Before you start

Residence registered with the Comune di Milano, or a valid permesso and an address
Codice fiscale
Permesso di soggiorno or its receipt, for non-EU nationals
For voluntary registration: proof of income for the contribution calculation

Step-by-step

1
Establish whether your registration is compulsory or voluntary
Employees, self-employed people, family members of both, and holders of several permit types register free of charge. Students, elective residents and others who fall outside those categories register voluntarily and pay the annual contribution — the distinction decides whether the year costs nothing or €2,000.
In personWho: YouWeek 2–4
2
Register at the ATS district office and choose a GP
Take your documents to the ATS Milano district counter covering your address. You choose a medico di medicina generale from the list for your area — this is the person who writes every referral and prescription — and can change them later.
In personWho: You
3
Pay the voluntary contribution if it applies to you
Since the 2024 budget law the contribution is calculated on the previous year's worldwide income at 7.5% up to a first band and 4% above it, with statutory minimums of €2,000 for most adults, €700 for students and €1,200 for au pairs. It runs to 31 December regardless of when in the year you pay.
In personWho: You
4
Collect or await the tessera sanitaria
The health card carries your codice fiscale, works as the European Health Insurance Card on its reverse, and is posted to your registered address. It is the card pharmacies and clinics ask for.
OnlineWho: You
5
Learn how Lombardy books appointments
Specialist visits and tests are booked through the regional CUP system by phone, online or at pharmacy counters, using the prescription code from your GP. Waiting times vary enormously by specialty, and the same examination is often available far sooner at a hospital an hour away that the booking system will offer you.
OnlineWho: You
6
Know the out-of-hours route before you need it
Between 20:00 and 08:00 on weekdays and around the clock at weekends the GP service is covered by continuità assistenziale, reached in Lombardy on 116117. For anything genuinely urgent it is 112. Milan's pronto soccorso departments triage by colour code and a non-urgent case can wait many hours.
In personWho: You

Documents you’ll need

Codice fiscale
Permesso di soggiorno or filing receipt
Certificate of residence or self-declaration of address
Employment contract or proof of self-employment, for free registration
Proof of previous year's income, for the voluntary contribution

Things most newcomers don’t know

The voluntary SSN contribution stopped being a flat €387.34 on 1 January 2024, and that figure is still everywhere.

The 2024 budget law replaced the old flat fee with an income-based calculation — 7.5% on a first income band and 4% above it — and set statutory minimums of €2,000 for most adults, €700 for students and €1,200 for au pairs. For a student that is more than four times the old fee; for a well-paid elective resident it can be far more than €2,000. Anyone budgeting from a pre-2024 blog or an old consulate page is out by an order of magnitude.

Source: Ministry of Health; 2024 budget law

The voluntary contribution runs to 31 December no matter when you pay it.

It is a calendar-year charge that does not pro-rate. Registering in October costs the same as registering in January and expires ten weeks later. Students in particular are advised at the counter to pay for two consecutive years at once so that a single academic year is actually covered end to end. Timing your first payment badly can double the real cost of your first year.

Source: Ministry of Health

The medico di base is a genuine gatekeeper, and choosing one badly costs you months.

Nothing in the Italian public system moves without a prescription from your assigned GP — not a blood test, not a specialist, not a scan. Lists fill up, and the practical difference between a doctor with evening surgeries near your flat and one with two hours of walk-in a week is enormous. You can change GP at any time at the ATS counter, and almost nobody realises that until they have suffered one for a year.

Source: Regione Lombardia

Lombardy's system is unusually open, and that cuts both ways.

Lombardy runs a quasi-market in which accredited private providers deliver publicly funded care alongside public hospitals, and patients can choose between them on the same ticket. It is why Milan has some of the shortest waits and best outcomes in Italy, and why the same procedure can be available in two weeks at one accredited centre and five months at another. Checking the regional waiting-time lists before accepting the first slot offered is normal practice here.

Source: Regione Lombardia

Common mistakes to avoid

Budgeting for the pre-2024 flat contribution of €387.34.
Paying the voluntary contribution late in the year and losing most of it on 31 December.
Not realising the SSN registration lapses with the permesso and must be renewed with it.
Keeping a GP whose surgery hours make routine prescriptions impractical.
Accepting the first CUP appointment offered without checking other accredited providers.

Some of this may be out of date. Spotted something inaccurate? Help us keep it right for the next newcomer.