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Retiring in Italy

Residency routes, healthcare and pension tax · EUR

Routes to residency

Where in Italy

Cost, climate and access to healthcare vary more within Italy than most people expect.

The North West

Milan, Turin, the Italian Riviera and the lakes. The economic centre, with the best hospitals in the country and the Ligurian coast as its retirement edge.

Cost: The most expensive part of Italy, Milan especially. The Ligurian hinterland and inland Piedmont are far cheaper.

Climate: Continental and foggy on the plain, Mediterranean on the Ligurian coast, alpine in the mountains. Three climates in one grouping.

Altitude: The plain is low; the Alps rise steeply behind it. Lake and coastal towns are low-lying.

Who is already there: Large and international around Milan and the lakes; a long-standing British and German presence on the Riviera.

Groups four regions: Piedmont, Valle d'Aosta, Liguria and Lombardy.

The North East

Venice, Bologna, the Dolomites and the Adriatic coast. Prosperous, well served medically, and less visited by retirees than Tuscany despite being cheaper.

Cost: Moderate to expensive. Bologna and Venice are costly; the Emilian plain and the Friulian interior are not.

Climate: Cold foggy winters on the plain, hot humid summers, and alpine conditions in the Dolomites.

Altitude: Mostly low plain. South Tyrol is genuinely alpine, with towns well above 1,000 m.

Who is already there: Substantial in South Tyrol, which is German-speaking, and around Venice. Smaller elsewhere.

Groups Veneto, Trentino-Alto Adige, Friuli Venezia Giulia and Emilia-Romagna.

Tuscany, Umbria and Le Marche

The central hills. The most familiar Italian landscape to foreign buyers and the one with the deepest established expatriate infrastructure.

Cost: Chianti and the Florence area are expensive. Umbria and Le Marche offer much the same countryside for considerably less.

Climate: Mediterranean with real seasons — hot dry summers, cool damp winters, and colder in the Apennines.

Altitude: Hill country throughout, generally 200-600 m. Not a health factor.

Who is already there: Among the largest and longest-established foreign communities in Italy, heavily British, American and German.

Groups three regions: Tuscany, Umbria and Le Marche.

Rome, Lazio and Abruzzo

The capital and the mountains behind it. Rome has the specialists; Abruzzo, an hour and a half away, is among the cheapest and emptiest parts of central Italy.

Cost: Rome is expensive. Abruzzo and southern Lazio are among the best value in the country.

Climate: Mediterranean on the coast, genuinely alpine in the Abruzzo interior with heavy winter snow.

Altitude: Rome is low. The Abruzzo interior is high — L'Aquila sits above 700 m and the Gran Sasso above 2,900 m.

Who is already there: Very large and varied in Rome. Growing in Abruzzo, drawn by prices and by the tax regime.

Lazio and Abruzzo grouped together. Note that Abruzzo is one of the regions whose smaller towns qualify for the 7% flat tax described below, while Lazio is not.

The South

Naples, the Amalfi coast, Puglia and Calabria. The cheapest mainland Italy, and the destination of the tax regime that has drawn foreign pensioners south since 2019: a 7% flat rate on foreign income for new residents of towns under 20,000 people in these regions.

Cost: The least expensive part of mainland Italy by a wide margin, outside the Amalfi and Salento tourist strips.

Climate: The hottest and driest part of the mainland, with mild winters and severe summer heat inland.

Altitude: Coastal plains with mountainous interiors. Basilicata and Calabria are largely upland.

Who is already there: Growing quickly in Puglia, much of it driven by the tax regime. Thin in Calabria and Molise, where services and transport are limited.

Groups Campania, Puglia, Basilicata, Calabria and Molise. All five qualify for the flat-tax regime described below.

Sicily

Large enough to be self-sufficient, with two airports, university hospitals at Palermo and Catania, and a year-round economy.

Cost: Inexpensive. The south-east around Ragusa and Noto costs more than the interior but remains cheap by Italian standards.

Climate: The warmest winters in Italy and very hot summers. The interior is dry; Etna has its own weather.

Altitude: Coastal and hilly, with Etna at 3,300 m. Settlements are low.

Who is already there: Established and growing, drawn by cost and the tax regime. Smaller and more dispersed than in Tuscany.

Sardinia

Quieter than Sicily and further from the mainland. Cagliari is a real city; the interior is among the emptiest places in Western Europe.

