Our situation: I am a dual citizen (Italy/US) with

Hi Ugo, thanks for the quick reply.

Our marriage was conducted in the US but it is also registered in Italy, in the comune where I was listed in the AIRE before I became a resident.

Do you have a source for this information, about the health insurance? Because from the limited information I am able to find, it seems like she would have to purchase an insurance policy. I am required to fill out a form attesting to how she will be able to be supported (or support herself) but there are several versions of this form, some seem to be suited to those seeking a visa rather than a soggiorno document.

ok grazie Ugo! This is all very confusing, they tell you what documents you need but not where to find them... for instance the "dichiarazione di ospitalità" form that I found on the website of the comune, says it is for a tourist visa. But my wife is not here as a tourist, as my wife she has different rights than does a tourist, so perhaps the information she needs to provide is different, and if I come to the appointment with that document filled out instead of the "right" one I could be wasting everyone's time! I also don't wish to unnecessarily purchase a health insurance policy for her, if it is not needed or if it is needed but it is not the "right" one (the coverages).

Si Ugo, sono cittadino italiano.

For the benefit of anybody else reading this and as well for Ugo who was kind enough to help me understand the situation... 

to recapitulate, I am an Italian citizen and now live in Italy with my wife who is an American citizen. She is eligible for the carta di soggiorno per familiari UE, it is valid for five years. We have been given much conflicting information by many well-meaning people (not including Ugo who is clearly knowledgable!) about the requirements and even the desirability of this particular document compared to others. We have been told she must purchase (expensive) health insurance in the US first for the first year, we have been told to apply for a permesso di soggiorno instead, we have been told to get the elective residence visa (one year duration), we have been told she must pass a language exam (not true in her case, we are not applying for citizenship through marriage!) and so much more that I have forgotten because I became frustrated and annoyed and confused with all the advice which was often conflicting.

Out of all of this advice, there are only two pieces of it that I now agree were accurate and/or wise:

1. apply for the elective residence visa may be a very good idea unless you already have some other sort of visa that allows you to stay beyond 90 days. This visa must be applied for at your consulate and not when you are already in Italy. It is difficult to get but if you get it, you or your spouse who needs to be "normalized" can go through the process without anxiety over whatever hurdles must be overcome. One year is plenty of time to get things arranged, whatever may come up. We came here with her only having the automatic 90 days tourist visa and as well during the pandemic (with offices closing and reopening then swamped with the backlog), we think we will get this process done in time so that she doesn't have to go away for 90 days but it is going to be close and 90 days really is not a lot of time. I and others advised my wife multiple times that we should apply for the elective residence visa and for various reasons she refused to do so. We are fortunate we got here well before the summer vacation months of July and August when everything here slows to a crawl.
2. once here, we got connected with a local 'fixer' who has had lots of experience navigating the bureaucracy. We could NOT have gotten as far as we have without him. Find one of these, talk to the local "expat" community and it is very likely they will know someone like this. The issue is not a language barrier, the issue is that frequently the various bureaucrats don't understand all the procedures and often don't want to be bothered to work too hard on your behalf if your case is in any way outside of their usual duties or experiences. It requires someone who knows how to 'set them straight' and if necessary go over their heads but all of this done in a graceful manner. He also helped us interpret what the questura was really asking for when they gave us a list of documents to bring to our appointment! I could not have figured that out all on my own even with my very good Italian language skills.

Remember that everyone's immigration situation is unique to their personal circumstances and what they are going through or have gone through may not apply to you and your spouse or partner. (One should especially be skeptical of advice one may be given on Facebook! I would not even try to ask questions there, it is almost a certainty that all of it will be wrong or misleading with respect to your specific circumstances!) As I said above, we received a LOT of well-meaning advice and most of it was wrong for our specific situation because the advice or experiences others had pertained to couples where neither of them were Italian citizens in the first place or they came here with some kind of visa and were looking to convert that visa to a permesso di soggiorno or another visa, etc. I made this post in the first place because I became unnecessarily worried that we would need to pay for an expensive US (but I repeat myself) health insurance policy that covered my wife in Italy thanks to well-meaning advice given by friends of ours who live here already. Thanks again Ugo for setting me straight about this.

Here is the point we are currently at after a visit to the questura in our comune on Friday 28 May: because she changed her name when we married in the US (pro-tip DO NOT DO THIS [change your maiden name] IF YOU THINK YOU MAY LIVE IN ITALY SOMEDAY), we must go to the US consulate and obtain a document that attests that her maiden name and her married name as shown on her old passport (maiden name) and current passport (married name) belong to the same person. Then our fixer will take it to the prefettura to get an apostille, then we can submit all of her paperwork. Once her paperwork for the carta di soggiorno is accepted, then they have six months to respond and the tourist visa clock either stops or no longer applies: she can stay without worrying about it. The fixer told us the approval is fairly automatic so long as the paperwork is in order.

Unfortunately we have to go up to Milan to get this document so that we have it in time for the apostille and then our next appointment at the questura in mid June, but I am going to keep checking the website for the US consulate in Florence because sooner appointments do open up every so often. Fingers crossed, incrociamo le dite!