One more small step: Enrollment in the Italian health care system

After dragging my feet for a few years, I have finally enrolled in the Italian health care system. Lucy and I have divided our lives between Italy and the USA for 14 years now, and a question we’re sometimes asked is how we take care of our medical needs while abroad—a very good question, indeed. The short answer is that we took our chances that we wouldn’t come down with a major illness in Italy, not necessarily the smartest idea, but, per fortuna, it came out OK.

I retired from teaching in 2010 at age 57, and since Lucy and I are essentially the same age, we didn’t yet qualify for Medicare. To tide us over until we reached 65, we enrolled in Samaritan Ministries, a health care sharing program that saved us thousands of dollars while completely covering Lucy’s successful battle with breast cancer in 2013. We became residents in Italy in the 2016, so at that point we could have applied for the Italian tessera sanitaria, but by then we had enrolled in Medicare. This covered our medical needs while in the USA, but Medicare doesn’t provide health services overseas. Fortunately, we enjoy excellent health. We do our annual physicals and inoculations in the USA, and we knew that Italian hospitals would provide us with emergency treatment should a sudden accident or illness befall us while in Montecarlo.

One reason I didn’t enroll before is that I had received conflicting information about the cost. I didn’t want to pay an annual fee for something we probably wouldn’t need. But an additional reason is that I wasn’t sure how to do it, and I lacked confidence in my ability to wade through the bureaucracy with my still limited ability to communicate in Italian. However, as the years passed and my language ability improved, I realized these excuses were pretty flimsy. I just had to go to one of the ASL (Azienda Sanitaria Locale) offices and ask for help.

I chose an office near Lucca, about an hour-long bike ride. I could have taken the train, but I try to take a bike ride every sunny day, and this gave me a good destination. I had to go to three different offices before I found the right one, but once there, I easily explained what I wanted. I had all the right documents in hand for both me and Lucy: carta d’identità, codice fiscale and, for Lucy, her permesso di soggiorno. It turned out that residents under a certain income don’t have to pay anything. Within an hour of finding the right office, I received paper copies of our health cards.

The only problem is that the doctor assigned to us was in Segromino al Monte, eight miles from Montecarlo. That’s not far in car miles, but it would require us to go down the hill of Montecarlo and up another long hill. Google maps say it is 50 minutes away by bicycle, which is all we use for a good part of the time here. I had given the clerk the names of three doctors I knew in Montecarlo and Altopascio, but she said they had no openings. I asked her to give us any doctor near Montecarlo; she told me she could only search the list by name, not by location. She had already been looking for almost 10 minutes, so I felt obligated to say OK when she offered this doctor.

A few days later, I went on the ASL website to see if I could find a doctor in Altopascio who had openings for new customers, and I found five. Armed with this list, I rode off to another office, this time in Capannori, a little closer, only to be told that none of these doctors was actually available. However, there was a new young doctor just starting out in Altopascio, so I asked for and was granted a change to dottor Alessandro Fulceri.

Once back home, I did a web search to see if I could find his office and office hours. I found out that a well-known doctor in Altopascio had recently retired, and the ASL was not able to find a replacement. They advertised the opening a second time and received only one applicant, a third-year medical student. They granted him a provisional certificate, and he will serve in an out-patient clinic 18 hours per week in Altopascio while he continues his studies.

Dottor Fulceri

I’m happy to have a doctor closer to home and am not concerned about his lack of experience. New doctors are often more current on new techniques and procedures, and there’s a good chance he speaks some English if we have trouble communicating in Italian. Next week, I’ll ride to Altopascio to see if we can get an appointment to meet him and get the latest Covid vaccinations. Meanwhile, I feel a little swell of pride that I was able to surmount another hurdle without having to rely on my Italian friends.