Hi This page is a work in progress. As I find new things that I think would be useful to know I will add them.
I created this page to help people understand the ins and outs of a move to Italy. It is aimed at Americans. First off, I wish to say the information is specific to our own personal situation. Each Italian region has it’s own quirks. Each Consulate in the US has their own interpretation of the rules. There is no rule of thumb here. No recourse. If your consulate or region wants something you have no choice but to give it to them. It can sometimes be possible to work with another individual and get different results. Not easy, but possible sometimes. So please use all the information here with that in mind.
Before and during the move
A word of warning before starting the process of getting all your cards, visas, and permits. Be SURE your vital information is the SAME for every document you have. Always use your full middle name. No initials. Don’t omit it. Your Codice Fiscale, your Permesso di Soggiorno, your passport, birth certificate – It should all match exactly for your name, date of birth, place of birth, etc. We know many people, including ourselves, who have run into problems here with differences in our documents. So try hard to make them agree.
“How Can I legally move, and remain, in Italy?” You ask?
Well, the first way is to be a EU citizen. An EU citizen can live anywhere in the EU. Or you could be married to an EU citizen and obtain citizenship through them. Many Americans, of Italian descent, have sought to obtain their Italian citizenship. Dual passport holders, they can move to Italy with no issues and will receive all the benefits of their Italian brethren. There is a Facebook page called Dual u.s.-Italian citizens. I am not of Italian descent but I’ve heard it is helpful to folks trying to do this. I’ve also heard thousands of people are trying for this and the waits can be literally years long! So better get started!
The second way is to obtain a Visa from the Italian Consulate that handles your address in the US. This is what we did.
Otherwise, you can only come as a tourist. And as a tourist, you are allowed to stay 90 days and then you must leave the Schengen zone for 90 days. (Schengen zone is comprised of 26 EU countries without border controls, see link below for list). But it is complicated to calculate because they use a “rolling 180 days” definition. Here’s how they define it: “ This means on any given day, you need to look back to the previous 180 days, and you must not have stayed in the Schengen zone for more than 90 days in that period, including entry and exit dates.” (see link below to help you calculate). Immigration is stricter nowadays on enforcement. All passports are controlled electronically. If you overstay the 90 days you can be fined and banned from the EU for a number of years.
Here is a helpful calculator to keep track of your visits in Schengen.
Obtaining a Visa
There are several types of Visas.
- If you are planning to work, your employer will sponsor you for a Visa that allows you to work.
- You can try for a freelance/self employed visa. I’ve heard they only issue a limited number of these worldwide and they are really hard to get. The only people I know who managed this had to retain a lawyer in Firenze to negotiate the ropes. All important, you need a lawyer with good connections. Be sure to get recommendations. [Link with info. https://visaguide.world/europe/italy-visa/long-stay/self-employment/ ]
- You can enter on a Student Visa. People of any age are eligible, you must be enrolled in school and it allows you to work 20 hours a week. This Visa is of limited duration so if you wanted to stay it could be possible to convert to a work visa.
- We are retirees. We opted for the Elective Residency (ER) Visa. We are not allowed to work here on this Visa.
Obtaining an Elective Residency (ER) Visa
The websites for the various Consulates list the specific items required for an ER Visa. Each Consulate or the main Embassy makes their own independent decisions on Visas, often setting different rules. You must use the Consulate designated for your area. We used the main Embassy in Washington DC. For us we each had to bring:
- One National (Italian) Visa Application Form, completely and clearly filled out, and to be signed in the presence of a Consular Officer.
- Handling visa fee (this changes so you need to look it up) must be paid in exact amount in cash, money order or cashiers check made out to the Consulate General of Italy. Some have said they wouldn’t accept cash but our Embassy did.
- Two copies of our entire passports (all pages) valid for at least three months after the visa period with a blank page available for the Visa.
- Copies or our birth certificates.
- Copies of our marriage certificate.
