Healthcare in Abruzzo: How It Works for Foreigners

The Italian Healthcare System

Italy's Servizio Sanitario Nazionale (SSN) is a universal, tax-funded healthcare system established in 1978. The World Health Organization ranked it second globally in 2000, and more recent assessments place it around 22nd-still scoring 98.3 out of 100 for medical infrastructure and professionals, first in Europe for that measure.

The system operates on three principles: universality, equality, and solidarity. In practice, this means once you're enrolled, most care is free or nearly free at point of service. You'll pay small co-payments called "ticket" for some specialist visits and prescriptions, but nothing approaching US costs or even UK private healthcare costs.

Crucially, the SSN is decentralised. Each of Italy's 20 regions manages its own healthcare through regional systems (Sistemi Sanitari Regionali). This means quality, wait times, and administrative processes vary significantly depending on where you live. Northern regions generally have better-resourced systems than southern ones. Abruzzo sits in the middle-literally and figuratively-with a system that's functional but not as polished as Lombardy or Emilia-Romagna.

The trade-off you'll hear about constantly: excellent care at low cost, but potentially long waits for non-urgent specialist appointments. Ophthalmology appointments can take up to 11 months. Orthopaedic consultations average 5 months. This is why many Italians-and most expats-use a hybrid approach: public system for major and emergency care, private for anything time-sensitive.

Coming from the US or UK

If You're American

The differences are stark. The US spends over $13,000 per person annually on healthcare; Italy spends around EUR3,500 and achieves better outcomes. American life expectancy is 79 years; Italian life expectancy is 83.6 years.

More tangibly: in 2025 surveys, 36% of US adults reported skipping or delaying medical care because of cost. In the EU, that figure is 3.6%. Medical debt is the leading cause of bankruptcy in America. In Italy, medical debt essentially doesn't exist as a concept.

What you give up: speed and choice. In the US, if you have good insurance, you can often see a specialist within days. In Italy's public system, you might wait months. The US system rations care by price; the Italian system rations by waiting lists. Neither is perfect, but only one bankrupts people.

One American expat reported two hospitalisations totalling four weeks, plus numerous prescriptions and follow-up appointments. Total cost: under EUR1,600. In the US, the same care could easily have been $50,000+ even with insurance.

If You're British

The adjustment is smaller. Both systems are universal and tax-funded. Both have wait time issues. The main differences: Italy charges small co-pays (ticket) for specialist visits and some prescriptions, where the NHS is mostly free at point of use. Italian GPs have more limited hours but make house calls. Pharmacists play a bigger first-line role in Italy.

Post-Brexit, access depends on your situation. If you receive a UK state pension, the S1 form entitles you to full SSN coverage with the UK reimbursing Italy. If you're pre-retirement, you'll need private insurance until you establish residency and can enrol voluntarily.

Important: the S1 doesn't make you an NHS patient abroad. It gives you healthcare on the same basis as Italian residents-meaning you pay the same co-pays they do. If an Italian pays EUR25 for a specialist visit, so will you.

Who Is Entitled to Italian Healthcare?

EU Citizens

If you're employed or self-employed in Italy, SSN enrollment is automatic and free-you're paying through taxes. If you're not working (retirees, early retirees, people living on savings), you have three options: use your home country's EHIC for temporary coverage, maintain private insurance, or enrol voluntarily in the SSN by paying an annual contribution.

After three months of residence, you need to register with the local ASL and choose a GP. Your EHIC covers emergency and necessary care during visits, but isn't a long-term solution for residents.

UK Citizens (Post-Brexit)

If you receive a UK state pension, apply for an S1 form from NHS Business Services Authority before or shortly after moving. Once registered with your local ASL, the S1 entitles you to full SSN coverage. The UK reimburses Italy for your care.

If you're moving before pension age, you'll need private health insurance to meet visa requirements. Once you have legal residency, you can enrol in SSN voluntarily by paying the annual contribution.

The GHIC (which replaced EHIC for UK citizens) covers emergency and necessary care during temporary visits, but doesn't cover routine care or pre-planned treatment.

Non-EU Citizens (US, Canada, Australia, etc.)

Private health insurance is mandatory for your visa application-whether elective residence, digital nomad, or other long-stay visas. The insurance must be valid for at least one year, covering medical care, hospitalisation, and emergencies in Italy and the Schengen area.

