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accessing SSN healthcare

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Wolfman
  11/18/2019 15:55 EST

I worked in Italy for two years, had a work contract, a tax code and my employer paid my social security and welfare contributions. Am I entitled to access SSN health care?

Shtinky
  11/18/2019 16:45 EST

I’m a little confused. Are you talking about being on the Italian Health system? It’s not called SSN as far as I know it is ASL (Azienda Sanitaria Locale – Local Health Unit). Are you an Italian citizen? Then you are eligible. If not, are you a registered resident with a Permit to Stay (Permesso di Soggiorno)? In order to be on the health system you’d need to go to the ASL with your Passport, Permesso, and Carta d’identita. Be prepared to pay for the coverage if you aren’t a citizen. If you are talking about the US SSN as in Medicare, it does not cover you in the EU.

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Sergios
  11/19/2019 01:49 EST

To expand on Shtinky's response, you need to be registered as a resident in one of Italy's communes to have Italian health coverage. If you are not a citizen of Italy then you have to have a visa and a permesso di soggiorno. If, on the other hand, you are eligible to have an existing Italian citizenship recognized or if you are eligible to have a lost citizenship reinstated, then you could register for residency after the citizenship process is started. In that case you don't need a visa. Your Italian work may give you a bit of cost advantage if the commune charges you for health coverage (less than 500 euro a year) but it appears most communes don't charge anyway. Another advantage may be that if you are a citizen, you could move to other parts of Europe and with an S1 form you can still be covered by the Italian system.

Wolfman
  11/19/2019 01:57 EST

Thank you, that's very helpful.

Wolfman
  11/19/2019 02:03 EST

When I apply for resident status, do you know what documentation I will need to prove my work status as self-employed?

Shtinky
  11/19/2019 03:13 EST

Hi Sergios, just so you know, everyone I know pays for the coverage (non-citizen). The amounts vary from region to region. Some I know pay the minimum amount (€387.34] because their ASL doesn’t bother with income. We pay far higher than the minimum here in Umbria. Officially the costs are:

“Currently, the annual contribution is €387.34 for an annual income between 0 and €5165.00. The rate (“aliquota percentuale”) for an income exceeding €5165.00 and up to €20,658.28 is 7.5% rate, while it’s 4% for amounts exceeding €20,658.28 and up to the limit of €51,645.69.

Without regard to the gross income, the amount of the contribution cannot be less than €387.34 or higher than €2.788,86 with the currency exchange rate applicable at the date of the application.”

Hope this helps.

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Wolfman
  11/19/2019 04:32 EST

My situation is that I'm a UK citizen looking to live in Italy and set up a business here as a self-employed sole trader. i already live here, registered within the first three months of my stay. I'm fluent in Italian, but I still can't get anyone in any of the offices in Florence to give me any information on how to apply for resident status. So any information on how I do this AND prove my work status as self employed from someone who has done this as a self employed person would be greatly appreciated

Wolfman
  11/19/2019 04:43 EST

.....and so to prove my income as a self employed sole trader in my first year of operation is not possible. Is there a flat rate for someone like me?

Sergios
  11/19/2019 07:48 EST

It does. And yet I am now in Tuscany and I am not being charged, once again. Same happened in Palermo. The French charge 8.8% of you taxable income. Since we were pensioners they charged nothing as well since pensions are not taxable in France.
It wouldn't all be that complex if everyone followed the rules in the same way. But it is clear that the functionaries who are supposed to be knowledgable are not so much. I recently went to the firenze questura to submit my wife's paperwork for renewal of PS. The man behind the glass said that we did not need to wait 4 hours and that we could get an appointment online. I said I needed the receipt for residency and he said that the receipt is also printed online. That last part turns out to be complete BS requiring a second 4 hour line at the questura. I did not misunderstand him because I speak Italian. The guy was just misinformed and remains so because nobody else cared when I told them.

