OBJECTIVES: In Italy, the National Health System (SSN) provides full access to essential healthcare services to all citizens. Nonetheless, in 2013 each Italian citizen paid about 508.70 euros as Out Of Pocket payments for healthcare services. The aim of the study is to offer a picture of the Private Health Insurance (PHI) in Italy. METHODS: Data from Italian Authority of Insurance Sector (Ivass) were used to evaluate insurance premiums over a 5-year period (2008-2013) and the distribution of private health insurance by geographical area and individual characteristics was evaluated using data from the “Indagine Multiscopo Aspetti della Vita Quotidiana” of the Italian National Institute of Statistics (ISTAT). RESULTS: In 2013 Private Health Insurance is the second most important insurance coverage (15% of total non-life insurance) in Italy after compulsory motor insurance (45% of total non-life insurance); over the last five years, total direct premiums remained constant been over 5,000 million of euros per year. In 2013, less than one quarter of Italian citizens owned or shared with his\her family a PHI. Northern areas showed the highest frequency of policyholders (17% and 21% in the North West and North East respectively) and Southern regions the lowest (less than 8%). PHI coverage was less frequent among older people - over 65 years - (about 7%) and among subjects with low level of education (9%). PHI was mostly widespread among employees (24%) and among self-employed (38%). CONCLUSIONS: In Italy, PHI is still confined to a minority of people with high variability related to geographical area and individual characteristics. PHI could represent a more efficient and more equity instrument to provide coverage for healthcare needs replacing out of pocket expenditure for Italian householders, with high potential for development of new insurance services.