This post aims to explain the new law under which Italian citizens living in America (and outside the European Union) who are registered with AIRE and who pay an annual contribution of 2,000 euros will be able to enjoy full Italian healthcare coverage whenever they are in Italy.
This represents a landmark shift in the relationship between the Italy and the Italian citizens living abroad, who, prior to this law, lost access to their Italian family doctor and virtually all Italian protections upon registering with AIRE — except for the most urgent forms of care.
Let's take a look at all the details.
1. THE NEW LAW ON ITALIAN HEALTHCARE COVERAGE FOR ITALIANS LIVING ABROAD.
The brand-new law we are talking about is Law N. 111 of June 12, 2026, which was published in the Gazzetta Ufficiale and came into force on June 27, 2026.
This law radically changes healthcare coverage for Italian citizens residing in America who are registered with AIRE.
We have previously covered the issue of healthcare coverage in Italy and AIRE registration in several articles:
Use the "Translate" tool on the right to see the English version.
All of these articles now need to be updated in light of the legislation that has just come into force, which we cover in this piece.
2. WHO IS ELIGIBLE FOR ITALIAN HEALTHCARE COVERAGE?
The first point worth examining is this: who is eligible for Italian Healthcare Coverage under this new Law?
The individuals interested are those who meet all three of the following requirements:
a) being an Italian citizen;
b) being registered with AIRE (an essential condition);
c) living in America or in another foreign country not included in the European Union or the EFTA countries (Iceland, Liechtenstein, Switzerland, and Norway).
The central point among the three requirements is undoubtedly the necessary registration with AIRE: back in 2024, a rule already came into force making AIRE registration mandatory for Italian citizens residing in America and abroad in general:
Dal 2024 è sanzionata la mancata iscrizione AIRE dei Cittadini Italiani all'estero
In light of this new development, being registered with AIRE therefore becomes essential in order to benefit from Italian healthcare coverage.
It is to be expected, then, that a large number of Italian citizens who are not yet in compliance with AIRE registration will need to act immediately to sort out their AIRE status.
We remind you of our article with step-by-step instructions for AIRE registration:
3. WHAT THE NEW LAW PROVIDES REGARDING HEALTHCARE
Law 111/2026 provides that all individuals meeting the requirements just described can enjoy full Italian healthcare coverage, provided they pay the annual contribution to the National Health Service, which currently amounts to 2,000 euros per year.
This is a hugely important step forward for Italian citizens residing in America, who often travel to Italy for vacation, sometimes for extended periods (though still under 183 days per calendar year), without triggering Italian tax residency.
We remind you of some of our articles related to tax residency in Italy:
Before June 2026, registering with AIRE automatically meant losing one's health card, family doctor, and hospital healthcare coverage.
Let's recall what the consequences of AIRE registration were before Law 111/2026 came into force (we've marked in bold the ones that have now been overcome by the new law):
a) the right to vote in elections and referendums can be exercised from abroad;
b) a range of documents and certificates can be requested or renewed at the Consular authorities of the foreign country of residence;
c) loss of the right to a general practitioner (now no longer the case, provided the new law's requirements are met);
d) loss of free hospital healthcare coverage (now no longer the case, provided the new law's requirements are met);
e) loss of the discount on medicine prices (now no longer the case, provided the new law's requirements are met);
f) vehicles owned by the individual must be registered in the foreign country of residence after 6 months of living abroad.
Therefore, starting in July 2026, all Italian citizens duly registered with AIRE, living in the US (or in a country other than the European Union and Iceland, Liechtenstein, Switzerland, and Norway) and who have paid the annual contribution required by the law (currently 2,000 euros) can now apply for their Italian health card ("Tessera Senitaria").
It's also important to note that this provision states that the healthcare coverage granted in this way can only be used while the Italian citizen is physically in Italian territory: this means that this type of healthcare coverage ends the moment the Italian citizen returns to America or to their country of residence.
This point may seem obvious, but in our view it could give rise to significant practical issues.
Consider, for example, a case where a long-term treatment for a condition that began during a stay in Italy, and was treated there, requires ongoing care once the person returns to America. In such cases, under the law, healthcare coverage — including all benefits related to prescription drug benefit — ends once the individual returns to America.