- Proof of enough income to live in Italy without working. It is hard to find actual amounts published. As of this writing (2019) the LA Consulate says, “a single applicant must have a monthly income of a minimum Euro 2,596.60.” https://conslosangeles.esteri.it/consolato_losangeles/it/i_servizi/per_chi_si_reca_in_italia/italian-elective-residence-visa.html
- Proof of medical coverage.
- A copy of the final sales agreement for a house or a certified lease from the landlord where you will be living. The lease must be registered with your town Comune or City Hall to be accepted.
- We did not have to, but at least one Consulate (Chicago) requires that you write a letter explaining why you want to move to Italy. A friend who had to do this said, “The official read this over carefully. We were careful to not write a letter full of cliches such as wanting to improve our language skill, or love the culture. If you have a personal connection of any kind it Italy, that would be a good point to emphasize. Family and the connections between people resonate within Italian culture.”
Item number eight means you will need to travel to Italy and buy a house or rent an apartment before applying for the Visa. I know it seems counter intuitive but there it is. I also highly recommend that you know someone in your chosen town. It will greatly help with your transition.
When you go to your appointment (everyone going to Italy needs a separate appointment) you should be very organized with your documents and highlight the pertinent information on them, you should dress nicely and be friendly. Present your documents. Answer questions as shortly as possible and do not volunteer any extra information. Be truthful.
Times vary for obtaining a Visa. You can only apply for one 90 days or less from your departure date. And each Consulate has their own appointment portal on their website. Depending which Consulate it can take a while to get the appointment. So check your Consulate ahead time so you can plan. Once you’ve had your appointment times vary for receiving the Visa in your Passport. We got ours in a week. Some it took two. One of my friend’s took 60 days.
Getting a Residence in Italy – rent or buy
Many people opt to rent, at least at first. It allows you to know if you like living here and in the location you choose. Rents outside of the large cities can be ridiculously cheap. In my town you can rent a one bedroom, one bathroom house for €300 or less a month. Larger cities, Rome, Florence, Milan, have more expensive rents, but still they are less expensive than in the US. Except maybe for small town America.
For your Visa requirement you will need a Registered Lease for at least a year. It must be registered with your town Comune. This makes it legal. Some unscrupulous landlords will try to circumvent this because they don’t want to pay taxes on the rent. This is not legal and you will not have the protections renters get by law. A vacation rental cannot fill the requirement either. It cannot be registered. Normal leases are 4×4 or 3×2. This means you sign a lease for 4 years with an option to renew for 4 more at the same rent. Or 3 years with 2 year option. You can, and should ask for an “escape” clause which allows you to give 3 months notice to break the lease early. This all said, everything is negotiable and some landlords will allow you to rent a place for only a year if that’s what you prefer. Typically you will pay more for this.
Buying a house in Italy
Buying a house in Italy is not as hard as one might think. You don’t need anything to buy a house except a Codice Fiscale and money! The Codice Fiscale is a personal number everyone must have to buy things in Italy. You can get it from your Consulate or Embassy. We did ours in person. It was easy to do ourselves. Don’t pay anyone to do this for you.
Real Estate is not taxed if it is your prima casa (i.e. you live there as your primary house) AND you have Residency. So we pay no taxes. Otherwise, it is taxed but at a much lower rate than in the US.
Next, find a house. This is, of course a simplification. You need to first decide what region you want to move to. Then what area or town. Then the house. Some people opt to rent before buying to be sure they like their choice. That would be a personal choice.
There is no MLS in Italy. Each agent or agency handles his or her own listings. Our realtor arranged with other agents to meet us with the keys and show us properties he thought we might like.
About agents: there are many Brits working illegally as agents in Italy as passing the exam is difficult. In addition there are no requirements for “estate agents” in the UK, so they think they can work without the training and licensing required here. Naturally there are also many who are completely legit.
Private people can also list and sell their homes. I HIGHLY recommend you do not use a private person. People will take advantage of newbies here who (usually) don’t speak Italian well and will charge exorbitant prices to “rich Americans”. Also to consider, the Italian inheritance laws are very different. Many members of an extended family can inherit and own a piece of a property. And they can come years later to claim it. You would have no recourse. It is on you to be SURE you have a clear title. And this is where the professionals come in. Don’t try to save a few percent to find out later you don’t own your house!
