Italian National Health Service for Swiss pensioners: increase in minimum premiums.

Dear Mr Pogliani
Dear Mr Engeler,

We are a couple who have lived for many years in Switzerland, where we have built up our pension. We recently moved to Italy and, when we left Switzerland, we cancelled our health insurance because the cost of extending medical care to Italy was too high for us. So we opted for the Italian health service, which unfortunately we had to register with for a fee, as required by the ATS in our region of residence in Italy.

We wonder why we have to pay for this service, as we pay tax in Italy with deductions from our pension, which we only receive from Switzerland.

We hope you will address this issue in the "Gazzetta Svizzera" and answer our question. We have made a voluntary contribution to the Gazette.

A.S. (place omitted)


Dear reader,

Thank you for your letter. Let us try to explain.

The general principles stipulate that health care is paid for by the country paying the pension. More specifically, this means that if a pensioner moves to an EU/Swiss country other than the one paying their pension, they will have full access to healthcare in the new country of residence under the same conditions as local citizens. However, they will need to apply for an S1 form (from the central health insurance institution in Switzerland: LaMal) in the country paying their pension; this form will enable them to register with the health insurance institution in their new country of residence and access healthcare free of charge.

In your case, however, it is important to bear in mind that when you moved to your new country of residence, Italy, you decided to cancel your membership of the Swiss health insurance fund, thereby forgoing medical assistance. However, this choice means that you will not be able to obtain the aforementioned S1 form and will therefore not be able to access Italian healthcare free of charge. In other words, deregistration from your health insurance fund, and the consequent inability to obtain form S1, means that the health costs you incur and/or will incur on Italian territory cannot be reimbursed by the Swiss institution, as should be the case according to general principles, since it is the country that pays your pension. If you had been in receipt of an Italian pension, even a modest one, you would have been entitled to register with the National Health Service, at the expense of the Italian State.

In view of the above, we therefore consider that the request by the ATS in your region of residence in Italy for payment of an annual contribution of 7.5% of your income is correct. However, this will only guarantee you healthcare in Italy and not in the rest of Europe, since you are not a holder of the European Health Insurance Card (TEAM) - except, of course, in emergencies, under EU social security regulations, which are also extended to Switzerland via bilateral agreements.

We are sorry not to be able to give you any better news, but please accept, Madam, Sir, the expression of our best wishes.

Andrea Giovanni Pogliani
Robert Engeler


Hello, I read your articles with great interest,

I've never paid pension contributions in Italy (I spent all my schooling and working life in Switzerland), so I pay for my health card in Italy. Unfortunately, I can't afford to pay in Switzerland. The amount is modest, around 400 euros a year, and the service is equally modest. However, I am subject to a 5% deduction from my pension. Today, my wife went to renew her health card and was told that it was valid until June because the prices will be adjusted and it's possible that it could reach 2,000 euros a year. But is it really possible that it could go up to €2,000? That's a lot of money, and I get the minimum from Switzerland.

I look forward to your reply and thank you very much.

M.P. (location omitted)


Dear reader,

Unfortunately we have to confirm what you have been told.

Article 34 of Legislative Decree no. 286 of 25/07/1998 (Immigration Consolidation Act) provides that legally resident foreigners who do not work (and do not have a pension) in Italy are obliged to insure themselves against the risks of illness and accident by taking out an insurance policy or registering with the National Health Service; to obtain this registration, they must pay an annual contribution, at the same percentage as that provided for Italian citizens, on their total income for the previous year. This contribution is calculated by applying the rate of 7.50% up to an amount of income equal to €20,658.28 and the rate of 4% on amounts in excess of €20,658.28 and up to a limit of €51,645.69.

The aforementioned provision also stipulated that, in any event, the amount of the contribution could not be less than €387.34.

With the Finance Act for 2024, enacted on 30 December 2023, this minimum contribution was increased to €2,000 (also valid for dependants), with the exception of students (€700) and au pairs (€1,200).

As a result, when health insurance cards expire, Italian ATS offices can be expected to request an adjustment to the contribution.

Finally, we believe that this regulation also applies to dual nationals who do not receive a pension in Italy, due to EU regulations on social security, which stipulate that healthcare must be paid for by the country providing the pension.

Yours sincerely

Andrea Giovanni Pogliani
Robert Engeler

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