in Italy: the ticket, the classes and the exemptions

On paper the Italian healthcare system is one of the most accessible in Europe: no premium, no excess, a free GP. In practice it revolves around three things that no desk explains: the ticket, the classes and the exemptions.

Access: ASL, GP and the tessera

Your right to care runs via your residenza: with it you register with the ASL of your district. Employees and the self-employed are registered compulsorily and free of charge, on an equal footing with Italians; Dutch pensioners come in with the S1 form from the CAK. Whoever doesn't work and has no S1 chooses between a private policy or voluntary registration — which since 2024 costs at least € 2,000 a year, a silent doubling. On registration you choose your medico di base: free, freely changeable, and the gatekeeper for everything after that. The tessera sanitaria that follows is three things in one: health card, codice fiscale and European health insurance card.

If you leave before your AOW (the Dutch state pension) 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. Whoever brings only an early-retirement pension, an RVU payment or an occupational pension taken early then falls outside it and ends up, until AOW age, in the category above: a private policy or voluntary registration. Whoever is 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 the ticket per prescription: capped nationally at € 36.15, lower in many regions. The "superticket" of € 10 that older sites still add to every consultation was abolished nationally back in 2020. Class A medicines are in principle free, plus a regional ticket of a few euros per prescription — and the price difference if you choose a brand where a generic exists. The exemptions are generous and worth applying for: children under six and over-65s with a household income below € 36,152 pay no ticket, and there are separate exemptions for chronic conditions, pregnancy and low incomes. The code goes on every prescription.

The classes: learn to read the prescription

Every specialist prescription carries a priority class, and that 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 fills up anyway (in the South and with popular specialisms it happens), there is the intramoenia route: the same hospital specialist, outside the waiting list, at a private rate of roughly a hundred euros. For A&E 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. This system has no major financial healthcare risks; whoever knows the classes also knows the waiting times.

In Vertrekklaar this is phase 5 of 5 of the journey: the same steps, but for your situation — in your order, tickable, and with the deadlines watched. See the whole journey to Italy.