Once we found our house we made an offer through our Realtor. A down payment is common when making an offer; it certainly is the only way to give the offer teeth. In Italy you can have the house inspected but it is not like in the US where things are contingent on the outcome.
Law requires that the building had a building permit, and works done since were authorized. There are some exceptions to the building permit based on the age of the building (1942/1967 being pivotal years). There should also be an occupancy permit but this is not a firm requirement to purchase/sell. The sale is by law contingent on the required permits that apply be in place.
It is possible to pay a professional (geometra, architect) to issue a conformance report on building and land registry issues. It might not make sense for an apartment but it makes a lot of sense for a home in the countryside. An inspection on issues common in the US like mold etc is rare.
It is important to trust and like your Realtor. Also, it is best if they are English speaking. Ours was British as are most of the English speaking ones here. He also helped us open an Italian bank account into which we would wire money.
Agents Fees: if the agent is unlicensed, no fee of any sort is due (they are working illegally) regardless of the euphemism they use to try to confuse people, e.g. marketing fee etc, Fees are “free market” (in theory it is negotiable, but this has to be done before s/he does any work for you…) but are typically 3-4% for each the buyer and seller, e.g. the buyer will pay 3-4% to their agent, regardless if the agent collaborated with others or not. By law an agent is suppose to be impartial and represent both the buyer and the seller, the reason both parties pay fees. At least in theory.
Our offer was accepted. You don’t need any money in hand to make this offer so don’t let anyone tell you different. We next had to give our Realtor a limited Power of Attorney so he could sign for us and go to the closing. We visited a Notaio to do this. He is a cross between a Notary and an Attorney. It was quite the show. Then we flew home to the US. Next step was to pay a 10% deposit.
Wiring money – We had 20 days contractually to pay the 10% deposit. Before we retired we opened a new checking account with USAA. We know that since they cater to the military and families they have members all over the world. My local bank always seemed unfamiliar with these procedures not to mention the exchange rate was ridiculous. USAA gives the official exchange rate with no mark-up. We are very happy with them. This all said many people have good things to say about Transferwise. Do shop around. We had the numbers our bank in Italy gave us and we called up our bank and sent the deposit. Then we waited to see if it would arrive OK.
Four days later it had arrived in Italy. We got an email from our Realtor and he arranged for the final signing of the compromesso (sales agreement). Once this was complete if we backed out we would forfeit our deposit. If the seller backed out they would have to refund the deposit back to us plus another payment equal to the deposit. I.e, if we gave them Euro 10,000 they would have to give us Euro 20,000 to back out. Normally once the compromesso is signed the deal should go through without a problem.
Once the deal closes you receive COMPRAVENDITA REPUBBLICA ITALIANA or the final sale agreement. It is in effect your deed. This is what you need to copy and bring to your Visa appointment.
If your house is not new you will probably want to do some renovations. We worked with a Geometra. Here is an online definition I found:
There is no exact equivalent for a “Geometra” in English as this profession with its special form is probably unique to Italy.
This job is a combination of architect, building surveyor and expert in the field of surveying. In any case this person is absolutely essential when buying a property but also when doing major renovation work or building a new house. He is a specialist who identifies, surveys and evaluates the plot of land or the property, he comments on the condition of the subsoil and refers to possible difficulties.
His professional competence is not only of a technical kind. A “Geometra” can also be of help when it comes to legal issues or tax related estimates.
Our Geometra also was a sort of general contractor with a crew of workers who could complete the renovations. You should get recommendations from someone you know and trust. There are also architects and contractors in the same sense as we have in the US. It depends on the extent of the work you need to do.
Things to do before you leave the US
Rent a mailbox from an online company (dropbox).
There are lots of companies that do this. We rented one for 2 years and renew it. You will have to forward your mail to this address. And you will want to do Changes of Address for all your mail. They receive your mail and notify you it has arrived. You have the choice of having it scanned (for a fee), having it forwarded to Italy (for a fee) or discarding it.