Once you have your residence permit (permesso di soggiorno) and are registered as a resident at the comune, you can enrol voluntarily in the SSN. This requires paying an annual contribution of EUR2,000-EUR2,788 depending on income. The contribution covers the calendar year (January to December), isn't pro-rated, and isn't refundable if you leave mid-year.

Many non-EU expats maintain private insurance rather than paying the SSN contribution, especially if they're healthy and costs are comparable. Private insurance typically runs EUR1,000-EUR2,500/year depending on age and coverage level.

Property Owners (Non-Residents)

If you own property but aren't resident in Italy, you're not entitled to SSN. Emergency care is available to everyone (you may be billed afterwards), but routine care requires private insurance or paying out of pocket. Private costs in Italy are far lower than in the US-a specialist visit runs EUR75-EUR150-but you're not covered by the public system.

Enrolling in SSN

Enrollment happens at your local ASL (Azienda Sanitaria Locale). Abruzzo has four: ASL 1 covers L'Aquila, Avezzano, and Sulmona; ASL 2 covers Chieti, Lanciano, and Vasto; ASL Pescara covers Pescara; ASL Teramo covers Teramo.

You'll need to bring:

• Codice fiscale (tax code)
• Proof of residency (certificato di residenza or registration receipt from the comune)
• Valid ID or passport
• Residence permit (permesso di soggiorno) for non-EU citizens
• Proof of entitlement: employment contract, S1 form, pension documentation, or payment receipt for voluntary enrollment

For voluntary enrollment (elective residence visa holders, retirees without S1), you'll pay via F24 form (tax code 8846) before visiting the ASL. The payment must be made in advance; bring the receipt.

Once enrolled, you'll choose a medico di base (GP/family doctor) from a list of doctors accepting new patients in your area. This doctor becomes your gateway to the system-they provide prescriptions, referrals to specialists, and manage your ongoing care.

Within a few weeks, you'll receive your tessera sanitaria (health card) by mail. Until it arrives, the ASL provides a temporary certificate that allows immediate access to services.

What Things Cost

Within the Public System

GP visits are free. Emergency care is free. Hospital stays are free. For other services, you'll pay the ticket (co-payment):

• Specialist visits and diagnostic tests: EUR15-EUR36, with a national ceiling of EUR36.15 (some regions add a EUR10 surcharge, maximum EUR46)
• Non-urgent emergency room visit (codice bianco): EUR25
• Prescriptions: varies significantly depending on the particular medicine. Class A drugs (essential/life-saving) are often free or low-cost; Class B and C drugs are fully out-of-pocket

As of January 2025, Italy has implemented a unified national tariff system. For the first time in decades, the same exam costs the same across all regions. Some regions may take up to 18 months to fully implement the new rates.

Exemptions exist for low income, certain age groups, chronic conditions, and pregnancy. If you have one of 59 recognised chronic conditions (diabetes, asthma, Crohn's, etc.), apply for an E-code at the ASL with a specialist's certificate. This waives most co-pays.

What's Not Covered

• Routine dental care (emergency and paediatric dental only)
• Vision care (eye exams, glasses) unless medically necessary
• Non-essential medications
• Faster service (that's what private is for)

Private Healthcare Costs

Private costs in Italy are a fraction of US prices:

Using the System Day-to-Day

Your GP (Medico di Base)

Your GP is your first point of contact for everything except emergencies. They have set office hours (typically mornings and a few afternoons per week) and can make house calls if you're too unwell to visit. Visits are free and don't require appointments-you show up during surgery hours and wait your turn.

GPs provide prescriptions for medications, referrals to specialists (required for public specialist appointments), sick notes for work, and ongoing care for chronic conditions.

You can change your GP at any time through the ASL, often online in Abruzzo. If you move to a different comune within the region, you need to update your registration but keep the same tessera sanitaria.

Specialist Appointments

For specialists, you need a referral (impegnativa) from your GP. This specifies the urgency: U (urgent, within 72 hours), B (breve/short, within 10 days), D (differibile/deferrable, within 30 days), or P (programmata/scheduled, standard waiting list).

Book through the CUP (Centro Unico Prenotazione)-by phone, online, or in person at ASL offices. Abruzzo has a regional call centre covering all four ASLs.

Wait times for P-coded appointments can stretch to months. This is where many people go private: get the referral from your GP, then book privately for faster service while paying out of pocket.

Pharmacies

Italian pharmacies (identified by the green cross) play a bigger role than in the US or UK. Pharmacists are highly trained and can advise on minor ailments, suggest over-the-counter remedies, and sometimes provide basic treatments. For anything beyond paracetamol, you'll need a prescription-antibiotics are never available without one.

