New tax for cross-border workers: 3% more to fund doctors' salaries

Context

TL;DR

• New 3% tax on cross-border workers' net salary from Sept 2026
• Funds will increase doctors' and nurses' salaries in Lombardy
• Affects 'old' cross-border workers living in Switzerland
• Tax aims to retain healthcare professionals in Italy

Key facts

• Tax rate: 3% of net salary for cross-border workers
• Start date: September 2026
• Affected workers: Cross-border workers living in Switzerland and working in Lombardy
• Funding purpose: Increase salaries for doctors and nurses in border areas
• Doctors' salary increase: Around 10,000 euros gross per year
• Nurses' salary increase: Around 5,400 euros gross per year
• Total investment: Approximately 45 million euros
• Ministerial decree: December 15, 2025

New tax on cross-border workers: 3% more to fund doctors' salaries

Starting from September 2026, cross-border workers who live in Switzerland and work in Lombardy will be subject to a new 3% tax on their net salary. This measure, announced by regional assessor Massimo Sertori, was made operational by the ministerial decree of December 15, 2025, and derives from state law 213/2023. The stated goal is to retain healthcare professionals in Italy and ensure the sustainability of services in border provinces such as Varese, Como, and Sondrio.

Who will be affected by the new tax?

The tax will affect so-called 'old' cross-border workers, i.e., those who work in Lombardy but reside in Switzerland. For a practical example, a cross-border worker residing in Mendrisio and working in Varese with a net salary of 4,000 euros per month will find themselves paying 120 euros to support the local healthcare system. This tax has been dubbed the 'health tax' by unions and opposition parties.

Operational checklist for cross-border workers

• Verify your status: Ensure you are classified as an 'old' cross-border worker.
• Calculate the tax: Apply the 3% to your monthly net salary.
• Tax compliance: Prepare to file your tax return with the new tax.
• Tax consultation: Consider consulting an accountant to optimize your tax situation.

Salary increases for doctors and nurses

The plan includes a 20% salary increase for doctors and nurses working in border areas. In concrete terms, we are talking about significant figures: around 10,000 euros gross per year for doctors and around 5,400 euros gross per year for nurses. The operation will involve approximately 7,000 healthcare professionals, with a total investment approaching 45 million euros.

Comparison of practical scenarios

• Before the tax: A doctor earning 60,000 euros gross per year receives a net of approximately 3,500 euros per month.
• After the tax: The same doctor will see a net of approximately 3,400 euros per month, a reduction of 105 euros per month.

Reactions from cross-border workers

The controversy is not only economic but heavily political. The regional council recently rejected the request to cancel the contribution, locking in the norm just before a crucial electoral appointment. The issue of taxing cross-border workers has become the heart of the campaign for the municipal elections on May 24 and 25, 2026. In Lombardy and Piedmont, the discontent of workers who cross the border every day could heavily influence the vote, putting the parties that supported the measure in difficulty.

"This tax is unfair and hits workers who already contribute to the Italian healthcare system."

Key regulations and dates

• State law 213/2023: Introduced the possibility of taxing cross-border workers to fund local healthcare.
• Ministerial decree of December 15, 2025: Made the tax operational from September 2026.
• Municipal elections May 24 and 25, 2026: Crucial electoral appointment that could be influenced by the new tax.

Conclusion

The new tax on cross-border workers represents a significant change for cross-border workers and will have a direct impact on their finances. It is essential that cross-border workers prepare adequately and consider the available options to mitigate the tax impact.

Operational details

Practical Implications for Cross-Border Workers

The new 3% tax on net salary, introduced as of January 1, 2024, represents a significant increase in the tax burden for cross-border workers who work in Ticino and reside in Lombardy. For a worker earning 4,000 euros net per month, this means an additional monthly expense of 120 euros. For those earning 6,000 euros net, the tax amounts to 180 euros per month. It is important to note that this tax is not the only tax levied on cross-border workers, who already contribute with withholding tax in Switzerland and Italian taxes.

Operational Checklist for Cross-Border Workers

• Calculate the impact of the tax: Determine your net salary and calculate 3% to have a clear idea of the monthly impact.
• Update your family budget: Integrate this new expense into your personal finances.
• Consult an accountant: Evaluate if there are opportunities for tax optimization.
• Monitor healthcare services: Keep track of improvements in local healthcare services to assess the return on the tax.

Comparison with the Previous Situation

Before the introduction of this new tax, cross-border workers were not subject to specific contributions for the Lombardy healthcare system. The new measure, approved with Regional Law No. 15 of 2023, therefore represents a significant change in their tax situation. It is important that cross-border workers are aware of this new tax and plan their finances accordingly.

