Medical deductions for border workers in Italy (cross-border guide)

Context

In a nutshell

• G-licensed frontier workers are entitled to LAMal option in Switzerland with a CHF300-2,500 annual allowance for adults
• New 2024 Agreement (effective January 1) regulates double taxation on medical deductions
• Expenses not covered by LAMal are deducted in Italy within €7,500 (old border guards) or €10,000 (new)

Key facts

• What: LAMal health insurance for border workers with optional choice
• When: New Frontier Agreement in force from 1 January 2024 (Italian ratification: Law 83 of 13 June 2023)
• Who: Ticino border guards with G permit
• Deductible: CHF300-2,500 adults, depending on the LAMal policy
• Deduction limit: €7,500 (frontier workers before 17 July 2023), €10,000 (after)
• Convention in force: Double taxation Italy-Switzerland, signed 9 December 1976

A Ticino border crossing simultaneously accesses two health systems: LAMal in Switzerland and the Italian National Health Service. The right to reimbursement is not automatic, but follows precise rules. From 1 January 2024, the New Frontier Agreement clarified how cross-border medical coverage works, eliminating the conflict of tax allocation.

LAMal is not a tax, but a mandatory health insurance. Border workers with a G permit have the right to choose: register with LAMal in Switzerland or stay in the Italian system. Choosing LAMal means paying an annual premium (varies by insurer and model) and a deductible between CHF 300 and CHF

Operational details

The issue of medical reimbursement for border workers is not only a technical insurance issue, but also interacts directly with taxation. The Italian system provides for two channels: direct INPS reimbursement or deduction from the tax return.

If the Italian National Health Service covers a service (general practitioner visit, hospital diagnostic tests, admissions), INPS reimburses the border worker through the contribution registration number, without the need to declare anything extra. If, on the other hand, the expense is not covered by the NHS or is incurred in Switzerland and not by LAMal, the border worker attaches a receipt and invoice to the declaration 730 or Income model in the dedicated section. The Revenue Agency validates the expenditure within the annual limits (€7,500 or €10,000).

How the Swiss franchise impacts Italian reimbursement

The LAMal deductible is relevant because it automatically reduces the Swiss reimbursement, increasing the personal expense borne by the border worker. That difference can then be partially recovered with the Italian deduction, as long as it falls within the limit. Example: a frontier worker chooses a LAMal policy with a CHF 2,500 deductible (lowest premium) and supports a specialist visit of CHF 500. LAMal covers 100% after the franchise is exceeded. But if you pay CHF 200 out of your own pocket because you are still within the franchise, those CHF 200 are not covered by LAMal and can be deducted from Italian income.

The New Frontier Agreement

Useful planning tools

To estimate your pension strategy, use the pension planner and the pillar 3 simulator.

Key points

Getting reimbursed for medical expenses requires different procedures depending on whether the service is covered by LAMal or not. Here's how to operate concretely.

LAMal reimbursement procedure (covered expenses)

1. Pay your groceries at your Swiss healthcare provider (pharmacy, hospital, doctor's office). 2. Receive recipe, invoice, or expense document. Always keep a copy and receipt. 3. Notify the supplier of the LAMal policy number. 4. LAMal reimburses the provider or patient within 30–60 days (depends on the insurance company). 5. If LAMal covers only part of it, the remainder borne by the patient can be deducted from the Italian declaration.

Italy deduction procedure (expenses not covered or partially covered by LAMal)

1. Collect receipts and invoices with the reason "medical service" or "health expense". 2. On your annual tax return (Form 730 or Form Income), enter your expenses in the “Medical and Specialist Expenses” box. 3. Attach a copy of the medical documentation. The bank transfer for foreign medical expenses is not mandatory, unlike restructuring. 4. The Revenue Agency validates the expenditure within the annual limits: €7,500 for frontier workers before 17 July 2023, €10,000 for subsequent ones. 5. The deduction reduces the taxable income. The benefit is proportional to the marginal rate.

Border checklist

• Check with your LAMal company which service is covered before supporting it in Switzerland
• Always collect

First day as a cross-border worker? Our practical guide walks you from cantonal registration to your first paycheck.