Moving physically to Italy
Shipping to Italy
We used a shipping company to send household goods to Italy but not big items like furniture.
Bringing pets to Italy
We elected to bring our two cats into the cabin with us. Only a few airlines do this. You need to make reservations ahead of time. Larger animals will need to go into the hold. There are companies that ship animals and deliver that you could look into as well.
There is no quarantine of animals in Italy. There are, however, several hoops you have to jump through to bring animals to Italy. It is important that you do them in the proper order.
- First get your pet microchipped at least 1 month prior to your trip. Personally with hindsight, I think you should just go ahead and do it the moment you know you are going as it is never too early.
- After that (and at least 30 days before you leave) get a new rabies shot even if they already had one.
- 10 days or less before your flight download the official dual language forms to bring a pet into Italy from the Italian Embassy website.
- Take that form no more than 10 days before you go and have your USDA certified vet fill it out. Make sure you have your rabies certificate from the shot about a month ago.
- Last go find the United States Department of Agriculture Animal and Plant Health Inspection Service Veterinary Services in your state. Either FedEx all your forms (Italian form and Rabies certificate) to them or take them to them for certification. Then you should be good to go.
You take all the forms with you to show when you arrive in Italy. They never asked to see ours but still…you should not take any chances with this!
Here are the links to sites with forms or information that is useful.
This is the Italy embassy information about bringing pets
This is the form that your vet must fill out – and the vet must be USDA certified.
This is the USDA site
Once you arrive
A word of warning before starting the process of getting all your cards, visas, and permits. Be SURE your vital information is the SAME for every document you have. Always use your full middle name. No initials. Don’t omit it. Your Codice Fiscale, your Permesso di Soggiorno, your passport, birth certificate – It should all match exactly for your name, date of birth, place of birth, etc. We know many people, including ourselves, who have run into problems here with differences in our documents. So try hard to make them agree. (I know I’m repeating myself but it bears repeating!)
Obtain your Permesso di Soggiorno – (permit to stay) (PdS)
You must apply for a Permesso di Soggiorno (PdS) within 7-9 days after you arrive in Italy. This supersedes your Visa, which never has to be renewed.
To apply for the PdS you will need:
- To go to your Italian Post Office and pick up a ‘yellow packet’ for the Permesso di Soggiorno application. The yellow is for US citizens while there is a blue packet for EU members, etc. The yellow packet has two modules and we just filled out the first 4 pages of Module 1. Depends on your dependents etc.
- After filling out the packet you will need:
- Copies of all of your Visa documents (proof of residency, financial documents, health insurance, copies of your entire passport, etc)
- A €16 stamp from a tobacco shop – it’s called a Marco da Bollo.
- 4 passport-style photographs
- Your completed packet including all the blank pages
- The post office will require you to fill out your own invoice – bollitino. It comes in the Yellow packet.
- You go to the post office with all your materials, get a number to go to the correct window – as only certain windows at the post office handle the Permesso applications.
- Give them your materials, they flip through them, ask you for signatures, your Bollitino paying the fee (found on the Internet – it can change from year to year), they bundle everything into an envelope and they schedule your appointment at the Questura (police station) and give you a receipt (do NOT lose the receipt! Very important!).
- At your appointment with the Questura (Immigration police). You will need:
- Your passport photos – as the post office doesn’t take those
- A complete copy of your passport (Again!) and other documents used for your Visa.
- a copy of the receipt you got at the poster office, and the original
- All of your post office receipts including a copy of them
The policewoman/man will take your fingerprints and process your paperwork.
When we first went to the Questura we had to sign an agreement to stay in Italy. The letter we signed is an agreement between us and the “State, in the person of the Prefect of PERUGIA”. We agreed to attend an Italian culture and civics class and pass the A2 Italian proficiency test. There is a point system. The letter clearly states that we get 16 points up front. If we do not take the class we lose 15 points. We need a total of 30 points after two years. I have found out this agreement is also regional and many do not sign one. But if they ask you to, you must comply with these rules. [Addendum: after 2 years we received a letter of non-compliance and were put on probation for a year. Presumably, we would be deported after that had we not complied. We had not taken the Civics class as it’s date was past when we signed the agreement. We had one point. So we visited the immigration office and it turned out all we needed to do was pass the A2 test, bring proof we owned a home here, and proof that we had gotten Italian health insurance. This gave us 34 points so we complied.]
