Health Changes – Budget 2016

January 14th, 2012 - Pat Breen

• PRIMARY MEDICAL COVER: A Medical Card entitles you to most health services free. A GP Visit Card covers the cost of visits to the doctor for your family. The means test for these cards is based on net income i.e. after the deduction of tax and PRSI; of reasonable expenses on rent or mortgage; on travel to work; on childcare and of regular weekly out-of-pocket medical expenses. Savings are valued in the same way as for non-contributory OAP. The cards will be granted if your family’s remaining income after these deductions does not exceed the following guidelines for 2016:

Medical Card GP Only

Under 66 66 and over Under 66 66 and over
• Single living alone e184.00 e201.50 e276.00 e302.00
• Single living with family e164.00 e173.50 e246.00 e260.00
• Married or cohabiting couple (or single parent) e266.50 e298.00 e400.00 e447.00

Additional Allowance for Dependent Children: Medical Card GP Only
• for each of first two children under 16 e38.00 e57.00
• for third and each subsequent child under 16 e41.00 e61.50
• for each of first two children over 16 e39.00 e58.50
• for third and each subsequent child over 16 e42.50 e64.00
• for each child over 16 in full time third level education (no grant) e78.00 e117.00

The HSE will consider cases outside these guidelines in special circumstances, for example to cover one family member with high medical costs. Medical Card holders do not have to pay exam fees for children. Persons with British or EU pensions, who have no Irish Social Welfare pension, generally qualify for the Medical Card regardless of income. Students will only qualify for a Medical Card in their own right if they have an independent income of at least e164 (this can include a student grant which would not count in the Medical Card means-test).

• Persons aged 70+ all now qualify for free GP services, and qualify for a Medical Card if their gross weekly income is less than €500 per week (single), or €900 (couple).

• Once either spouse qualifies at 70, both get cover, if their combined income does not exceed e900 per week.

• A surviving partner aged over 70 will be allowed to keep their Medical Card for three years, provided their income does not exceed e900 per week.

• In the means test, the first e36,000 (single), e72,000 (couple) of savings and investments are disregarded. On the balance only the income actually earned will be counted, on submission of a certificate of interest.

• Children aged five and under qualify for GP Card regardless of parents’ means (contact:, locall 1890 252919). This will be extended to children aged 11 and under during 2016.

• A A2.50 charge per prescription item applies to Medical Card holders (max e25 per month per family). It does not apply to those on the Long-term Illness Scheme.

• Drug Refund: Any individual or family can get a refund on the cost of prescribed drugs used in any month in excess of e144 provided the drug is on the government list.

• GENERAL HOSPITAL ENTITLEMENTS: Everyone is entitled to public in-patient and out-patient hospital services. However, if you see a consultant privately, you will have to pay privately for any test or care arising, unless you give notice that you wish to switch back to join the public waiting list for the treatment.

• Charges: With the exception of Medical Card holders, and children with long-term ailments or referred from school health examinations, the following charges must be paid in major public hospitals:

• Casualty and Outpatients pay e100 unless referred by your doctor or admitted to hospital.

• Public patients pay e75 per night (up to a max e750 in a year).

• Private patients pay charges even if they are in public wards. The charges are e329-e407 (day care) and e659-e813 per night (in ward), e800-e1,000 (single room).

• NURSING HOME SUPPORT: Under the “Fair Deal” patients seeking a place in either a Private or a Public Nursing Home now have the same assessment of need and the same means-test for payment. The patient will be liable to pay towards the cost of care:

• 80% of assessable income (i.e. after deduction of tax, PRSI, mortgage/rent and out-of-pocket medical expenses)

• plus 7.5% of the value of any assets, for a maximum of 3 years. The first e36,000 (single), e72,000 (couple) of assets are disregarded.

A spouse is assessed with half of the couple’s joint income and assets. The HSE can assess assets transferred in the past 5 years. The balance of the cost will be met by the State.

If the assets are in property, the contribution can be deferred until settlement of the person’s estate, but the money owing will be increased by the Consumer Price Index each year. In the case of the family home only, the contribution will be capped at 22.5% (i.e. after three years of care). The deferred charge against the home will not be collected during the lifetime of a surviving spouse or a disabled child. This deferral must be separately requested by the patient, or by a care representative approved by the Circuit Court for a patient who is not capable of making the decision themselves.

• HOME CARE PACKAGE can be applied for, where care in the home is necessary either on discharge from hospital, or to keep a person out of institutional care. Eligibility is based on a Care Needs Assessment and is not based on a means-test or holding a Medical Card.

• CARER’S ALLOWANCE: A person who is living with (or close by with a direct communication system) and giving full-time care to a child on Domiciliary Care Allowance, or to any person aged 16 or over requiring full-time care, can apply for a means-tested weekly Carer’s Allowance of e204 (e242 if carer is 66 or over) plus an annual e1,700 Respite Grant. In the means-test, any weekly income of the carer in excess of e332.50 (single), or half of their own and their spouse’s income in excess of e665 (married) is assessed. The allowance is reduced accordingly. Half rate Carer’s Allowance is payable to persons receiving another Social Welfare payment.

An additional 50% allowance and full respite grant will be paid to a person caring for more than one incapacitated person. Carers are entitled to free travel in their own right. A carer can take up training or paid employment for up to 15 hours per week. Carers are entitled to credited contributions to keep them in benefit. The Allowance is paid for 12 weeks after the death of the person cared for. When they cease caring, a carer is entitled to go on Back to Work, Back to Education or Community Employment Schemes.

• Persons caring full time can qualify for e1,700 Respite Grant (being renamed Carer’s Support Grant) regardless of means, but persons working over 15 hours or on Jobseeker payments will not qualify.

• A Carer’s Benefit of e205 based on your Social Insurance can be claimed for short-term absences from work (up to 24 months) for caring responsibilities. It is available to all insurance classes except S and J. Limited work earning up to e332.50