# Health Insurance



## PauloPievese

Okay, let's try this again. I've searched the forum and when the topic of health insurance comes up the discussion seems to get sidetracked into secondary issues. So ...

If (and only if) you are a resident and you have gotten health insurance:
* from whom did you get it?
* what did you pay for it?

I am going to hate myself for introducing what could become an opportunity to not answer the questions above, but if there is a difference in requirement between residents from the EU and outside the EU I am only interested in responses about residents from outside the EU.

There will be follow-on questions but right now let's keep a laser-like focus on these two questions.

:flypig:


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## PauloPievese

PauloPievese said:


> Okay, let's try this again. I've searched the forum and when the topic of health insurance comes up the discussion seems to get sidetracked into secondary issues. So ...
> 
> If (and only if) you are a resident and you have gotten health insurance:
> * from whom did you get it?
> * what did you pay for it?
> 
> I am going to hate myself for introducing what could become an opportunity to not answer the questions above, but if there is a difference in requirement between residents from the EU and outside the EU I am only interested in responses about residents from outside the EU.
> 
> There will be follow-on questions but right now let's keep a laser-like focus on these two questions.
> 
> :flypig:


It appears that of the 99 people who have viewed this post, none have gotten health insurance.

It seems that either Cigna or IMG are the most affordable choices. I've never heard of IMG. Does anyone have any experience?

:flypig:


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## Italia-Mx

If you are a legal resident, your health insurance is provided by the Italian Healthcare system. If you are a legal resident but from outside the EU, (USA for example), you must pay a yearly fee for the coverage. Doctors in Italy will not bill private health insurance companies, nor will they bill you for anything. Co-payments are made by you before the medical service is provided.


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## PauloPievese

Italia-Mx said:


> If you are a legal resident, your health insurance is provided by the Italian Healthcare system. If you are a legal resident but from outside the EU, (USA for example), you must pay a yearly fee for the coverage. Doctors in Italy will not bill private health insurance companies, nor will they bill you for anything. Co-payments are made by you before the medical service is provided.


Thank you for this. It is however my understanding that there is a waiting period before one can apply for coverage under the Italian healthcare system, no? Several Internet fora posts (and you know what that's worth) discuss having proof of insurance when going to the _questura _to apply for an initial PdS.

Re "you must pay a yearly fee for the coverage", I would be more than happy to do so. Can you give me a sense of how much this would be?

I am merely trying to slog my way forward to legal residence.

:flypig:


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## Italia-Mx

You can enroll in the Italian healthcare system after you have received your residence documents, not before. This should take around one month but must be completed within three months. So probably you should buy health insurance for at least three months. Last I heard you would pay around 300 euros per year for the Italian coverage. Don't know for sure as I don't have to pay a yearly fee.


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## NickZ

Legally the fee is based on income. The €387 is the least you can pay. It seems some ASL are either too lazy or don't understand the system so they only charge €387 

But this is the correct amount

http://www.salute.gov.it/imgs/C_17_pagineAree_2522_listaFile_itemName_0_file.pdf

You'll need to do the math.


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## PauloPievese

NickZ said:


> Legally the fee is based on income. The €387 is the least you can pay. It seems some ASL are either too lazy or don't understand the system so they only charge €387
> 
> But this is the correct amount
> 
> http://www.salute.gov.it/imgs/C_17_pagineAree_2522_listaFile_itemName_0_file.pdf
> 
> You'll need to do the math.


Thanks as always.

To whom, how, does one apply to join the Italian healthcare system? What is an ASL?
:juggle:


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## PauloPievese

NickZ said:


> Legally the fee is based on income. The €387 is the least you can pay. It seems some ASL are either too lazy or don't understand the system so they only charge €387
> 
> But this is the correct amount
> 
> http://www.salute.gov.it/imgs/C_17_pagineAree_2522_listaFile_itemName_0_file.pdf
> 
> You'll need to do the math.


Math is not exactly my long suit but it appears that if you earn more than about €5000 a year you would owe more than €387.
:flypig:


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## NickZ

ASL is the local health body. They'll have an office in your area that handles sign ups. Ask the town for a form and where the ASL is . You'll need to bring your codice fiscale in addition .