You leave with your receipts and are told to check in online for when your Permesso card is ready. They send us a text message on our phone too but it’s best to check after a couple of months. If you get a text it will have a date and time to come and pick up the PdS. Otherwise you may need to call. Getting your Permesso card takes at least a couple of months and could be six months (or more).
The second appointment at the Questura is pretty short, checking your receipts again, another finger print and they give you your Permesso card. This card is good for one year from the date of your Visa so by the time you get it, it’s good for 6-10 months and you need to do the same process all over again for the annual renewal. Some areas do two years. Umbria does not. Be sure to start early enough so that your Permesso doesn’t expire. Recommended 3 months minimum.
The receipt that you get when you drop off your packet at the Post Office is nearly as good as having a Permesso. We have learned however, that you cannot travel on the receipt through another Schengen country, nor can you travel on an expired card with the receipt. It is not considered an official document. Say you want to return to the US you can fly direct, non-stop there from an Italian airport. Or if you fly out you will need to fly to, or through a non Schengen country like the UK. Travel by train or car is not a problem because you won’t pass through a border control checkpoint.
After you get your Permesso you will need to get your Carta d’Identita. To do so go to your local comune Anagrafe office and pick up a form and show them your Permesso. The police then visit your house to be sure you live there. The Carta d’Identita is your Italian ID which you use when you are checking into Hotels, etc rather than showing your passport. You cannot fly on this if you aren’t an Italian citizen. You cannot buy a car without this card. For us, it meant we had to lease and rent cars for 6 months. An expensive thing!
Living in Italy
Living here in Italy can be challenging. For every step you try to take you must deal with waiting, roadblocks, and returning again and again to finally get the thing you need accomplished. If you are retired, like us, you do have time to wait. I don’t pretend to know how working Italians manage this! Also, as another friend has noted, “no does not always mean no”. Many times they ask for something I don’t have with me and they shake their heads. Then go ahead and do it! Sometimes asking me to bring whatever they need back. Another frustration can be the fact that nothing is set in stone. Friends will tell us they got this or that done with only this form but when we go, we need more or cannot get what we need. Bureaucrats can make decisions randomly and you have no recourse. It is just a fact of life here.
Taxes and expenses
Go here for an informal look at what ordinary things cost here in Umbria. Umbria, Abruzzo, Les Marche and Molise are the least expensive Italian regions in the center. Tuscany is more expensive due to its huge expat and tourist influx. Cities are always more expensive. The north is most expensive. The south (Basilicata, Puglia, Campagna (parts), and Calabria as well as Sicily and Sardinia) are less expensive. But you get what you pay for. Health care is not as good in the south. And infrastructure.
Taxes and required payments are your responsibility to know about and to pay. Being immigrants or stranieri we don’t always know what is required. Italians, on the other hand, know about these from birth! So it is best to inform yourself by asking an Italian friend or an ex-pat who has been here a while.
Italian Income Tax
Once you obtain residency and have been a resident for one year you need to file Italian income tax. The need to file and pay is determined by “physical presence”. So if you are physically in Italy for 183 days a year you will need to file and pay. You will need to use a Commercialista to file for you, ideally, one who is familiar with filing for US citizens. I am told it is a very complicated issue and you can get differing opinions from different Commercialiste. There is an agreement between Italy and the US concerning taxes. You can Google it. You are supposed to be protected from double taxation by both countries. Essentially we are taxed on our Social Security, dividends and on unrealized value of property (on investments and 401(k)s) held outside Italy. There is a .02% wealth tax. Italy also will tax you on any real estate you own in the US. Private pensions are not taxed in Italy nor are government and state pensions. Overall taxes are higher in Italy than the US.
