Medical Cards Special
Over 70 Years
The Health Act 2008 introduced a new scheme of entitlement to medical cards for persons over 70 as of the start of 2009. The Act replaced Section 45 of the Health Act, which had provided for automatic entitlement to medical cards for persons aged 70 and over who are ordinarily residents in the State without regard to means.
The means test differs for those under and over 70 years. Prior to 2010, there was no means test for those over 70 years.
Persons over 70 retained the prior universal entitlement provided that their income did not exceed specified limits. Persons above those income limits were obliged to notify the HSE that their income exceeded the limits by 2 March 2009.
Persons in the age category who do not have a medical card are required to make an application to the HSE and have their eligibility assessed by reference to their gross income. The gross income limits are €700 per week for a single person and €1400 per week for a couple.
Over 70s Means Test
Persons over the age of 70 years with gross incomes in excess of €700 for a single person and €1400 per week for a married couple are no longer entitled to Medical Cards. There are no deductions from this sum. A person over the limit may apply for an ordinary Medical Card or a GP Visit Card if they have high medical expenses.
The above limits were decreased to €600 and €1200, respectively, for persons under 70 years in 2013. For persons in the range of €600-€70 years0/€1200-€1400 over 70 years, entitlement to a GP Visit Card now applies.
The capital means test applies slightly differently to that for persons under 70 years. Investments on property other than the family home over €36,000 single person, €72,000 a couple are treated differently. The balance may be assessed either on the basis of a notional rate or an actual rate. The HSE may use the basis which is better for the applicant.
A notional interest rate is set by the HSE, periodically taking account of average deposit interest rates. The applicant may be assessed on the actual interest return. In the case of a long-term savings product, the HSE will, at the option of the applicant, determine interest at the date of maturity.
Income is not assessed on property where the family is home, holiday home or otherwise unless it generates an income. Actual income is assessed less necessary cost.
Both spouses will qualify for a Medical Card if one is over 70 years old and the other is under 70 years old, provided the income thresholds are satisfied. When a person is widowed and over 70 years, they retain the Medical Card for three years on the basis of the 1400/€1200 threshold.
The single-person threshold applies after that. This does not apply where a spouse or a cohabiting partner etc. dies under 70 years.
Medical Cards for persons over 70 years are subject to review generally every two years.
Extension to Younger Children
The 2011 Programme for Government committed to free GP care for all and the introduction of UHI in order ‘to develop a universal, single-tiered health service” guaranteeing access based on need and not on ability to pay. However, the planned single-tier health system with universal access had not come to fruition.
Similarly, the planned introduction of free GP care for all has not been implemented. However, on foot of the above policy prescriptions, ‘free’2 GP care for under 6s and some over 70s has been implemented since 2015.
One overall assessment is that the reform that has taken place has centred on restructuring and reorganising the governance and delivery of health services rather than significantly improving universal access and coverage.
The Act provides for:
the expansion of GP care without charges on a phased basis to children of primary school age as follows:
- 1st phase: children under 8, expanding current provision to 6 and 7-year-olds
- 2nd phase: children under age 10, expanding provision further to 8 and 9-year-olds
- 3rd phase: children under age 13, expanding provision further to 10, 11 and 12-year-olds
Younger Children
The 2014 Act provides that the HSE shall make general practitioner service available without fees to all children aged five years and younger. The parents and guardians of such children seeking access to the service must provide evidence as it is considered necessary to demonstrate entitlement to the service. Where possible, the HSE will offer a choice of GPs to those accessing the service.
The HSE is entitled to enter into a contract with qualified and vocationally trained general practitioners for the purpose of providing GP services to persons aged five years and younger. It may enter contracts for relevant services, with a registered practitioner who holds a GMS service contract.
The contract is to specify the service to be provided by the GP. The Minister for Health may, by regulation, with the consent of the Minister for Public Expenditure, fix the rate of fees and allowances that are to be paid to GPs for services provided under the contract.
When the Minister is making regulations, he must engage in consultations with prescribed bodies, and regard is to be given to these consultations. Where the rates fixed under the regulations are varied under subsequent regulations, the GP who does not wish to continue to provide services may terminate his contract.
DCA Children
The purpose of the Health (Amendment) Act 2017 is to confer full eligibility for general practitioner and other health services to all children in respect of whom the Domiciliary Care Allowance (DCA) is payable; a person who is a child within the Social Welfare Consolidation Act and in respect of whom an allowance is being paid shall have full eligibility for the services under Part 4 of the 1970 Health Act.
Health (General Practitioner Service) Act 2018 provide for the making available of a general practitioner medical and surgical service to persons in receipt of Carer’s Allowance or Carer’s Benefit under the Social Welfare Consolidation Act 2005. The Act extends the appeals process to decisions regarding the operation of general practitioner medical and surgical services for persons who are in receipt of Carer’s Allowance or Carer’s Benefit.
The Minister may make guidelines relating to the determination of persons being ordinarily resident in the State for certain services provided by the HSE. The existing “ordinarily resident” framework provided for under is amended to encompass the provision of general practitioner medical and surgical services for persons who are in receipt of Carer’s Allowance or Carer’s Benefit.
Health (General Practitioner Service) Act 2018. Provides that persons in receipt of either Carer’s Allowance or Carer’s Benefit are eligible for a general practitioner medical and surgical service without charge. The HSE shall make available without charge a general practitioner medical and surgical service to persons in receipt of Carer’s Benefit or persons in receipt of Carer’s Allowance. They must furnish any necessary documentation that the HSE requires to enable the HSE to establish if the person is, or continues to be, eligible for services.
The HSE may deem persons in receipt of either Carer’s Benefit or Carer’s Allowance, who do not furnish the necessary information required within a reasonable timeframe as specified, not to be eligible for the services. The HSE will, insofar as it is practicable, provide a choice of GP for the services provided.
Under 13 & over 70
Health (General Practitioner Service and Alteration of Criteria for Eligibility) Act provides incrementally for the making available of a general practitioner medical and surgical service to persons who are ordinarily resident in the State and who have not attained the age of thirteen years increase the gross income limits for medical card eligibility for persons aged 70 or older.
It increases the gross income limits for medical card eligibility for persons aged 70 or older. The new limits are €550 per week for a single person and €1,050 for a couple.
Health (General Practitioner Service and Alteration of Criteria for Eligibility) Act 202. provides for
- making available of a general practitioner medical and surgical service without charges to persons who are ordinarily resident in the State and have not attained the age of eight years.
- making available of a general practitioner medical and surgical service without charges to persons who are ordinarily resident in the State and have not attained the age of ten years.
- making available of a general practitioner medical and surgical service without charges to persons who are ordinarily resident in the State and have not attained the age of thirteen years.