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## PauloPievese

*Back On Topic*

It appears that we've drifted off the beam into the Promised Land of the Italian healthcare system. The pilgrim must however have previously passed through the wicket gate of private insurance (for, as ItaliaMx points out, three months). So ...

*If (and only if) you are a resident and you have gotten health insurance:
* from whom did you get it?
* what did you pay for it?*

While I'm at it, if ItaliaMx is correct and Italian doctors won't bill, how does this private insurance thing work? 

Having previously pursued this in other fora I have gotten _opinions_ of from "several thousand dollars per month" to "buy it at a kiosk in the train station"; not seeking opinion but rather experience this time.

The frustrating part is that I'm on Medicare in the USA and have sufficient resources to handle most emergencies up to and including medical evacuation. The odds of anything serious happening in ItaliaMx's three months are so slim.

I'm 'a thankin' ya.
:flypig:


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## Italia-Mx

I was on Medicare too when I came to Italy but it would not have covered anything in Italy so I just did without insurance until I had my residence, in my case, about two weeks. If I did have any sort of medical problem during that time, I would have paid out of pocket as it IS affordable to do so in Italy compared to the USA.


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## PauloPievese

Italia-Mx said:


> I was on Medicare too when I came to Italy but it would not have covered anything in Italy so I just did without insurance until I had my residence, in my case, about two weeks. If I did have any sort of medical problem during that time, I would have paid out of pocket as it IS affordable to do so in Italy compared to the USA.


I am aware that Medicare is not operative in Italy, hence the reference to medical evacuation.

Having, as a tourist, not a resident, received medical care in Italy, the affordability thing was my experience as well.

I am still trying to fight my way through the fog of implication surrounding relocation. The *only *reason I'm pursuing this is that the fog says that the _questura _will require medical insurance. I gather from your reply, in your experience, this was not the case. Can I rely on that? I would hate to drive to an appointment in Perugia and be given the raspberry as I lacked health insurance.

:flypig:


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## Italia-Mx

I can't give you any advice about what the questura requires. I came to Italy with an Italian passport and was not required to go to the questura for anything. I have been inside the questura exactly one time in the past -- to renew my Italian passport.


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## PauloPievese

Italia-Mx said:


> I can't give you any advice about what the questura requires. I came to Italy with an Italian passport and was not required to go to the questura for anything. I have been inside the questura exactly one time in the past -- to renew my Italian passport.


Well, as I suspect that almost all expats are travelling under their own national passports your reply, while fascinating, rather muddies the waters I think, don't you? Delighted, as always, to hear yet again about your Italian-ness of course. 

Lacking as I do an Italian passport I will revert to the rumors out of the fog that the _questura_ will require proof of health insurance unless someone with relevant experience can chip in. If your relevant experience is such that the _questura _required health insurance I would be interested in:

*If (and only if) you are a resident (residing with a non-Italian passport) and you have gotten health insurance:
* from whom did you get it?
* what did you pay for it?*

Grazie
:flypig:


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## Bevdeforges

Just as a point of reference, I can point you to the AARO health insurance plan for its members.
https://aaro.org/health-insurance/health-insurance-plan

AARO is a US expat organization that offers a group plan medical insurance designed with overseas residents in mind. It's meant to meet the requirements of both visa requirements and private insurance requirements for those countries that require private insurance in the absence of eligibility for the national program.

Full disclosure here - I used to be a member and on the board of AARO here in Paris, but I have never had insurance through them. They do, at least, publish their rates online (see the various brochures that are available on the website), which gives you an idea of the cost for private insurance here in Europe.
Cheers,
Bev


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## PauloPievese

Bevdeforges said:


> Just as a point of reference, I can point you to the AARO health insurance plan for its members.
> https://aaro.org/health-insurance/health-insurance-plan
> 
> AARO is a US expat organization that offers a group plan medical insurance designed with overseas residents in mind. It's meant to meet the requirements of both visa requirements and private insurance requirements for those countries that require private insurance in the absence of eligibility for the national program.
> 
> Full disclosure here - I used to be a member and on the board of AARO here in Paris, but I have never had insurance through them. They do, at least, publish their rates online (see the various brochures that are available on the website), which gives you an idea of the cost for private insurance here in Europe.
> Cheers,
> Bev


The forum will not let me "Thank" you so I will merely thank you.