Energy is very expensive in Italy. It is four times as much as any other country in Europe. When buying a house, keep this in mind. Town gas, electric and water is cheaper. Many people heat with wood. We have a “stuffa” or pellet stove which helps a lot to keep this old building warm. When you buy ask for the energy rating. Older houses are not insulated. Houses are rated from A+ to G, A+ being the most energy efficient.
In some areas you must read your own meter and report it to the utilities to avoid a big bill to settle your account. In larger cities the meters are self-reporting.
There is a TV tax which is added to your electric bill every year.
Real Estate is not taxed for the house you live in full time, or your prima casa, AND you have Residency…so we pay no taxes.
We have to pay a garbage tax semi-annually. You can also pay all at one time. If you don’t get a bill, inquire at your Comune.
Car tax – In our second year we found out we owed car tax! For two years! Just an example of how you can get blindsided here. So be sure to ask when you buy a car.
Buying a car
First rule…You must be a resident and obtain a Carta d’Identita (see above) from your Comune to buy or register a car. The rule is a result of anti-mafia legislation to prevent money laundering, I’m told. Buying expensive, “portable” property, like cars, is prohibited to non-residents.
Buying a car is not at all like in the US. First, I recommend that you not buy a used car from an individual. There are many pitfalls one of which is that you assume liability for any accident or infraction the former owner had incurred. You can buy used cars at auto dealers. They are inspected and warrantied. There is also the concept of Kilometer 0 cars, essentially demos. You get them from dealers. They have warranties etc. You can also buy a new car at the dealer…you just can’t do it fast. The dealers do not keep inventory on their lots. To buy new you normally have to order a car. It takes about 3 months to receive it. You must be an Italian resident with a Carta d’Identita to order or buy a car.
Car insurance is more expensive here. If you can join USAA they insure cars for Americans. Prices for auto insurance are higher than the US. USAA has good responsiveness in the event of an accident. You’d need to be a veteran or descended from one who was a member to join.
New cars have first inspection due in 4 years. After that it’s every two years.
Importing a Car
A word about importing a US car to Italy. I see questions all the time about this and the consensus is, DON’T DO IT! The car would need to be retrofitted to comply with EU standards, which can be costly. Dealing with the Italian Authorities is not for the faint hearted. It is infinitely easier to buy a car here. There are plenty of low cost vehicles. Another thing to consider is that you cannot drive a car on a new Italian Drivers License (see below) with more than 55KW of power or about 74 horsepower, for the first year.
Here are a couple of links from people who have tried to bring a car that are informative.
This one is from an ExpatForum so I’m not vouching for it’s facts.
One price you pay to live in Italy is that the US has not adopted a reciprocal policy with Italy to convert our US drivers license to an Italian one. I think I understand why now. Because we don’t have US driving licenses. We have a State license and there are fifty of those. When you change States you have to get a new license. In other countries it is issued for the Country. So, unless we come up with a national license we can’t get reciprocity. This means you can drive on your US license or an International one for ONE year after residency. After that you must take the Italian test. Much has been written about this but in a nutshell, you can study online to take the written test. It is VERY technical with trick questions and all in Italian. You can take the written test on your own. BUT you cannot take the practical driving test without enrolling in a driving school. The costs run around 500€. If you have managed your written test on your own then you only have to take 6 hours of behind the wheel training. If you have not done the written test it is very time consuming (and more costly) with much lecturing and still six hours spent driving with the instructor behind the wheel. Then your instructor takes you to take the test in the Autoscuola car. Usually manual transmission. All of this must be done in spite of the fact you’ve been driving many years. And you blow this off at your own peril. Your insurance is null and void in case of an accident if you have not gotten your Italian license and they can and do impound your car. Plus large fines. A friend recently had her US license confiscated in a routine traffic stop. And she got a fine. She studied hours each day and took on-line trial tests getting through over 5,000 possible test questions. She passed! So you can do it.
Another thing to consider is that you cannot drive a car on a new Italian Drivers License with more than 55KW of power or about 74 horsepower, for the first year. For three years you cannot drive more than 100kph on superstrade or 90 on regular highways. It matters not that you’ve been driving 40+ years!