Shtinky
  11/19/2019 08:07 EST

We are pensioners too. I’ve no idea how this all works. I think the individuals make their own decisions. Here, they are rigid. We pay quite a lot and not only that, they don’t allow us to self certify our income. Every January, when we sign up, we need to ask the US Embassy in Rome to send us a stamped certified copy of our social security statements. It is all they will accept and from that they determine our payment. I need to move out of Umbria!

guestuser
  11/19/2019 12:33 EST

Hi Shtinky.

I have an American friend living in Firenze who is a pensioner and we were talking not long ago about this topic. She said she had to pay just over 2,200 euros (lump sum, no monthly payments allowed) just for herself to register with the Italian health care system this year. They calculated the fee based on her pension income (from the States) using the same percentages you outlined in your previous post.

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guestuser
  11/19/2019 12:37 EST

Hi Sergios.

Are you not being charged to use the public health care system because you are an Italian citizen? I have a friend who used private health insurance until his Italian citizenship came through, after which he enrolled in the public system at no cost to him.

Shtinky
  11/19/2019 13:13 EST

JacksterJam, We had friends in Firenze who paid the full, as stated, percentage too. It stinks that some other places only charge the €387 minimum. And occasionally I hear someone gets charged nothing at all! But it’s Italy. We get used to it,

HenryGiovanni
  11/19/2019 13:16 EST

Hi Shtinky and Sergios,

Shtinky says: " everyone I know pays for the coverage (non-citizen)".

Time to put in my two cents worth.
I am American, not Italian. My wife is Italian. It's no secret.

I pay no annual premium for the healthcare here in Padova. But, ..., I'm told it comes out of my taxes, so I just now checked my tax return. It could have said that Martians are invading for all I know (shades of HG Wells), but could find no numbers or categories for healthcare, or anything that looked like that number, so I'm having some wine instead (shades of Orson Welles ("I will drink no wine before it's time", he said of some rot-gut brand)). I digress, but couldn't help myself!

I pay for "incidentals" like EKG, x-rays, blood tests, and such, plus for farmacia items, but truth to tell, I don't use the system much. My MD visits are free unless I choose to use a private doctor (I don't)n or a private service, and then I pay (did that for the x-rays one time, and it was worth it at $40). I'm told (by the tax-prepper) that one needs to have spent a minimum of EU 125 before tax-year deductibility kicks in. I take her at her word, because I surely don't know, nor do I know how they calculate it.

But, and this comes back to the point, I no outside "premium" payment at all. So if it ain't in the tax return, then it doesn't exist, for me.

DISCLAIMER: this is my perception. I pay no premium, period. Whether it is listed on that incomprehensible tax return is a different matter, and I will always stand correction (well, almost always. OK, I'll do it sometimes. OK, once I stood correction, so that surely counts!).

Hope I didn't Muddy the Waters, because that would give me the blues!
Cheers, John.

Shtinky
  11/19/2019 14:19 EST

Henrygiovani, well, if you’re married to an Italian it’s as if you are Italian, so that’s a little different., yes. And I should have mentioned that.
There is more to the health system as well, private appointments with doctors of choice, and pay for tests outside the system to speed up the process which can be slow. But that’s a who ‘nother story!
Enjoy your wine... I am ! :-)

whidden39
  11/19/2019 15:12 EST

Had what I thought were significant out of pocket medical expenses beyond a set threshold, but no. What ever you spend above this threshold is then severely discounted before it qualifies as a deduction. I don’t bother obsessing over receipts now.

whidden39
  11/19/2019 15:12 EST

Had what I thought were significant out of pocket medical expenses beyond a set threshold, but no. What ever you spend above this threshold is then severely discounted before it qualifies as a deduction. I don’t bother obsessing over receipts now.

Wolfman
  11/19/2019 15:23 EST

Hello everyone. Remember me? I'm the one who many posts earlier, started this thread by asking how me as a self-employed sole trader can access health care in Italy. You're all talking amongst yourselves and have veered off topic. Most posts not relevant to my original question. Unless you have specific experience of accessing healthcare in Italy as a self employed person to share with me, please could you not post on this thread. I'd rather have no replies than my email in-box full of irrelevant chatter.
In the meantime, until the conversation amongst yourselves dies down, I'm going to unsubscribe to receiving email notification of posts.