Cost: Cheap inland and in the south. The Costa Smeralda in the north-east is among the most expensive places in Italy.

Climate: Mediterranean, windy, with mild winters and hot dry summers.

Altitude: Coastal and hilly. The Gennargentu interior rises above 1,800 m but is barely inhabited.

Who is already there: Modest and concentrated in the south and around the northern resorts. Ferry and flight dependency is the main practical constraint.

Healthcare

Foreign residents with a valid permesso di soggiorno may access Italy's national health service (Servizio Sanitario Nazionale, SSN). Non-EU retirees on an elective residence visa typically register voluntarily (iscrizione volontaria), paying an annual contribution based on income, rather than being automatically enrolled; some permit types allow compulsory free registration, others require voluntary paid registration.

Registration generally occurs once residence is formally established with the local ASL (local health authority), typically after completing residency registration (anagrafe), often within about 3 months of arrival; holders of permits valid for less than three months, or medical-treatment-only permits, cannot register for the SSN at all.

Private health insurance is a condition of residency in Italy.

Private health insurance is typically required to obtain the elective residence visa itself (covering the applicant for the initial period before/alongside SSN enrollment), and is also commonly purchased afterward to avoid long public-system wait times and access English-speaking providers; costs and coverage vary by provider and age of applicant.

US Medicare: US Medicare does not cover medical care received in Italy; Medicare generally only pays for care outside the United States in very limited circumstances, so retirees relying on Medicare must separately arrange Italian public (SSN) coverage or private insurance.

Pension income tax

Italy taxes foreign pension income of its residents.

Italy taxes its tax residents on worldwide income, which includes foreign pension and retirement account payouts; the taxable treatment of a given US pension or 401(k) payout depends on its nature and is addressed partly through the US-Italy tax treaty rather than a blanket exemption or flat rate.

There is a US income tax treaty with Italy.

Article 18 of the US-Italy income tax treaty covers private pensions and generally assigns primary taxing rights to the taxpayer's country of residence, while Article 19 addresses government/public-sector pensions separately; application depends on the specific type of pension or account and the circumstances of payment.

Sources: Do you have to pay Italian taxes on your foreign retirement funds? · Italy Healthcare for Expats: SSN Registration Guide · Italian public healthcare (SSN): Your 2026 Guide

Checked Oct 2026

Customs & etiquette

• Greeting with cheek kisses and handshakes — Italians commonly greet friends and family with two light cheek kisses (starting on the left cheek) and use a firm handshake with direct eye contact in more formal or business settings. Close friends and relatives may hug as well. Wait for the other person to initiate a cheek kiss if you are unsure of the relationship level.
• Cappuccino and coffee timing — Italians typically drink cappuccino and other milk-based coffees only in the morning, often standing at the bar counter, and switch to espresso after meals or later in the day. Ordering a cappuccino after a meal, especially dinner, is seen as unusual by locals.
• Proper meal structure and ordering — A traditional Italian meal follows a set structure: antipasto, primo (pasta/rice/soup), secondo with a side (contorno), and dolce. Diners are not expected to order every course, but mixing courses unusually (like ordering pasta as a side to meat) can confuse waitstaff. Bread is eaten alongside the meal, not with olive oil and vinegar as a starter dip in the Italian tradition.
• Dress modestly at religious sites — When visiting churches, cathedrals, and other religious sites such as St. Peter's Basilica, visitors should dress modestly, covering shoulders and knees. Some sites enforce this rule strictly and will deny entry to those in shorts, tank tops, or overly revealing clothing.
• Dining pace and communal enjoyment — Meals in Italy are meant to be leisurely social occasions rather than quick transactions; servers will not rush you or bring the bill unprompted. Take time between courses and enjoy conversation, and expect to explicitly ask for the check when ready to leave.
• Dressing well in public (la bella figura) — Italians place high value on presenting oneself well in public, known as 'fare bella figura.' Even casual outings often involve neat, coordinated outfits rather than athletic wear or overly casual attire, especially in cities and upscale areas.

Religion

Christian 80.8% · Muslim 4.9% · unaffiliated 13.4% · other 0.9%

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Reference information compiled from the sources cited above and reviewed by hand. Immigration, healthcare and tax rules change and are applied at the authorities' discretion — confirm with the consulate, an immigration adviser or a tax adviser before making plans. Nothing here is tax or immigration advice.

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