Border health: 120 euros per month for medical salaries

Context

Briefly

• A 20% increase in salaries for doctors and nurses within 20 km of the border.
• Measure financed by contribution of old frontiersmen from 3% to 6% net.
• A frontiersman earning 4,000 Swiss francs net will pay around 120 euros per month for the SSN.
• Article 1(237–238) of Italian Law No. 213/2023 does not apply indiscriminately to all cross-border workers. It covers: (a) Italian residents who work and stay in Switzerland and use the Italian SSN; (b) frontier workers under Article 9(1) of the Italy–Switzerland Agreement whose income is taxable only in Switzerland and who exercised the legal right to choose health insurance; and (c) dependants of those two categories. Paragraph 238 sets a progressive 3–6% share of net Swiss salary, with a €30 minimum and an ordinary €200 maximum for each month worked from 2024. The cap may be doubled in cases of omitted payment or omitted communication specified in Article 1(100) of Law No. 207/2024. The Region of residence sets the rates and procedure each year.
• When: Second half of April 2026
• Where: Border area within twenty kilometers from Switzerland and Lombardy region
• Who: Regional Councillor Massimo Sertori, Lombardy Region, healthcare employers
• Amount: From 30 to 200 euros per month at the expense of frontiersmen; 20% bonus for doctors (around 10,000 euros per year) and nurses (5,400 euros per year)

The Lombardy plan to value healthcare personnel

In April 2026, the operational details are defined to counter the emigration of Italian healthcare personnel attracted by Swiss salaries. The Lombardy Region aims to increase salaries of doctors and nurses working in public structures within a radius of twenty kilometers from the Swiss border by 20%. The measure aims to make Italian border hospitals attractive, where professionals are increasingly difficult to engage due to salaries across the border that are three or four times higher than those in Italy.

How much does the contribution collect from frontiersmen

Translated into concrete figures, the provision translates into a retributive increase of around ten thousand euros per year for each doctor and 5,400 euros per year for each nurse in service in the border area. The financing of this measure, not burdening central coffers, is guaranteed by a contribution requested from workers residing in Italy employed in Switzerland under the discipline of old frontiersmen. For a worker earning the equivalent of four thousand Swiss francs net per month, the rate involves a deduction of around 120 euros per month in favour of the National Health Service. The provision is defended by Regional Councillor Massimo Sertori, who reiterates the goodness of the regional choice of applying the contribution starting from the minimum percentage of 3%, even in the presence of a state law that allows going up to 6% of net income. To verify how these withholdings impact on the overall salary before claiming the salary calculator, it is essential to carefully analyse the differences between gross and net income produced by the application of the tax system.

Operational details

The historical roots of the old frontier regime

To understand the reasons for the measure, it is necessary to retrace the history of the tax and health treatment reserved for those who reside in Italy and work abroad. Those who have held the G permit since before July 2023 fall under the transitional regime and benefit from the historical mechanism of exclusive cross-border taxation. For 27 years the old frontier workers have benefited from the benefits of the Italian National Health Service together with their family members, while paying the tax at source exclusively to the Swiss authorities and without having to pay income taxes to the Italian Revenue Agency.

Until 1999, commuters paid sick pay in Switzerland for their own personal coverage and paid a bill of about 600 thousand lire to guarantee assistance to their family members in Italy. With the transition of health management to the Regions and the introduction of the agreement between Switzerland and the European Union on the right of option, the framework has changed. Each border worker had the right to choose within three months of hiring whether to subscribe to the Swiss LAMal coverage (with premiums starting from about 350 euros per month for the individual worker) or rely on the Italian SSN. However, due to a prolonged regulatory vacuum, the old border workers did not pay additional fees for Italian health care while maintaining its full coverage.

Tax federalism and negotiations with the

Useful tools for your case

To verify your within/over 20 km tax scenario, use the net salary calculator and the tax return guide.

Key points

Modalities of operation, controls, and self-certifications

The regional offices are preparing the dedicated informatic applications for the collection of the health contribution. One of the open issues concerns the retrieval of the complete list of old border workers: the Swiss fiscal authorities keep the lists confidential, protecting the data of foreign residents in a similar way to bank secrecy. In the face of Switzerland's refusal to transmit the complete lists of cross-border workers, the Lombardy Region will proceed through mandatory self-certifications for taxpayers, accompanied by rigorous sampling controls based on cross-referenced data available from Italian databases.

For workers who need to plan their monthly exits and verify their fiscal position vis-à-vis the healthcare system and taxes, it is recommended to follow these procedural steps:

1. Retributive status verification: ascertain whether the employment contract is prior to 17 July 2023 to establish membership in the category of old border workers. 2. Calculation of the net taxable base: quantify the net salary received in Swiss francs and convert it to the reference exchange rate to identify the 3% quota. 3. Contribution threshold verification: consider that the law provides for a monthly contribution band ranging from a minimum of 30 euros to a maximum of 200 euros. 4. Choice of medical coverage: compare the Italian contribution with the costs of Swiss health insurance through the LAMal health coverage guide. 5. Monitoring of refunds and border crossings: consult the evolution of agreements between Italy and Switzerland and examine the map of transit points such as Brogeda to plan daily commuting.

Despite political disputes, the Region is proceeding at a fast pace towards the full operation of the bulletins, relying on the fact that the collected resources will remain in the border provinces to strengthen hospital departments and value medical staff on duty.

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Source: ilgiorno.it