Do US Citizens Need Health Insurance in Europe?

US citizens planning to travel or relocate to Europe often wonder whether they need health insurance and whether their American insurance policy will cover medical expenses abroad.

In Italy, access to public healthcare depends on the individual’s immigration and residence status. While American tourists can receive medical treatment at their own expense, US citizens holding certain residence permits may be eligible for registration with the Italian National Health Service (Servizio Sanitario Nazionale, or SSN).

Understanding these differences is essential to ensure adequate healthcare coverage during a temporary stay or long-term residence in Italy.

Healthcare in Italy for US Tourists

American tourists visiting Italy are not automatically entitled to register with the Italian National Health Service (SSN).

Under Article 35 of Legislative Decree No. 286/1998, foreign nationals who are not registered with the SSN can access medical services, subject to the applicable regional healthcare fees. In particular, tourists can receive urgent or essential medical treatment, including emergency hospital care, but must generally cover the associated costs.

For this reason, private travel health insurance is strongly recommended for US citizens visiting Italy.

American citizens travelling to the Schengen Area under the visa-free regime are not legally required to purchase travel medical insurance. Nevertheless, taking out a policy covering medical emergencies, hospitalization and medical repatriation is advisable to avoid unexpected expenses.

Before departure, US travellers should also check whether their existing American health insurance provides international coverage and whether any limitations apply.

Mandatory Healthcare Registration for US Residents in Italy

Unlike tourists, US citizens legally residing in Italy may be entitled to register with the Italian National Health Service.

Under Article 34 of Legislative Decree No. 286/1998, registration with the SSN is mandatory for foreign nationals holding certain residence permits or meeting specific employment-related conditions.

These categories include individuals who:

• Hold a residence permit for subordinate employment or self-employment.
• Are legally employed or registered with the relevant employment services.
• Hold a residence permit for family reasons.
• Hold certain permits related to international protection or other categories expressly covered by Article 34.

Eligible dependent family members who legally reside in Italy may also benefit from healthcare coverage.

Once registered with the SSN through the competent local health authority (Azienda Sanitaria Locale, or ASL), US residents can access public healthcare services under the same general conditions as Italian citizens.

This includes choosing a general practitioner, obtaining prescriptions and accessing specialist consultations and hospital services in accordance with the rules of the Italian public healthcare system.

Private health insurance is not required as a substitute for SSN coverage when mandatory registration applies, although residents may choose additional private coverage for specific healthcare needs.

Voluntary Healthcare Registration or Private Insurance for Other Residence Permits

Not all residence permits entitle US citizens to mandatory registration with the Italian National Health Service.

American nationals residing in Italy under other immigration categories, such as study permits or elective residence permits, may instead be required to arrange their own healthcare coverage.

This also applies to retirees residing in Italy who do not qualify for mandatory SSN registration under another legal provision.

In these cases, eligible foreign residents can generally choose between:

• Voluntary registration with the SSN, subject to payment of an annual contribution.
• Private health insurance valid in Italy, providing adequate coverage for medical expenses, illness and accidents.

Since January 2024, the minimum annual contribution for ordinary voluntary registration with the SSN has been increased to €2,000, with the actual amount potentially depending on the applicant’s income.

For eligible international students, a reduced annual contribution of €700 applies to individual voluntary registration.

Voluntary registration allows eligible residents to access the Italian public healthcare system, while private insurance provides coverage according to the terms and conditions of the selected policy.

US citizens should verify the healthcare requirements applicable to their residence permit before applying for registration or purchasing private insurance.

Healthcare Agreements Between Italy and the United States

Italy and the United States do not have a bilateral reciprocal healthcare agreement granting their respective citizens automatic access to public healthcare services.

Consequently, American citizens cannot rely solely on their US nationality or American health insurance to obtain coverage through the Italian National Health Service.

Their eligibility depends on their legal status in Italy and the applicable registration requirements under Italian immigration and healthcare legislation.

Similarly, Italian citizens travelling to the United States cannot rely on the Italian public healthcare system for automatic medical coverage in America. They are therefore advised to arrange appropriate private health insurance before travelling.

For more information, consult our guide on healthcare in the US for Italian citizens.