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Healthcare in Italy

By Gareth Horsfall
This article is published on: 9th March 2024

You may have seen the interview I did (you can see it again HERE) for Real Expats in Italy channel .

It has taken my name a little bit farther and wider that it had been previously and created a surge in new enquiries and queries, which I am very grateful for. It’s always nice to be introduced to new people and learn more about how people are living in Italy. The more I understand the more I can hopefully pass back to you through this E-zine. Anyway, hence why the E-zine is a bit later than usual.

I was contacted by 2 people in late January to tell me that their local health offices were now asking for the full € 2000 pa. payment to renew their Tessera Sanitaria.   They were not recognising the fact that they were UK citizens covered by the UK / EU withdrawal agreement.  To be fair to the Italian authorities nothing was mentioned in the text stating that there would be an exclusion clause for UK citizens resident pre-Brexit, so it’s no surprise they were asked for the full amount.   I asked some people I know who are still involved in the campaign to protect UK citizens rights post-Brexit and they could only tell me that the issue had been lodged with the UK Embassy, but that they had not heard anything back. I am not sure if that situation has changed but it may just be one of those cases where we just have to learn to live with it.

 On the subject of healthcare in Italy I saw an article in  Sole 24 Ore just this week saying that 5 Italian hospitals were in the Top 100 in the (Western) world, according to NewsWeek.  The highest ranking being Gemelli hospital in Rome at place No 35.   I know everyone has varying experiences of the healthcare service, but most people I talk to especially from the UK and USA say that the healthcare is much better than in their home country.  So hat’s off to Italy for providing such a good health service and one which we all rely on.  If you are interested just click for the article (in Italian):   Sole24Ore
IVAFE
IVAFE: Imposta sulle attività finanziarie all’estero
Increase in wealth tax 2024
In my Oct 2023 E-zine I also pointed out that the wealth tax on assets was going to increase from 0.2% to 0.4% pa if your assets were being managed or held in a privileged tax jurisdiction. The list being as follows:

Alderney; Andorra;  Anguilla;  Antigua e Barbuda; Dutch Antilles; Aruba; Bahama; Bahrein; Barbados; Belize; Bermuda; Brunei; Costa Rica; Dominican Republic; United Arab Emirates, Ecuador; Philippines; Gibraltar; Gibuti; Grenada; Guernsey; Hong Kong; Isle of Man; Cayman Islands; Cook Islands; Marshall Islands ;   Isole Vergini Britanniche; Jersey; Libano; Liberia; Liechtenstein; Macao; Malaysia; Maldive; Maurizio;   Monserrat; Nauru; Niue; Oman; Panama; Polinesia Francese; Monaco; Sark; Seychelles; Singapore; Saint Kitts e Nevis; Saint Lucia; Saint Vincent e Grenadine; Taiwan; Tonga; Turks e Caicos; Tuvalu; Uruguay; Vanuatu; Samoa.

I mention this because a few people have contacted me recently who have had, or are having, an ‘expat’ professional career often working in places like Hong Kong or the United Arab Emirates and have accumulated assets in those jurisdictions; mainly investment portfolios and savings. In addition, it is not unusual for someone working overseas to invest/save in an offshore territory like Jersey or the Isle of Man as a way of retaining assets in a more familiar jurisdiction whilst living abroad. However, a subsequent move to Italy would mean that you would end up paying double the amount of wealth tax, and not only.  In addition, Italy penalises some assets which are not held within the European regulatory framework so you could end up getting a double whammy tax bill when it could quite easily be avoided by re-structuring assets in a more tax efficient manner for Italian life.

UK Self Invested Personal Pensions

For anyone (UK citizen or any other national) who has contributed to a UK SIPP (Self Invested Personal pension) we now have a little more clarity on the tax treatment of the pension account. On 11th January, the Agenzia delle Entrate published an Interpello (opinion on a tax question submitted to them) specifically on the subject of this type of account. You can read the document HERE (interestingly, US retirement accounts (IRA’s) are pretty much the same legal structure as a UK SIPP and so it would make sense that the same logic is applied to them in Italy, as well).

The document pretty much confirms what I have known and been advising clients and commercialisti for some time. The first thing being that the Italian ‘previdenza complementare’ tax regime cannot be applied to these accounts, but equally neither should the wealth tax be applied to this kind of retirement accounts.

If you have any kind of UK personal pension account then I would suggest you take a look at the section RW on your Italian tax return and see if the wealth tax has been applied. The tax will be shown in the box No 15, and it should not be there!   If you find this is the case you need to speak with your commercialista. Instead the box No 20 should appear with an ‘X’, in it which applies the ‘monitoraggio’ status, but not taxed.  Also, do not assume that because wealth tax is not applied that it does not have to be reported…it does.  It’s just that it is monitored as an asset rather than taxed on the fund each year.   You will  normally be subjected to tax when you make a withdrawal from the account. If you are unsure what to look at, then you can always contact me and I can take a look for you.

Tax declaration time is rapidly approaching, commercialisti are starting to be run off their feet and mistakes can be made so if you are invested in a UK personal pension plan (individual or corporate), a SIPP, or a QROP’s, then check your tax return for accuracy and ensure that you are not paying tax that you shouldn’t be paying!

In my next article I will be looking at the subject of the expenses that you can detract from your taxes in Italy, such as medical expenses. So stay tuned for the next edition!

If you have any questions about any of these issues and how they apply to you and your financial situation, or if you think that you might be paying more than need to, then do get in touch and I will be happy to see if I can help you with your plans.

I can be contacted on email: gareth.horsfall@spectrum-ifa.com or on cell: +39 333 6492356

Article by Gareth Horsfall

If you live in Italy and or have financial interests in Italy you can contact Gareth Horsfall directly on: gareth.horsfall@spectrum-ifa.com to request more information about how he may be able to help you. Alternatively you can complete the form below and a message will be sent to him. If you would like to read more about Gareth's work you can follow his blog on tax and financial planning in Italy HERE

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