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## PauloPievese

*IMG Global Insurance*



Bevdeforges said:


> Just as a point of reference, I can point you to the AARO health insurance plan for its members.
> https://aaro.org/health-insurance/health-insurance-plan
> 
> AARO is a US expat organization that offers a group plan medical insurance designed with overseas residents in mind. It's meant to meet the requirements of both visa requirements and private insurance requirements for those countries that require private insurance in the absence of eligibility for the national program.
> 
> Full disclosure here - I used to be a member and on the board of AARO here in Paris, but I have never had insurance through them. They do, at least, publish their rates online (see the various brochures that are available on the website), which gives you an idea of the cost for private insurance here in Europe.
> Cheers,
> Bev


AARO appears to want to insure me for a year with a range of options costing from a few to many thousands of dollars. Presuming that Italia-Mx is correct, and why shouldn't she be being as Italian as she is, all I should need is coverage for about 3 months. In addition, as noted, I have coverage at the moment in the USA and if I got really sick I could just go back. I'm not sure that I really need anything more than a CYA.

There is something called IMG Global Insurance which would offer me a 3 month, renewable, policy for under $500. This is all good but I've never heard of them. *How about y'aall?*
:flypig:


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## Bevdeforges

Don't know about Italy, but in France, you need 3 months of residence before you can lodge an application to enroll in the national insurance, and that process takes an additional 3 to 6 or more months. It's often recommended (in France at least) that you take a private insurance for the first year just to cover both the initial time to establish residence plus the processing time to enroll. With Brexit looming over the horizon, many of the administrative offices are getting backlogged and some of the processing times are increasing.

But Italy may be better at handling these things.
Cheers,
Bev


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## PauloPievese

Bevdeforges said:


> Italy may be better at handling these things.


ound: Good one!


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## rsetzer99

I keep seeing the reference to 'three months', so I am a little unclear whether the OP is looking at permanent relocation, or a Schengen three back and forth holiday home. My wife and I are Americans living in Abruzzo. We came on the Elective Residency Visa. We live here full time and have all our documents. We have gone through the voluntary registration for participation in the Italian system. 

The amount you will be charged will vary depending on where you live. Also what documents you will need will vary as well. We have friends living in Umbria who were required to get certified copies of their SSN statements. (Easily gotten from the Rome embassy as it turned out) as that region decided it was, for them, the easiest way to compute the fee. Italian offices like documents. Especially official ones. 

For us, in more rural Abruzzo, we went to the main hospital designated for our Commune. We asked a couple people and soon half a dozen were poking their heads into offices to get us directed. Italians are amazingly helpful that way. Soon we found ourselves in a small office with one gentleman behind a desk who waved us in. We presented our Identity Cards which verified we lived in an appropriate commune and after a few minutes typing we had temporary cards and a primary doctor assigned. 

As has been stated, the minimum is around 387EU. Allow the official to guide the process. If they hand you your temp cards and simply say your yearly fee is 387, thank the nice person and go on your way. The last thing you will want to do is try and tell them how to do their job. It seems to really annoy them.


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## PauloPievese

rsetzer99 said:


> I keep seeing the reference to 'three months', so I am a little unclear whether the OP is looking at permanent relocation,


OP is solely interested in getting a _permesso di soggiorno_ (PdS); health coverage is a bonus. 

Re the "three months" thing, I have read (elsewhere?) that the _questura_ will require that I have health insurance before getting a PdS. Earlier in the thread someone said that all I would really need is about three months, the amount of time between the application for PdS and its issuance. So my questions are about affordably getting that.

Agree about the helpfulness of the Italians; part of the joy of living here. While waiting for my interview at the Consulate in September I decided to "vacation" in my Italian apartment in August. I had planned to rent a car but my landlord said that he would pick me up at the airport. I pointed out that my limited Italian might make that problematic. He said that his English speaking daughter would come along. All this sounds pretty nice but normal until you realize that it is a two and a half hour drive each way to the airport. Nice people.

