Medical Cards

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Click here to read our submission for arthritis to be included on list of conditions eligible for a medical card.

Below you will find a detailed description of what a medical card entitles you to, how to apply for one and how to deal with a review and an appeal.

What is a medical card?

How do I apply for a discretionary medical card based on medical hardship?

Medical Card Checklist

What do I do if my card is under review?

I’ve been refused a medical card - what should I do?

 

What is a medical card?

A medical card entitles you to receive free health care services from the HSE.

What will a medical card cover?

You are entitled to the following services if you have a medical card:

  • Free GP visits
  • Prescription medications – Subject to a charge of €2.50 per item.
  • All outpatient services in public hospitals
  • All inpatient treatment in public hospitals.
  • Some dental, ophthalmic (eye), and aural (ear) services
  • Maternity and infant care.
  • Some community personal and social care services

Am I entitled to a medical card?

There are a number of ways in which you can qualify for a medical card:

  1. If your only source of income is social welfare allowance.
  2. Your weekly income is below the income threshold as set by the HSE. See income guidelines: 

Under70’s

Over 70’s 

3. If your income is above the income limit, you can apply for a medical card on the basis of hardship grounds.

How do I apply for a discretionary medical card based on medical hardship?

Many people do not qualify for a medical card under means guidelines i.e: your income is in excess of the income threshold for a medical or GP card and as such are not eligible.

However, if you have an ongoing medical condition like arthritis, you can apply for a medical card if this is placing undue hardship on you. The HSE will assess your medical or social situation to establish whether you are suffering “undue hardship” because you do not have a card.

When applying under hardship grounds it is essential that you provide the HSE with as much information as possible regarding your condition. Any extra costs that are absorbed and cause financial hardship should be stated.

When making your application you should aim to cover this below questions:

  • What is you the condition? How long have you had it?
  • How does it affect your day to day life? And your health?
  • What medications are you on? Are these regular medications? Are there medications that you are not on all the time but may take regularly?
  • Do you need any extra equipment as a result of your condition(s)? E.g: adaptations, orthotics, specialist footwear?
  • Do you acquire extra costs as a result of your medical condition e.g: costs of heating, extra clothing layers etc...
  • What specialist/ consultant are you seeing? ( Name all)
  • When did you last see them and when will you see them again? Include other visits to the hospital here such as appointment for blood test, rheumatology nurse, occupational therapist, physiotherapist etc...
  • Do you require inpatient/day treatment for your condition(s)? E.G: Infusions , joint injections etc..
  • Copies of letters of attendance/detailed medical reports? Download your doctor's letter of support form here
  • How much extra does it cost you to purchase the medication/equipment?
  • What are the financial implications of not having a medical card?
  • What are the medical implications of not having a medical card?
  • Do you require extra visits to other health professional as a result of your arthritis? e.g: People who are on biologics should visit the dentist twice per year to get their teeth cleaned .
  • As a result of your condition or medication are you more susceptible to other illness?Which requires you to visit the doctor more often e.g infections.
  • Do you require extra/ careful monitoring as a result of your medical condition? e.g blood monitoring. 
  • Do you require extra items that place a financial burden on you. e.g : Some treatments like biologics or methotrexate may require you to wear sun cream all year round.
  • If you use special gadgets such as can openers or electric toothbrushes because of your arthritis it is important to state this.
  • Other family factors i.e poor money management, addictions, limited finances etc...
  • Is there loss of earnings as a result of taking time off work for appointments or time off sick, inability to pay for medication costs etc..
  • Are there any extra costs involved in order to reduce further health difficulties (compared to a person without the condition) and associated additional costs. These extra costs which are absorbed, may be causing additional financial hardship.

 What else should you know?

The HSE cannot assume to know your situation unless you truly provide as much information as possible to fully assess your application and condition.

It’s important to note that the person assessing your application is unlikely to have an in-depth knowledge of arthritis or your other conditions. For this reason it is very important to give as much information as to the level of hardship the condition places upon you or your family. i.e why it is important for you or your family to have a medical card and if you didn’t have one what are the implications of this on you and your family?

  • If you are applying under hardship grounds, it’s best to send it by post.
  • Fill the form in full and answer all questions.
  • Make the form easy for the HSE to understand and read.
  • Make copies of all supporting documentation.
  • Send your application by registered post to ensure that it arrives to the correct location.
  • If there is a change in your circumstances, make the HSE aware.
  • Follow up on your application by making a phone call. 
  • Keep a record of everything from when you sent application, what you sent and who you spoke to.

