Healthcare for Italian emigrants

Until recently, Italian citizen may hold an Italian passport, vote in Italian elections and own property in Italy, but if he or she resides permanently abroad and is registered with AIRE — the Registry of Italians Residing Abroad — registration with Italy’s National Health Service has traditionally ceases.

For Italians living in the United States and other countries outside Europe, a new Italian law is now changing that framework.

Law No. 111 of June 12, 2026, published in the Italian Official Gazette on June 27 and effective as of July 27, 2026, introduces a new system for Italian citizens registered with AIRE who reside in countries that are neither members of the European Union nor of the European Free Trade Association (EFTA). The United States falls within that geographical category.

Under the new law, these citizens may be registered with a local health authority in Italy — an Azienda Sanitaria Locale, or ASL — and may obtain a national Italian health card allowing access in Italy to health care services paid for by the Servizio Sanitario Nazionale, or SSN.

The change is significant because AIRE registration has traditionally resulted in deregistration from the Italian National Health Service. Until now, an Italian citizen permanently residing abroad could not assume that Italian citizenship alone entitled him or her to ordinary SSN assistance during a temporary stay in Italy.

There were limited exceptions. In particular, under the previous rules, certain Italian citizens resident abroad — including persons receiving a pension from an Italian social security institution and persons qualifying as Italian emigrants — could receive urgent hospital treatment in Italy free of charge for up to 90 days in a calendar year, provided that the applicable statutory requirements were met and that they did not have other public or private health coverage. That limited protection was not equivalent to ordinary enrollment in the Italian National Health Service.

Law No. 111/2026 creates a much broader mechanism specifically for AIRE citizens residing outside the EU and EFTA.

The key figure is €2,000.

The statute provides that issuance, and subsequent renewal, of the national health card is subject to payment of a contribution currently set at €2,000 per year. The contribution cannot be prorated, and the card is valid for continuous annual periods beginning on the date on which it is issued.

Thus, the law does not establish a calendar-year contribution running automatically from January through December. The relevant twelve-month period begins when the health card is issued.

The amount may change in the future. The Minister of Health, acting together with the Minister of Economy and Finance, is authorized to adjust it annually, taking into account the results of the statutory monitoring process and changes in the relevant Italian consumer price index.

The statute also contains a useful provision for families. A minor who is registered with AIRE and lives in an eligible country is exempt from paying a separate contribution if at least one parent, or the minor’s legal guardian, holds a valid health card under the new system.

There is, however, one aspect of the new regime that prospective participants should understand before enrolling.

The €2,000 contribution is not simply the price of a health card that can necessarily be purchased for selected years and then resumed later without consequence. The new regime does not appear to operate on a simple year-by-year “opt in, opt out” basis.

If the annual contribution is not paid, the law provides for suspension from access to SSN services rather than termination of the underlying position. If the individual later wishes to renew the health card, he or she must pay not only the contribution for the current annual period, but also the contributions relating to the entire period of suspension, together with statutory interest.

The statute does not expressly provide a mechanism allowing a participant to withdraw from the regime and later re-enter it without paying for the intervening years. This is one of the points on which the implementing decree may provide further clarification and is therefore worth considering when deciding whether to enroll.

Take, for example, an Italian citizen who lives in Chicago, is registered with AIRE and regularly spends several months each year at a home in Italy. The new law creates a route through which that person may obtain access to services provided by the Italian National Health Service without first transferring his or her legal residence back to Italy.

For someone who divides the year between the United States and Italy, that may represent a meaningful new option.

The €2,000 contribution should not, however, be confused with the purchase of an annual travel insurance policy. The statute creates a mechanism for access to the Italian public health system. The health card is valid in Italy under this legislation, while the law does not provide health insurance coverage in the United States.

There is also an important practical point concerning timing.

Although Law No. 111/2026 has been in force since July 27, the statute expressly requires an implementing decree from the Ministry of Health, acting together with the Ministry of Economy and Finance. That decree is to establish the practical rules for accessing SSN services, the related administrative procedure and the monitoring of the new system. The law provides that the decree is to be adopted within 90 days of the law’s entry into force. (Art. 4(2).)

At this transitional stage, it is therefore not yet possible to apply in practice for the new health card. Italian citizens residing abroad who may be interested in the new regime should monitor the official website of the Italian Ministry of Health, as well as the websites of the Italian embassy or consulate serving their area of residence. Practical instructions are expected to be published through those official channels once the implementing decree has been adopted and published in the Italian Official Gazette.

The legal framework is therefore already in place, while the detailed administrative procedures are still being finalized.

What is already clear is that the new law applies to Italian citizens registered with AIRE and resident in non-EU, non-EFTA countries; that it creates a route to access SSN-funded health care services in Italy; that the health card is tied to an annual, non-proratable €2,000 contribution; that qualifying minor children are exempt from an additional payment; and that a lapse in payment may have financial consequences if the holder later wishes to renew the card.

What remains to be determined in practice are the detailed procedures through which eligible citizens will apply, pay the contribution and access the system.

For Italian-Americans who spend substantial periods in Italy, particularly those who maintain a home there or are considering spending more time in the country in the future, the reform may prove to be a valuable new option.

Italy has, in short, created a new way for citizens living abroad to reconnect with its public health system without first transferring their residence back to Italy. The opportunity is already established by law; the next step is to wait for the implementing rules that will make it operational.

Send your questions regarding Italian law to cbortolani@aliantlaw.com and I’ll be glad to answer them.

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