For Italians living abroad, the relationship with the National Health Service is changing. And for those living in Brazil, the issue is particularly delicate, also due to the presence of a healthcare agreement between Italy and Brazil.
For decades, the relationship between Italians permanently residing abroad and the Italian National Health Service (SSN) has been governed by a specific set of rules. Registration with AIRE typically entails the loss of regular healthcare in Italy, because the citizen residing abroad is no longer registered with the Italian SSN as a resident.
However, there was specific protection for certain categories of emigrants who returned to Italy temporarily.
The previous legislation in fact recognized Italians registered with AIRE with the status of emigrant, i.e. born in Italy, and those entitled to a pension paid by Italian social security institutions, Emergency hospital services free of charge for up to 90 days per calendar year, provided they did not have other public or private health coverage.
It was not, therefore, a general right to “all treatments free of charge for 90 days”: the free treatment concerned in particular emergency hospital services, and not indiscriminately every visit, examination, therapy or scheduled treatment.
The new law: 2,000 euros per year
From the July 27, 2026 Law no. 111 of 12 June 2026 came into force, modifying the healthcare regulations for Italian citizens registered with AIRE residing in countries that are not members of the European Union or EFTA.
The new legislation introduces the possibility for these citizens to obtain a national health card valid in Italy, but making it subject to the payment of a annual contribution of 2,000 euros.
The most important point is that the contribution is not divisible: it is not, therefore, a matter of paying a sum proportional to the number of days spent in Italy. The card is valid for one year, and the fee required by law is €2,000 for the year of validity.
The law also provides that the amount can be changed annually by ministerial decree.
A special regime is in place for minors registered with AIRE: they are exempt from payment when at least one parent or legal guardian holds a valid national health card obtained under the new regulations.
And what about Italians living in Brazil?
Here the issue becomes more complex.
The Brazil is one of the countries with which Italy has an agreement on healthcare and social security.. The Ministry of Health has expressly included Brazil in the list of contracted countries.
The Italian-Brazilian Convention also includes, among the matters covered, benefits relating to sickness and maternity.
This means that It is not correct to automatically state that every Italian resident in Brazil must necessarily pay 2,000 euros to be able to receive healthcare in Italy.. The specific situation depends on the category of citizen and the procedures established by the convention and the implementing legislation.
It is therefore particularly important for Italians residing in Brazil to verify their status with the relevant local health authority (ASL) and the relevant social security and healthcare agencies before planning a return to Italy for health reasons.
The case of the double passport
Even more delicate is the situation of those who own Italian and Brazilian citizenship.
An Italian-Brazilian citizen residing in Brazil can, under certain circumstances, enter Italy using Brazilian documentation. However, this does not automatically mean that by presenting themselves as Brazilian citizens, they acquire the right to the Italian National Health Service (SSN) free of charge.
For non-EU foreigners temporarily present in Italy for a period not exceeding 90 days, the Ministry of Health specifies that healthcare services are normally provided for a fee, according to regional rates, except for specific agreements or other forms of protection.
Furthermore, the Italian Embassy in Brazil reminds that Brazilian citizens are normally exempt from visas for stays of up to 90 days for tourism and other purposes, but the exemption does not apply when the reason for the stay is medical treatment.
Therefore, simply changing your passport upon entry is not enough to automatically transform a stay for medical treatment into a tourist stay.
And the 100 euro insurance?
The figure of 100 euros for 90 days of health coverage There is no fixed amount established by Italian health legislation as a general alternative to the 2,000 euros.
It may instead refer to a private travel or health insurance, the price of which depends on the company, the age of the insured, the duration and above all the level of coverage.
It is therefore important not to confuse three different situations:
1. Italian resident in Italy:
is normally registered with the NHS and benefits from assistance according to the ordinary rules, including any co-payments.
2. Italian citizen registered with AIRE and residing abroad:
They do not automatically have the same healthcare rights as Italian residents. The new law introduces the possibility for those affected to obtain a national health card by paying an annual contribution of €2,000.
3. Brazilian citizen temporarily present in Italy:
Healthcare services are not automatically free. The Ministry of Health requires temporarily resident foreigners to pay the relevant regional rates, unless specific agreements or other forms of coverage exist.
An issue that concerns thousands of Italians abroad
The new legislation was created with the stated aim of allowing Italians residing outside Europe to maintain a structured relationship with the Italian National Health Service (NHS) through the payment of an annual contribution.
During the parliamentary hearing, it was emphasized that the €2,000 should allow access to the National Health Service and guarantee greater certainty for Italians living abroad who periodically return to Italy for visits, treatment, or family needs.
But for many emigrants the issue is above all economic.
An Italian citizen who lives permanently abroad, pays taxes and contributions in the country of residence and maintains Italian citizenship may be faced with a choice: pay 2,000 euros per year to have access to the Italian National Health Service or otherwise provide for your own health coverage during your stay in Italy, when the new regulation is applicable.
For those living in Brazil, however, the situation is still different, as a healthcare agreement exists between the two countries. It will therefore be crucial to understand, on a case-by-case basis, which services are actually covered by the agreement and which fall under the new rules.
The issue isn’t just a health one. For millions of Italians living abroad, it also represents a concrete change in their relationship with their country of origin: Being an Italian citizen does not necessarily mean having the same health rights as those residing in Italy.
And it is precisely this distinction that, after the new law comes into force, Italians residing in Brazil will need to be particularly aware of before leaving for Italy, especially when the trip is motivated by medical needs.