I WOULD LIKE TO KNOW THE PROCESS FOR ACCESSING HEALTH CARE IN ITALY AS A SELF EMPLOYED PERSON. THANK YOU

Wolfman
  11/19/2019 15:30 EST

Unsubscribed to emails temporarily

Shtinky
  11/19/2019 15:42 EST

Wolfman, maybe I missed it, but what is your status here? A citizen? Married to Italian? If not, what visa? This all makes a difference to your healthcare.

maradel
  11/19/2019 16:26 EST

Wolfman, you can find this information if you do a little web searching. CURRENTLY, and until Great Britain exits the EU, you don't need a visa or residency permit. If you have a European Health Insurance Card from Great Britain, you will be covered for health care in Italy. If you want to register with the Italian system, as far as I can tell, you need an S1 form from your home country. You take that to your local ASL office (the Comune or Province in which you registered your residence), along with other documents, and tell them that you want to apply for the public health insurance. Alternatively, you can just go to the local ASL office and they are supposed to contact your home country health agency and request the S1 form (according to the EU site).

However, all of that will likely change in the near future. I do not keep up with the continually shifting sand on BREXIT, since I'm American/Italian. I suggest you read The Local online and connect with the British expats who are keeping up with that to see how your rights and access to health care will be affected, and what you need to do in the meantime to make sure that you can stay in Italy.

maradel
  11/19/2019 16:34 EST

Wolfman, I should add that if you don't know where to go, just do a web search to find where your local ASL office is. Go there when it's open and stand in line (the Great Italian Pastime). Since you're fluent in Italian, you may be able to just call the office and if anyone bothers to pick up the phone, you might get some useful information.

Again, you don't need a residency permit. As long as you registered you home/apartment/living place with the Comune, You can apply for the Italian public health care .

Sergios
  11/20/2019 02:08 EST

jacksterjam, I don't have a clue. I could try to find out by asking that question of the agent at the other side of the desk but I may not like the answer she comes up with., so I will not ask. In this case, ignorance is bliss.
Like Henrygiovanni I too limit my use of the healthcare system to getting prescriptions from my assigned doctor. For anything medical I tend to use the private system because I am an impatient patient and when I want something taken care of I don't want to wait. Given the costs are relatively low, why not.
Orson Wells below
https://m.youtube.com/watch?v=Fs5YwFONswQ

whidden39
  11/20/2019 03:46 EST

Sergio, I am also an impatient patient. I have been using the private system locally for labs and imaging. In my area of Puglia EBM does the labs and CDM does all types of imaging. Very modern and efficient for both. Speedy appointments and results available from within minutes to next day. I know both of these medical facilities operate in other cities, but in any case I am sure these types of facilities are available throughout Italy. I just had an ultrasound at one place and a very long list of tests fur urine and blood. Cost for all was about €100.

whidden39
  11/20/2019 03:49 EST

Sorry, Wolfman, for responding a bit off topic to another post here.

rsetzer99
  11/20/2019 03:57 EST

Relevant links for Self Employed EU in Italy. 1https://italylawfirms.com/en/self-employement-in-italy-for-eu-and-non-eu-nationals/ 2. http://www.aspag.it/index.php/english 3. https://www.poliziadistato.it/articolo/10930 4. https://easydiplomacy.com/en/info-directory/guides-newly-arrived-diplomat-in-italy/healthcare/foreign-citizens/eu/ ---- How it will work will vary from region to region, Since you said you are just beginning, you may have to pay to participate until you have a financial trail in Italy. I have found that for many Brits facing confused clerks with Brexit in their ears, the magic words can be Voluntary Registration. This is how non EU people participate, and can be a useful last resort with an office that cannot figure what to do with you.

guestuser
  11/20/2019 05:02 EST

Sergios,

Thanks for the reply. It seems that way to me, but, as you say, sometimes ignorance is bliss. Besides, we could all ask the same question at the appropriate office and, as you know, all get a different answer. ;-)

Thanks for the video - too funny!

jj

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