Our family lived in the US for eight years before moving to Monza in 2026. The difference in healthcare costs was one of the first things we felt in our wallet. This article lays out the official numbers from both countries so you can plan calmly, with no promises.
In the US: premium, deductible and annual cap
Most American families get coverage through an employer. According to KFF's annual survey, in 2025:
average annual premium for employer-sponsored family coverage
the worker's share of that family plan, per year
average annual deductible for single coverage
out-of-pocket cap for a family on Marketplace plans in 2026
On top of the premium, there's the deductible, the copay and coinsurance until you reach the annual cap (out-of-pocket maximum). In 2026, that cap is US$10,600 per person and US$21,200 per family on Marketplace plans. On average, Americans spent US$1,632 per person out of pocket in 2024, not counting premiums.
In total, the country spent about US$5.3 trillion on healthcare in 2024: US$15,474 per person, 18% of GDP.
In Italy: the Servizio Sanitario Nazionale (SSN)
Italy has a public, universal system, funded mainly through taxes. Legal residents enroll in the SSN through their region's ATS (in Monza, ATS Brianza) and receive the tessera sanitaria. With it, you choose a medico di base (primary care doctor) and, for children, a pediatrician, with no charge for visits.
Italian public spending is much lower than in the US: about US$3,952 per person in 2025 (at purchasing power parity), 6.2% of GDP, according to the GIMBE Foundation using OECD data. That's below the European average, and it shows up day to day as waiting lists for tests and specialists.
Who joins for free and who pays to join
- Mandatory enrollment, no premium: employees and self-employed workers with a valid permesso, family members on family reunification, holders of an EU long-term permesso, among others. Resident Italian citizens too.
- Voluntary enrollment, with an annual contribution: people who don't work in Italy, such as elective residence holders. Since 2024, the minimum contribution is €2,000 per year. Students with no income pay €700 and au pairs €1,200.
What you pay when you use it: the ticket
Visits with your medico di base are free. Tests and specialists have a copay called a ticket. In Lombardy, according to ATS Brianza:
- tests and specialist visits: up to about €36 per prescription, with up to 8 services of the same specialty [confirm the regional variable share];
- prescription drugs: up to €2 per box and €4 per prescription;
- ER for a non-urgent case: €25 for the visit, including tests done there.
There are exemptions based on age, income, pregnancy and chronic conditions. Young children in lower-income families, for example, are usually exempt. [confirm current exemption brackets]
Comparison for a family
| Item | USA (employer plan) | Italy (SSN, working) |
|---|---|---|
| Monthly premium | ≈ US$570/month (worker's share) | None |
| Primary care / pediatrician | Copay or deductible | Free |
| Tests and specialists | Deductible + coinsurance | Ticket, up to ≈ €36 per prescription |
| Medications | Depends on the plan | Up to €2 per box |
| Annual out-of-pocket cap | Up to US$21,200 (Marketplace 2026) | No formal cap, but amounts are low |
| Main weakness | Cost | Wait times |
For the visa, though, you need private insurance before you arrive. And if you join through voluntary enrollment, you pay €2,000 per person or more. Add that to your budget in the cost of living calculator.
Is a private plan still worth it in Italy?
Many families keep supplemental insurance to skip lines and get access to private clinics. Paying for one-off private visits is also common. Prices vary a lot by specialty and city. [research price ranges in Monza and Milan]
Some Italian companies offer supplemental health funds under the collective bargaining agreement. It's worth asking when you're hired.
Frequently asked questions
Does my American plan work in Italy?
Usually only for travel emergencies, and not always. For the visa and life in Italy, you need a policy that covers treatment and hospitalization here, or SSN enrollment.
Can digital nomads join the SSN?
It depends on your status. If you open a Partita IVA and work as self-employed in Italy, enrollment is usually mandatory. Confirm your case with the ATS and our partner commercialista. See the digital nomad path.
How long does it take to get the tessera sanitaria?
After you enroll at the ATS, you get a temporary document on the spot and the card arrives by mail. Timing varies. [confirm average wait at ATS Brianza]
Are pregnancy and childbirth covered?
Yes, if you're enrolled in the SSN. Prenatal tests included in the protocols are exempt from the ticket.
What about elective residence?
If you don't work in Italy, you pay for voluntary enrollment or keep private insurance. See the elective residence path.
Sources: KFF, 2025 Employer Health Benefits Survey (Oct 2025); HealthCare.gov, Out-of-pocket maximum (accessed Oct 2026); Peterson-KFF Health System Tracker, US health spending in 2024 (2026); AGI, GIMBE report on public health spending (Sep 2026); ATS Brianza, Ticket (accessed Oct 2026); AUSL Modena, SSN enrollment for foreigners (2024, accessed Oct 2026).