Interesting about the certified (?) SS statements; can you think of any way to get that done in advance, in the USA?

:flypig:


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## rsetzer99

As I recall from my Elective Visa process, it was necessary to show health insurance coverage valid for the entire one year visa period. My PdS package also included this information as well. Really the PdS process is kind of a local repeat of what you go through at the Consulate back in the US. Housing, Income, Insurance. People up in the more populated areas are reporting that is can take up to six months to get your PdS. It took us about four months down in the Vasto area. Once I was enrolled in the Italian system about a month after that, I was able to cancel the policy I had purchased prior to my move to Italy. 

I would imagine you can get a certified copy in advance. My friends in Umbria did not have to travel to the Embassy, it was mailed to them. Apparently the Embassy was actually prepared for these requests.


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## PauloPievese

rsetzer99 said:


> As I recall from my Elective Visa process, it was necessary to show health insurance coverage valid for the entire one year visa period.


That was my impression as well however the info from the Miami consulate did not mention health insurance. I might as well get it in advance.

*With whom did you get your insurance? What did it cost you? *Do you recall the name of the policy plan?

Thanks
:flypig:


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## Jakes Place

NORMALLY to gain your residency, you will have to have proof (certificate) of 12 months private health insurance. Alot of expats I have spoke to have purchased this for between €300 - €500. I can not remember our company - Sorry. 
I know you are a US citizen - so not sure about the insurance premiums once the 12 months is completed. 
UK citizens (IF recieveing some form of state payment - pension / disability / etc) can register with the ASL in their local town. IF you do not recieve a state payment, you still have to pay for the private insurance OR pay for the ASL insurance (which changes per ASL office!!).


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## Italia-Mx

Everyone who holds legal residence in Italy must also be registered with the local ASL. If not an Italian citizen, the resident is charged a yearly fee. Private health insurance is not available for legal, long term residents. For example if you need ambulance service, an ambulance service will not bill your private health insurance. You would only be entitled to the ambulance service because you are registered with the ASL. Likewise if you need treatment in the emergency room, it will not bill a private insurance company for your care. You would be entitled to the emergency room service because you're registered with the ASL. An American citizen holding an elective residence visa but who does not yet have official residence and has not yet been registered with the ASL would need private health insurance only until he has become registered with ASL. If it were necessary to use the private insurance he would have to pay for the service out of pocket and then collect from the insurance company on his own accord. Italian health services do not bill private insurance companies.


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## NickZ

The above isn't true.

Italian citizens and foreign workers are automatically part of the national health service. Basically everybody else can if they WANT become part of the system. 

L'iscrizione volontaria


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## tomandmaje

PauloPievese said:


> Okay, let's try this again. I've searched the forum and when the topic of health insurance comes up the discussion seems to get sidetracked into secondary issues. So ...
> 
> If (and only if) you are a resident and you have gotten health insurance:
> * from whom did you get it?
> * what did you pay for it?
> 
> I am going to hate myself for introducing what could become an opportunity to not answer the questions above, but if there is a difference in requirement between residents from the EU and outside the EU I am only interested in responses about residents from outside the EU.
> 
> There will be follow-on questions but right now let's keep a laser-like focus on these two questions.
> 
> :flypig:


I don't know if you still need this information, but I read on another post that you are retired US Navy. If you are, you have TRICARE. You can use that here and get reimbursed. My understanding is that the Italians will accept it for the elective visa medical requirement.

Maje


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## PauloPievese

tomandmaje said:


> I don't know if you still need this information, but I read on another post that you are retired US Navy. If you are, you have TRICARE. You can use that here and get reimbursed. My understanding is that the Italians will accept it for the elective visa medical requirement.
> 
> Maje


My 28 months in the Navy seemed to be about all that the Navy and I could take. I may be the only person in the history of the service to (a) get an honorable discharge but (b) no "re-up" lecture.
:flypig:


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## tomandmaje

Ok. So no military pension or health insurance. Now I understand why the difficulty. 

Good luck.

Maje


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