Searching for where to enroll in the Italian Health System and choose your doctors…. The secret word is Distretto. Google Distretto and your commune and it should pop up results for where to go. It is also commonly referred to as the ASL.
The Process
To be eligible to register you have to have a Permesso di Soggiorno and have your Residency Card. What you are wanting is “Voluntary Registration”. You are required to pay, but the amount will depend on your Comune. Some will calculate an amount based on your income, some will just charge minimum of 384EU. The amount is for a calendar year, and is not pro-rated. You pay the full amount whether you enroll in January or December.
- Your Permesso di Soggiorno (or the proof that you have applied and are waiting for the card)
- Proof of residency. This is usually your residency card, (your Carta d’Identità). If you don’t have a permesso di soggiorno because you are an EU citizen, you need to bring your attesta di residenza from the comune. If you do have a permesso di soggiorno, but not a Carta d’Identità you can bring your registered housing contract or an “autocertificazione di residenza.”
- Your codice fiscale. Registering for the SSN will grant you a tessera sanitaria – a health card. The health card is a legal confirmation of your tax code, so this is an important one.
- Proof of identity, e.g. your passport.
- Proof of payment for the voluntary enrollment (described in next tab).
- Photo copies of everything.
- You may also be asked for a copy of your employment contract, or you can sign another self-certification regarding your income. They should have these forms at the ASL office.
- They may also ask if you are registered with AIRE (Italian Residents Living Overseas) If you don’t know what this is, and it is almost certain you don’t because it is very unlikely to apply to you, your answer is no.
The cost is a yearly enrollment cost. It is based on a calendar year. It is not pro-rated. The cost is the same whether you join in January or December.
The base minimum cost is 384EU for your family. The Max cost is 2788EU. The formula they base it on is 7.75% of your income. Currently, the most common verification is to have to present a certified document from the Social Security section of the American Embassy. (I’m told they know exactly what you mean when you call and ask for it) It is also common that areas with fewer foreigners just get told to pay the 384EU.
How will you find out? You will have to go to the ASL to discover the amount, and what documents they may want. Because it can be involved the final tab covers all the potential comings and goings.
Your first stop is your local ASL. (Google Distretto and your Comune to find our where your office is. During this time of Covid, you typically have to email them to make an appointment. This is a good thing as it used to be that you went early and just waited)
At the ASL, armed with your folder full of documents, you ask for Voluntary Registration. (registrazione volontaria). This trip (yes likely more than one) you will begin the process and they will either just tell you and amount you need to pay, or tell you they want some specific documents for income verification.
If you have a specific amount to pay, you will next go to the Post Office. If this is the case, they will have given you a sheet of paper with the amount and the account number. You will take one of the Bollettini that can be found found on a rack. 
If you were told to present other documents for income verification, you will be repeating the above, and then going to the Post Office. Once you have your Post Office receipt, you will go back to the ASL to make things official.
At this time, you will be selecting your primary doctor. If you are in a tiny town, you may not have a choice. If you are in a larger place it would be a good idea to ask expat friends for recommendations and hopefully the one you end up wanting will be taking on new patients. If you have no idea, they will just assign you one. You will receive a printed sheet showing all your registration details. Health Registration Example Make a copy and keep it in a safe place. You will take this sheet the first time you go to your doctor and he will enter you into his computer. Later in the mail you will receive your plastic card. You are now registered in the Italian Healh Care System!
Depending where you are living, you may need to go back yearly and renew. At least you will have done it once and likely just go with updated income verification, pay at the post office and return for your new card.