Pharmacies keep standard shop hours and close for lunch (typically 1-4pm). Each area has a rotating farmacia di turno open 24 hours for emergencies-the rota is posted on pharmacy doors and available online.

Private Healthcare

Private healthcare in Italy is genuinely excellent and reasonably priced. Many Italians use it selectively-public for serious conditions with long-term treatment, private for diagnostics and consultations where they want speed.

Private options include: standalone private clinics, private wings of public hospitals (where doctors work "intramoenia"-in their private capacity), and fully private hospitals. The privato accreditato system means some private facilities provide services on behalf of the SSN, giving you another route to faster care within the public payment structure.

Private Insurance

Private health insurance costs:

• Basic policies: EUR50-EUR100/month
• Comprehensive: EUR100-EUR200/month
• International/premium: EUR200-EUR400/month

Costs increase significantly with age and pre-existing conditions. Most policies have waiting periods (often 6-12 months for certain conditions) and exclusions. Read the fine print carefully, especially regarding pre-existing conditions.

For visa applications, ensure your policy explicitly covers Italy and the Schengen area, has no major exclusions, and meets the minimum coverage requirements (typically EUR30,000 for medical expenses).

Emergencies

Emergency care is available to everyone in Italy, regardless of insurance or residency status. For emergencies, go to the Pronto Soccorso (emergency room) at any hospital or call 118 for an ambulance. The European emergency number 112 also works.

Emergencies are triaged by colour code: rosso (red) for life-threatening, giallo (yellow) for serious, verde (green) for less urgent, and bianco (white) for non-urgent. Red and yellow are treated immediately. Green and white can wait hours-this isn't the place for minor issues.

If you're not enrolled in SSN and not covered by EHIC/GHIC, you may receive a bill for emergency treatment. Keep documentation and submit to your travel or health insurance.

In Abruzzo, the main hospitals with full emergency departments are in Pescara, Chieti, L'Aquila, and Teramo. Smaller towns have guardia medica (out-of-hours GP service) and may have smaller hospitals, but for serious emergencies, you'll be transferred to a major centre.

Know where your nearest real emergency room is before you need it. In mountain villages, drive time to the hospital in bad weather is a genuine consideration.

Healthcare in Abruzzo Specifically

Abruzzo's healthcare system is organised into four ASLs:

• ASL 1: L'Aquila, Avezzano, Sulmona (inland/mountain areas)
• ASL 2: Chieti, Lanciano, Vasto (southern coastal and inland)
• ASL 3: Pescara (main coastal city)
• ASL 4: Teramo (northern province)

In 2023 AGENAS data, ASL 2 Lanciano-Vasto-Chieti showed significant efficiency improvements in patient outcomes. Abruzzo as a whole is described as a "relatively bright spot" compared to other central-southern regions, though still less resourced than northern Italy.

Chieti has a university hospital (teaching hospital), which often means access to more specialists and newer treatments. Pescara, as the largest city, has the most comprehensive facilities. L'Aquila's system is still recovering from the 2009 earthquake, with some services relocated.

Abruzzo's online services are reasonably developed-you can book appointments, access test results, and change your GP online through the regional health portal. The regional CUP call centre handles bookings for all four ASLs.

The voluntary SSN enrollment system is available here, so if you have an elective residence visa and want to join the public system, Abruzzo's ASLs will process it.

Language Considerations

Most healthcare professionals in Abruzzo speak limited or no English. This is more pronounced than in Rome, Milan, or Florence where expat populations are larger. Younger doctors may have some English; rural GPs typically don't.

This matters for:

• Describing symptoms accurately
• Understanding diagnoses and treatment options
• Discussing medication instructions and side effects
• Navigating the administrative system (booking, paperwork)
• Informed consent for procedures

Solutions: Learn basic medical Italian before you need it. Bring an Italian-speaking friend or translator for important appointments. Some private clinics specifically serve expats with English-speaking staff-these exist in larger cities but are rare in Abruzzo. Google Translate is better than nothing but unreliable for medical terminology.

Get your medical history translated into Italian before you move. Bring records for chronic conditions, current medications (with generic names, not just brand names), and any allergies. Italian doctors may not recognise foreign brand names.

For prescriptions: Italian doctors generally can't honour foreign prescriptions directly. You'll need an Italian doctor to re-prescribe, so bring documentation of what you're taking and why.

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