Italian medical system
If you are an Italian citizen or married to one you get your medical care for free. If you are an immigrant you must pay unless you work. Here is the latest information on payments. This information is from www.doctorsinitaly.com:
“Currently, the annual contribution is €387.34 for an annual income between 0 and €5165.00. The rate (“aliquota percentuale”) for an income exceeding €5165.00 and up to €20,658.28 is 7.5% rate, while it’s 4% for amounts exceeding €20,658.28 and up to the limit of €51,645.69.
Without regard to the gross income, the amount of the contribution cannot be less than €387.34 or higher than €2.788,86 with the currency exchange rate applicable at the date of the application.”
This said, it varies from region to region how much they charge. Quite a few just charge the minimum without a proof of income. Impossible to find out unless you know someone in your target area. Welcome to Italy.
You must have your Permesso di Sogiorno and Rezidenza to sign up. You sign up at the beginning of the year at the Azienda Sanitaria Locale (ASL). You have to pay your money at the post office and bring the receipt back. You will then get your medical cards in the mail. If you sign up in mid-year you will still pay the full annual amount. If you are unlucky, as we are, your permesso will expire sometime in the middle of the year so you can only get the card until the expiration date. This means you have to return when you get your new Permesso to get the rest of your year coverage. It seems every year our Permessi expire so we take the ever-important receipt from the Poste back in and they extend it for us.
When you sign up you choose a doctor who will be your primary care physician. You should already know who you want when you sign up. Ask around. All appointments to this doctor are free. All prescriptions you get from the doctor are covered and are usually free. The doctor writes prescriptions for procedures as well as medication. Then you take the prescription to your farmacia where they will give you an appointment. Sometimes you have to go to the health department for the appointment to be made. (You pay a fee for any special tests you get, i.e., blood work, EKG, etc. The fees for care are nominal. My blood work cost 15€. Colonoscopy was free. Mammogram was free.) Then, on the time and date you go for the test. On the appointment sheet it says if you owe anything. If so you pay in the hospital before the test.
There is a down side as sometimes it takes a long time to get an appointment for a test. If it is non-life threatening. If you don’t want to wait you can always go “private” and pay for it. This is faster. Also, before you are covered you can always go to a doctor on your own as well. You pay the doctor at the time you visit him/her.
Sometimes I want to go to a specific doctor or specialist and my doctor will arrange an appointment for me. Or I will do it. This would be “out of the normal system” or private pay. I usually pay €150 for a consult with specialist. I also went “private” for an MRI I needed quickly. I went to a clinic. It was €126. I had a total knee replacement last year. I wanted to chose the doctor. I paid private to consult with him, then he put me in the system. 8 months later I had the operation. It was totally free.
So the difference is, if you go through the system, you get any doctor available i.e., no choice. And you have to wait, sometimes a year for a test. Although the colonoscopy was free my husband had to wait 11 months. If you are in any hurry then you go private and pay, or go private, pay and they put you into the system.
Going to our Doctor
In different areas, and with different doctors your experiences may vary. But here is what we do when going to our primary care doctor, here in Umbertide. It is very different from the US. Our doctor has published office hours five days a week. Usually two hours a day. Here, we don’t make doctors appointments. We go during the hours. There are no staff, no receptionist as this is all cost/overhead. But the doctors cell phone number is prominently posted for us to call anytime. Let me know if that would ever happen in the US! When you enter the lobby there are usually a number of people ahead of you…and multiple doctors use the same building. So we must ask, “who is the last for [doctors name]”? Someone pipes up so you know you go in after he/she leaves. We found only one English speaking doctor in our town. I felt, with important stuff like my health, that I wanted an English speaker. My doctor is not proactive. We must manage our own health. I decided to get blood work done and an EKG for baselines. She gave me prescriptions for these tests which I took to the Farmacia. They are in charge of making appointments with other doctors for tests and procedures. After the tests they give the results to me and I have to take them back to the doctor who reads them and, if there is any problem, will tell me and we would discuss any actions that need to be taken. Quite different. Also, I have to retain all my records myself. Doctors do not keep files on individuals. So I bring all necessary tests and information when going to the doctor.
