A guide to your Entitlements 2009 – Health
• PRIMARY MEDICAL COVER: A Medical Card entitles you to all 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 remaining income after these deductions does not exceed the following guideline for 2009:
|MEDICAL CARD||GP ONLY|
|Under 66||66 and over||Under 66||66 and over|
|Single living alone||€184.00||€201.50||€276.00||€302.00|
|Single living with family||€164.00||€173.50||€246.00||€260.00|
|Married couple (or single parent)||€266.50||€298.00||€400.00||€447.00|
|Additional Allowance for Dependent Children:||MEDICAL CARD||GP ONLY|
|for first two children under 16||€38.00||€57.00|
|for other children under 16||€41.00||€61.50|
|for first two children over 16||€39.00||€58.50|
|for other children over 16||€42.50||€64.00|
|for over 16 in full time third level (no grant)||€78.00||€117.00|
Persons aged 70 and over will from 1st January only be entitled to a Medical Card if their gross income is less than €700 per week (single) or €1,400 per week (couple). If either spouse reaches 70 and qualifies, both will be covered by the Medical Card.
Income derived from assets will be assessed in the means test as follows:
- For those aged 70 and over, the first €36,000 (each) are disregarded and only the interest/dividend that was actually earned on the balance will be counted as means.
- For those under 70 the first €20,000 each is disregarded, the next €10,000 is valued as yielding €1 per week per €1,000,the following €10,000 is valued at yielding €2 per week per €1,000 and the balance is valued at yielding €4 per week per €1000.
Persons on Social welfare who have no other income will generally qualify for a medical card. An increase in Social Welfare will not cause you to lose your card.
The Health Board 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 the health levy nor 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 €204.30 but under the above guidelines.
• Drug Refund: A family can get a refund on the cost of prescribed drugs used in any month in excess of €100.00 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 Outpatient €100 unless referred by your doctor or admitted to hospital
- Public Ward Bed €75 per night (up to a max. €750 in a year)
- Private patients pay €795 per night (semi-private), €984.60 (private), €727.80 (day care).
• National Treatment Purchase Fund: Public patients who have been listed by a consultant for a procedure, are entitled after three months waiting, to have the treatment arranged privately by the National Treatment Purchase Fund. You can contact them yourself or be referred by your GP or consultant (Locall: 1890 720 820). You will be informed of the proposed consultant and hospital for your approval before treatment will be arranged. The maximum wait after contacting the NTPF is three months.
• NURSING HOME SUPPORT: A patient can apply for a subvention towards Private Nursing Home from the HSE of up to €300 per week (tel. 625 0403). The HSE may refuse subvention if the market value of your home exceeds €500,000 and you have income of over €200/week. The subvention is means tested so the maximum contribution will be reduced by:
- Any after-tax income of the applicant in excess of €262.80 per week. A spouse is assessed with half the couple’s joint income.
- 5% of the value of any savings in excess of €11,000.
- 5% of the value (less mortgage) of your home for the first three years, unless your spouse or a dependent (including a relative on social welfare) is living in it. If it is rented, 90% of the rent is counted as means. The property value may be disregarded for six months, if there is a genuine intention to rent/sell.
The subvention may be increased to an enhanced subvention of €763 per week minus the applicant’s net income under a hardship clause after a waiting period. A person who has a property will be treated as a lower priority in applying for this enhanced subvention.
• Access to a Public Nursing Home Bed operated by the HSE is determined based on an assessment by the Consultant Geriatrician in the public hospitals. There is a long waiting list for access. The maximum charge is €153.25 per week.
• During 2009, the whole system will change under “Fair Deal”. New patients seeking a place in either a Private or a Public Nursing Home will 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 accessible income (i.e. after deduction of tax, PRSI, mortgage/rent and out-of-pocket medical expenses)
- plus 5% of the value of any assets, in excess of a disregard of €36,000
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 deferred contribution will be capped at 15% (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: A Home Care Package can fund a care plan in the home, where the need is assessed on discharge from hospital or by the Public Health Nurse to keep a person out of institutional care. The HSE will fund the full cost where the patient’s income is no more than €100 in excess of the Contributory Old Age Pension. The HSE contribution would be reduced by income in excess of that limit.
• CARERS 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 18 or over requiring full-time care, can apply for a means-tested weekly Carers Allowance of €220.50 (€239 if carer is 66 or over) plus an annual €1,700 towards Respite Grant. The carer is assessed with weekly income in excess of €332.50 (single), or with half of their own and their spouse’s income in excess of €665 (married). Their allowance is reduced accordingly disregarding the first €7.60. Half rate Carers 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 and to free telephone rental, free TV licence and free electricity. A carer can take up training or paid employment for up to 15 hours per week. Carers are entitled to credited contributions to keep you in benefit. When they cease caring, they are entitled to go on Back to Work, Back to Education or Community Employment Schemes.
Persons caring full time can qualify for €1,700 Respite Grant regardless of means but persons working over 15 hours or on Unemployment payments will not qualify.
A Carers Benefit of €221.20 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 €332.50 per week is permissible, while claiming this benefit. Your job is protected for the 24 month duration.