Possible Scenarios

A crucial aspect is understanding how this tax will influence the behavior of cross-border workers. Some may decide to look for work in other Italian regions, such as Piedmont or Veneto, where tax conditions might be more favorable. Others may decide to move to Switzerland, where tax conditions for residents are different. For example, a cross-border worker residing in Mendrisio and working in Lugano might consider moving to Ticino to avoid the new tax.

📊 Comparison of Practical Scenarios

• Scenario 1: Cross-border worker who stays in Lombardy
• Net salary: 4,000 euros
• Monthly tax: 120 euros
• Annual impact: 1,440 euros
• Advantage: No change in residence or work.

• Scenario 2: Cross-border worker who moves to Ticino
• Net salary: 4,000 euros
• Monthly tax: 0 euros (if residing in Switzerland)
• Annual impact: 0 euros
• Advantage: No additional tax, but potential moving and adaptation costs.

The Challenge for the Lombardy Region

The Lombardy Region has the daunting task of demonstrating that the funds collected through this new tax will actually be used to improve healthcare services. With waiting lists that often force citizens to turn to private healthcare, the fear is that the new monthly payment will become yet another 'levy' without tangible benefits.

"The new tax must be accompanied by a concrete improvement in healthcare services, otherwise citizens will not accept it." — A union representative.

⚠️ Warnings

• Check local regulations: Make sure you know the specific regulations of your municipality of residence in Lombardy.
• Consult an expert: An accountant or tax consultant can help you navigate the complexities of the new tax.
• Monitor changes: The tax situation can evolve, so stay updated on the latest news.

Useful tools to protect your net income

To reduce FX leakage, compare CHF-EUR exchange options and banks for cross-border workers.

Key points

What to do if you're a cross-border worker

If you're a cross-border worker employed in Lombardy and residing in Switzerland, it's crucial that you're aware of the new tax introduced on January 1, 2023, and that you plan your finances accordingly. Here are some detailed steps you can follow:

1. Check your net salary: Calculate 3% of your net salary to get an idea of the amount you'll need to pay. For example, if your net salary is 3,000 CHF per month, the tax will be 90 CHF. For a salary of 5,000 CHF, the tax will be 150 CHF. 2. Plan your finances: Consider the impact of this new tax on your monthly budget and make any necessary adjustments. You can use the salary calculator available on our website for an accurate estimate. 3. Monitor healthcare services: Keep an eye on improvements in local healthcare services to ensure that the funds collected are actually used to improve service quality. The Lombardy Region has promised significant investments, but it's important to verify progress.

Operational checklist

• Check your employment contract: Ensure that the new tax has been included in your contract or that your employer has adequately informed you.
• Consult an accountant: If you have doubts about managing the tax, consult an expert to avoid tax surprises.
• Update your family budget: Integrate the new tax into your monthly budget to avoid financial discomfort.

Useful tools

To help you manage this new tax effectively, you can use the salary calculator available on our website. This tool will allow you to easily calculate the impact of the new tax on your net salary.

Practical comparisons

• Scenario 1: A cross-border worker from Lugano with a net salary of 4,000 CHF per month will pay 120 CHF more per month. This could mean a reduction in purchasing power, but also an improvement in local healthcare services.
• Scenario 2: A cross-border worker from Mendrisio with a net salary of 6,000 CHF per month will pay 180 CHF more per month. This could influence monthly expenses, but it's important to consider the long-term benefits.

Regulations and dates

The new tax was introduced with Regional Law No. 15 of 2022, which came into effect on January 1, 2023. The tax was set at 3% of net income to finance doctors' salaries and improve healthcare services in Lombardy.

Conclusion

The new tax on cross-border workers represents a significant change in the tax situation of those who work in Lombardy and reside in Switzerland. It's important that cross-border workers are aware of this new tax and plan their finances accordingly. The Lombardy Region has the challenge of demonstrating that the funds collected will actually be used to improve local healthcare services.

"The tax is a necessity to improve healthcare services, but it's fundamental that cross-border workers are informed and prepared." — A representative of the Lombardy Region

📊 Relevant data:

• Average tax amount: 90-150 CHF per month for a net salary of 3,000-5,000 CHF.
• Most affected Ticino municipalities: Lugano, Mendrisio, Chiasso.

💡 Tip: Use the salary calculator for an accurate estimate and plan your finances accordingly.

⚠️ Warning: Make sure to consult an accountant to avoid errors in your tax return.

Source: comozero.it

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.