3. Eligibility for Health and Personal Social Services

General Information

Eligibility for health services in Ireland is primarily based on residency and means. Any person, regardless of nationality, who is ordinarily resident in Ireland is entitled to either full eligibility (Category 1, i.e. medical card holders) or limited eligibility (Category 2) for health services. A person is normally regarded as "ordinarily resident" in Ireland if he/she satisfies the HSE that it is his/her intention to remain in Ireland for a minimum period of one year.

Persons in Category 1 (medical card holders) have full eligibility for the following services:

  • general practitioner services provided under the General Medical Service scheme;
  • approved prescribed drugs and medicines (subject to a 50 cent charge per prescription item, up to a monthly ceiling of €10 per person/family);
  • all in-patient public hospital services in public wards including consultants' services;
  • all out-patient public hospital services including consultants' services;
  • dental, ophthalmic and aural services and appliances;
  • maternity and infant care service.

The determination of eligibility for medical cards is the responsibility of the Health Service Executive (HSE). Medical cards are issued to persons who, in the opinion of the HSE are unable to provide general practitioner, medical and surgical services for themselves and their dependants without undue hardship. Everyone aged 70 years and over who applies for a medical card will be subject to a means test. If the over 70 years applicant has a weekly gross means below €700 for a single person and €1400 for a couple, they are entltiled to a medical card.

The National Assessment Guidelines used by the HSE to determine eligibility are not statutorily binding. A person whose income exceeds the guidelines may still be awarded a medical card if the HSE considers that his/her medical needs or other circumstances so justify.

A range of income sources are excluded when assessing medical card eligibility. Many allowances such as Carers' Allowance, Child Benefit, Domiciliary Care Allowance, Family Income Supplement and Foster Care Allowance are all disregarded when determining a person's eligibility.

For persons under 70 years of age the HSE assesses income after deduction of tax, PRSI and USC, rather than gross income. Allowance is also made for expenses on childcare, rent and mortgage costs and travel to work.

Specified services for children up to the age of 16 are made available without charge to all, regardless of eligibility. These include: in-patient and out-patient services for all children in respect of diseases and disabilities of a permanent or long-term nature; medical, surgical and nursing services for infants up to the age of six weeks and a health examination and treatment service for pupils of national schools and of other schools which have opted into this provision.

Persons in Category 2 are entitled, subject to certain charges, to all in-patient public hospital services in public wards including consultants' services and out-patient public hospital services including consultants' services. The current public hospital statutory in-patient charge is €75 per night, up to a maximum of €750 in any twelve consecutive months. Attendance at accident and emergency departments is subject to a charge of €100 where the patient does not have a referral note from his/her doctor. This charge applies only to the first visit in any episode of care.

For those who do not qualify for a medical card, a number of schemes apply. Under the Long-Term Illness Scheme persons with an intellectual disability can obtain the drugs and medicines required for the treatment of that condition free of charge. The Drug Payments Scheme provides that a person and his/her dependants will not have to pay more than €120 in any calendar month for approved prescribed drugs and medicines. In addition, a new GP Visit Card has been introduced, entitling holders to free GP services. Eligibility for the card is means-tested.

Treatment Abroad Scheme

The Health Service Executive (HSE) operates a Treatment Abroad Scheme (TAS), for persons entitled to treatment in another EU/EEA member state or Switzerland under EU Regulations and in accordance with Department of Health and Children Guidelines. Within these governing EU Regulations and the Department of Health and Children’s Guidelines, the TAS provides for the cost of approved treatments in another EU/EEA member state or Switzerland through the issue of form E112 (IE). An E112 form is issued to cover the cost of lawfully permitted medical treatment/examination that is not available to an “ordinarily resident” person within their resident member state.

Full details of the scheme, the criteria that must be adhered to when making an application and applications for download are available on the HSE website at the following link: http://www.hse.ie/eng/services/Find_a_Service/entitlements/E112