Abstract Municipal Solid Waste Incineration (MSWI) has become the most widespread Best Available Technology (BAT) to treat residual waste streams in a reliable and safe way. As such, MSWI has contributed to achieve the landfill diversion targets in many EU member states. Modern waste incinerators, also referred to as Waste-to-Energy (WtE) plants, have furthermore evolved to producers of electricity, heat and steam for energy-consuming industries, agriculture and residences. However, due to the specific composition and properties of MSW and similar waste, and due to the historical development of MSWI, the exploitation of WtE plants as combined heat and power (CHP) plants is not straightforward. The aims of this paper are to develop a better understanding of these limitations, to point out possibilities for increasing the level of energy recovery and utilization in WtE plants, and to document this approach with data and experiences from selected WtE plants currently integrated in CHP schemes. Finally, some design and operational challenges for waste-fired CHP plants are further elaborated from a WtE plant supplier’s perspective.