Does Medicare Cover You in Italy? What American Expats Need to Know
Italy consistently ranks among the world’s top healthcare systems. Life expectancy is 83.7 years – fifth globally. The public healthcare network, known as the Servizio Sanitario Nazionale (SSN), provides universal coverage. Private hospitals in Milan, Rome and Florence operate to an excellent standard. For Americans used to navigating one of the most expensive and complex healthcare systems in the world, the prospect of living in a country with genuinely good, low-cost healthcare is one of Italy’s most appealing attributes.
But there is a question that every American considering a move to Italy needs to answer clearly before they go. Does Medicare cover you in Italy?
The answer is no. And the implications of that answer – particularly around what to do with Medicare Part B before you leave – require some careful thought.
Medicare Provides No Coverage in Italy
Medicare – including Parts A, B, C and D – was designed for healthcare delivered within the United States. With very narrow exceptions that apply near the Canadian and Mexican borders and on certain cruise ships, Medicare provides no coverage for medical care received outside the US. Italy is not an exception.
This applies regardless of which Medicare parts you hold, how long you have been enrolled, or how serious your medical need is. If you receive care in Italy – a GP visit in Rome, a hospital stay in Florence, an emergency in Sicily – Medicare will not pay for it.
The narrow exception sometimes cited in Medicare guidance – Medigap foreign travel emergency benefit – is a traveller’s benefit, not an expat benefit. It covers 80% of emergency care after a USD 250 deductible for the first 60 days of a trip. It does not cover someone who has moved to Italy. It does not cover routine care, specialist visits, prescriptions or planned procedures. It is not a substitute for proper expat health insurance.
What to Do With Medicare Before You Move
For most Americans moving to Italy, the critical financial decision is what to do with Medicare Part B.
Part A – which covers hospital inpatient care – is premium-free for most Americans who have paid Social Security taxes for at least ten years. There is no cost to keeping it. It preserves your coverage for any period you spend back in the US. Keep it.
Part B – which covers outpatient and GP care – costs $202.90 per month in 2026, or over $2,400 per year. If you are living in Italy, you are paying for coverage that provides nothing in Italy.
The problem with dropping Part B is the permanent late enrolment penalty. For every 12-month period you were not enrolled in Part B, you face a 10% lifetime surcharge on your premium when you re-enrol. Drop Part B for five years and your premium increases by 50% permanently. Drop it for ten years and your premium doubles – from $202.90 to approximately $406 per month at 2026 rates – for the rest of your life.
The Social Security Administration’s own publication EN-05-10137 acknowledges directly that it may not be to your advantage to maintain Part B if you will be out of the US for a long period. That is the federal government acknowledging the trade-off.
Most financial advisers experienced with American expats recommend keeping Part A (free) and Part B (expensive but penalty-proof), using Italian private and public healthcare day to day, and treating Medicare as a safety net for any eventual return to the US. Whether that is the right calculation for your specific situation depends on your health, your likely return timeline, your income level and your plans. Take specialist financial advice before making any changes to your Medicare enrolment.
Medicare Advantage (Part C): If you are enrolled in a Medicare Advantage plan, be aware that permanently moving outside your plan’s service area triggers a Special Enrollment Period. If you do not act, Medicare will revert you to Original Medicare. Manage this transition carefully and in good time.
Part D: The prescription drug coverage penalty works similarly to Part B – going 63 or more days without creditable drug coverage creates a permanent monthly penalty when you re-enrol. If you drop Part D, ensure you have qualifying prescription coverage through a private international health insurance plan.
What Healthcare Actually Costs in Italy Without Insurance
For Americans used to US healthcare pricing, Italy is a significant contrast. Even without insurance or SSN registration, private healthcare in Italy is dramatically more affordable than in the US.
A private GP consultation in Italy typically costs EUR 50 to EUR 100. A private specialist appointment runs EUR 80 to EUR 150. Diagnostic tests, MRI scans and blood panels are available at private clinics at a fraction of US prices. Emergency care at public hospitals is free for everyone regardless of insurance status – call 118 for emergencies in Italy.
This affordability makes Italy a relatively lower-risk destination for being briefly uninsured compared to a country like Singapore or Switzerland. But it does not make insurance unnecessary. A serious hospitalisation, a complex diagnosis requiring multiple specialist consultations, or a medical evacuation back to the US can generate costs that no private savings cushion handles comfortably. And health insurance is a legal requirement for your visa application regardless.
Your Path to Italian Public Healthcare
Once you are a legal resident of Italy – holding a valid permesso di soggiorno – you can access the SSN. For Americans arriving on an Elective Residence Visa, the route into the SSN changes depending on your circumstances.
During your first year on the ERV, you need private health insurance. After that first year, you can enrol in the SSN as a voluntary subscriber by paying an annual fee of approximately EUR 2,000 per family. This gives you access to the full range of SSN services – GP care, hospital treatment, specialist referrals, prescription medication at subsidised rates and emergency care. It does not cover dental care for adults.
For Americans who came from Medicare and are used to relatively low out-of-pocket costs for comprehensive coverage, the SSN voluntary subscription is a meaningful transition. Many choose to supplement it with private insurance for faster specialist access and English-language care – particularly in regions of Italy where the public system’s waiting times are longest.
Private Health Insurance in Italy – What to Expect
Private health insurance for Americans in Italy is significantly more affordable than anything comparable in the US. A qualifying policy for the ERV application typically costs EUR 100 to EUR 200 per month depending on age and coverage level – a fraction of ACA marketplace premiums for equivalent cover.
The main international providers operating in Italy include Cigna Global, Allianz Care, AXA Global Healthcare and Bupa Global. Italian domestic providers include Generali, Unisalute, Previmedical and Filo Diretto. International policies cover you in Italy and worldwide – useful if you travel frequently or return to the US. Italian domestic policies cover you in Italy only, and tend to be cheaper.
For the ERV application specifically, your policy needs EUR 30,000 minimum coverage, Schengen Area validity, repatriation cover and a clear insurance certificate. Most reputable international policies meet these standards without modification.
ExpatInsure can help you find the right health insurance for your move to Italy – visit our Italy international health insurance page for more information.
Frequently Asked Questions
Does Medicare cover healthcare in Italy?
No. Medicare Parts A, B, C and D do not cover medical care received outside the United States in almost all circumstances. Americans living in Italy need separate private health insurance.
Should I keep Medicare Part B when I move to Italy?
This is one of the most important financial decisions before your move. Part B costs $202.90 per month in 2026 and provides no coverage in Italy. But dropping it creates a permanent 10% re-enrolment penalty per 12-month period you were not enrolled. Most advisers recommend keeping both Parts A and B and treating Medicare as a future safety net. Take specialist financial advice before deciding.
Can I access Italy’s public healthcare system (SSN) as an American?
Yes – once you hold a valid permesso di soggiorno, you can register with the SSN. In the first year on an Elective Residence Visa, you need private insurance. After that, you can enrol in the SSN as a voluntary subscriber for approximately EUR 2,000 per year per family.
Is emergency care free in Italy?
Yes. Emergency care at public hospitals is free for everyone in Italy regardless of residency status or insurance. Call 118 for medical emergencies.
What does private health insurance cost in Italy?
A qualifying private health insurance policy for an American in Italy typically costs EUR 100 to EUR 200 per month depending on age and the level of cover chosen – significantly less than comparable US premiums.
Does my US health insurance work in Italy?
No. US domestic health insurance plans do not cover care received in Italy and do not meet the documentation requirements for Italian visas. You need a qualifying international or Italian private health insurance policy.