The problem is that it will become very difficult for the Italian citizen who has been treated by Italian doctors to "discontinue" this health care (which is, moreover, essentially free) and "shift" to the American healthcare system based on health insurances.
It is therefore to be expected that there will be considerable practical difficulties, and that control and adjustment mechanisms will be introduced to prevent abuse in this regard.
4. THE ANNUAL CONTRIBUTION TO THE ITALIAN HEALTHCARE SYSTEM
As mentioned, the health card ("Tessera Sanitaria") is issued to eligible individuals once they have paid the annual contribution, which currently amounts to 2,000 euros per person.
We have already discussed the healthcare contribution in this article:
Please note the following points:
1) The contribution is annual and cannot be prorated; it is valid for the calendar year (January 1 – December 31) even if paid partway through the year.
2) The health card issued is valid for one year (also tied to the calendar year) and can be automatically renewed as long as the Italian citizen keeps paying the annual contribution.
3) If an Italian citizen residing abroad fails to pay the annual contribution, the health card is suspended, along with all associated healthcare benefits.
4) If an individual wants to reactivate a health card that was previously suspended, he must pay not only the fee for the current year but also the fees for all the years during which the card remained suspended.
EXAMPLE
Let's imagine that Mr. Mario Rossi, an Italian citizen living in the US, decides to apply for a health card for the year 2026: he therefore pays the 2,000 euros in July 2026 and obtains a health card valid through December 31, 2026.
He then decides not to pay the annual contribution for 2027 and 2028.
In 2029, in March, he requires the health card again and so proceeds with payment: the health card is reactivated, but he will also be required to pay the healthcare contribution for 2027 and 2028, plus interest.
This means the healthcare contribution cannot be paid on and off, or sporadically: it is a type of coverage meant to be viewed as long-term.
5) Another important point: in the case of a family with minor children, it is enough for just one of the two parents to pay the annual healthcare contribution, and this automatically means that the minor children can also obtain the health card and the related coverage — provided the minor children are also registered with AIRE.
On the other hand, adult children, even if financially dependent, can only benefit from healthcare coverage if they pay the annual contribution themselves.
6) As for the amount of the contribution, as of the current date (July 2026) it stands at 2,000 euros per year.
The law provides that a specific commission will assess the impact on state finances and may increase it in the future.
5. AN IMPORTANT STRATEGIC CHOICE
It is clear that this opportunity carries important strategic implications, including in terms of tax residency.
First of all, everyone who was previously hesitant to register with AIRE in order to keep their family doctor and related care can now safely register with AIRE, thereby avoiding potential challenges from the Italian Revenue Agency (Agenzia delle Entrate).
In this regard, we recall the following article from a few years ago:
On the other hand, it is easy to imagine that systematic and continuous use of the Italian National Health Service (think of the case mentioned above, of a person with conditions requiring ongoing care even after returning to America) could be viewed as a connecting factor and evidence of presence within Italian territory, potentially leading the Revenue Agency to declare Italian tax residency, with possible resulting tax litigations.
We therefore expect that the "borderline" between the legitimate right to healthcare granted by Law 111/2026 and the connecting factors to Italian tax residency that may arise from systematic use of this healthcare will certainly be an area of future scrutiny by the Italian Revenue Agency.
This is, in our view, a very slippery slope.
For Italian citizens residing in America — who number more than 2.5 million — this is a major opportunity, especially given the considerable difficulties many American residents face in obtaining healthcare coverage through US Healthcare Companies.
It's also worth noting that, beyond the large number of Italian citizens in America, our fellow citizens are numerous elsewhere around the world (excluding the EU) as well:
Australia: 172,000 Italian citizens;
Africa: 71,000 Italian citizens;
Asia: 82,000 Italian citizens;
Argentina: 987,000 Italian citizens;
Brazil: 671,000 Italian citizens.
So the overall pool of eligible individuals amounts to no fewer than 4.5 million people — an impressive figure.
YOU COULD BE ALSO INTERESTED IN:
1) Our selection of posts related to "MOVING TO ITALY":
2) The following posts:
CONTACT US FOR MORE INFORMATION
If you need more information you can send an email to:
enrico.povolo@dottcomm.net
or make a phone call to the following number:
+39 0444 322987
Enrico Povolo