For Americans this will take some getting used to. Hospitals are NOT at all like in the US. The buildings themselves can look pretty decrepit, but the important things, like equipment and cleanliness are top notch. Think of it as a no frills approach to medical care. The care and results are the most important.
I’ve had the misfortune to have two knee replacements here. Two completely different experiences. The following links are the first of several for each stay. Scroll UP for the next episode.
Many hospitals provide nothing for your stay. It’s on you to pack, and bring, a bag. There is no water and (sometimes depending on the hospital) toilet paper, you even have to bring your own cutlery, plate, cup and glass! For your personal self, bring a wash cloth, water, soap, a basin, toothbrush, toothpaste etc. for clean up.
Once at the hospital don’t expect there to be curtains or privacy. I learned that the nurses don’t help with many basic things like bringing drinking water. Or ice. Or help to the bathroom. [for my FIRST stay] They do blood pressure, medications, take blood for tests, basic bed making and body wash. For anything else you would need a helper. A family member or friend. Odd but true. Different hospitals have different rules. Where I was, my roommate’s husband spent the night every night beside her bed. He had a folding chaise. I saw other people carrying cots down the hall so it was common, actually expected.
And, of course, very few people speak English. It makes for a lonely time without being able to speak to anyone.
I have strong opinions on living in a non-English speaking country and not trying to learn the language. If you don’t want to put the effort into this then you shouldn’t come. It is the respectful thing to do. Most Comunes have nearly free Italian classes (I paid 10€ a year) for stranieri. Starting with the basic A1 level and going to A3. They also administer the A2 proficiency test to comply with the agreement we signed to stay here. There are also numerous private classes you can take and also on the internet via skype.
This all said, 5 years in and I’m nowhere near fluent. It takes time and effort and guts. I don’t have the guts. I avoid Italian conversation. This is probably the biggest mistake English speakers make, not to get to know Italians and speak in Italian. I’m still working on it 🙄
When we moved to Italy we changed our investments address to our Italian one. DO NOT DO THIS. If you do, you will no longer be able to invest in Mutual funds or bond funds. Nor will an advisor be able to help with anything related to investing. In hindsight I would have just changed the addresses to the Dropbox address. After a lot of research we found out that Schwab has a British presence and will service investment accounts for Expats. This recently changed. Americans living abroad cannot invest in Mutual finds, ETFs, or stocks at any brokerage. Let me know if you know different. Just don’t tell them you’re living out of the country!
Once you are residents be sure to change your Italian account to one as a resident. They really sock it to stranieri on fees.
I also highly recommend you keep a US bank account, and that they are used to international transactions
FBAR and FATCA
Look into FBAR and FATCA rules for expats. You have to declare any bank balance here that goes over $10,000 during the year. So when we purchased the house and cars we obviously were above that amount. Report is due in April. After all our big purchases were made we try to keep less than that in the account so we won’t have to file.
TV, Netflix, movies, phones
Sign up with one of the companies that provide DSL into your house. This will give you Internet. Our part of Italy is a third world country when it comes to internet speeds. Big cities are better.
We stream movies but not in HD. It cannot be supported where we live. For movies and TV shows we use a VPN. It masks your location so you can pretend to be in the US. But Netflix just started cracking down on people sneaking into the US sites this way. Netflix recently came into Italy but it is woefully meager in its offerings. Copyright rules I guess. But do keep your US account. And we have Apple TV which provides all the latest miniseries from the UK and the US etc. Of course you have to pay for them but we are really happy to have access.
We use Skye for satellite TV. We watch Italian TV to improve our Italian. There are some good game shows in the early evening that we love on RAI One. We get a lot of English language programs including news. We also get the History channel and NatGeo. These cost extra. I will mention, the costs for satellite TV are much cheaper than in the US.
When you arrive take your unlocked smart phone to one of the providers (TIM, Vodaphone…) and sign up for a plan. Then we buy minutes as needed. You can also purchase a phone and plan here.
I use Skype a lot especially to call 800 numbers in the US. It is the only way to access them from here. I also FaceTime with my friends.