Medical Card Checklist

Preparation

Either completing the form online at www.medicalcard.ie or by the paper-based application, it is essential to do your homework first! Gather all your information in advance of filling the form i.e.

Proof of Payment - Wage slips (showing deductions) or social welfare payment slips

Mortgage Payment Statements

Cost of Mortgage Protection – Is it separate or included in your mortgage?

House Insurance – Copy of the invoice and policy cover

Travel Costs – Distance to work, proof of ownership of the car (log-book), parking fees (if essential) or bus tickets if public transports is used

Childcare Costs – if you are paying someone privately you will need a statement of confirmation of payment. Please note – if the person receiving the payment is on a social welfare payment and it has not be declared, this may affect their payment, so beware!

Bank Statements – People tend to ignore answering the “savings” questions. It is o.k. to have savings but they must be declared even if they do not affect your application

Medical Evidence – It is important to note that you may require extensive proof – correspondence / reports / specialist reports in support of your case even if you are over the threshold. The HSE have discretion to grant a medical card purely on hardship grounds if above the threshold limits. Download your doctor's letter of support form here

Form Filling

Make sure you complete the form in full, and answer all the questions. By not completing the form in full it will delay the application process. Make it easy for the HSE to be able to read and understand your form.

Easier for them means easier for you!

GP Consent

Make sure your GP agrees to accept your application for a medical card even before it can be approved. It is essential you get your GP to complete and stamp the form before submitting.

Tips:

  1. Be clear in your application; assume the person accessing your application has no medical knowledge or understanding of your conditions.
  2. Provide as much information as possible.
  3. Provide as much documentation to support your application as possible, make copies of all supporting documentation.
  4. If you are applying under hardship grounds, it’s best to do this by post.
  5. If you are within the means limit, the online application is the most efficient route. www.medicalcard.ie
  6. Fill the form in full and answer all questions.
  7. Ensure you have all areas of the form signed.
  8. Make the form easy for the HSE to understand and read.
  9. Send your application by registered post to ensure that it arrives to the correct location.
  10. If there is a change in your circumstances, make the HSE aware.
  11. Follow up on your application by making a phone call, if needed.

My card is under review

What does this mean?

When a medical card is under review, it means that the HSE is reassessing the application. They do this to confirm your circumstances. This are assessing if:

  1. There are any changes in your circumstances?
  2. Is a medical card still required, do you still have this medical condition(s).
  3. Is the cost of this condition causing still causing you or your family financial burden?

How will I know if my card is up for review?

The HSE will send a review form to you, which you must return to the Client Registration Unit. It’s very important that you send this form back to them within the given time frame; if the HSE do not receive the form they will not re-issue the card.

Will my card be taken away?

While your medical card is under review you are still entitled to the same level of cover. If a decision not to review your medical card is reached you will lose your medical card and the benefits associated with it. You are entitled to appeal this decision.

When your card is up for renewal, it’s important that you think of information you provided when you initially applied for the card. This is particularly important when applying for a medical card under undue hardship grounds. Click here for a list of topics which should be covered.

I’ve been refused a medical card - what should I do?

Even if your application is unsuccessful don’t be afraid to appeal the decision. Mistakes can happen! This may occur in the calculations or human error.

If you believe your application is not being assessed truly and fairly you can seek a review/appeal and even if unsuccessful you can make a complaint to the Ombudsman Office. You have a right (under the Freedom of Information) to all information held on file about you stored by the HSE in relation to your application, so you can see how the assessment was done and if fairly and properly.

Don’t forget if you don’t let them know if your circumstances have changed or you left out some relevant information on your application, they cannot re-assess your application.

Often applications are turned down because the applicant didn’t provide sufficient evidence to support their claim for undue hardship.

When appealing you should:

Respond to the HSE “Right to appeal” notification which should accompany your refusal letter, do this as soon as possible to avoid delays.

Let the HSE know that you will send in more evidence of your circumstances or change in circumstances.

Provide as much medical evidence as possible but remember you need to demonstrate the financial burden and how not having a medical card will burden you and/or your family.

What happens next?

The appeals office will re-assess your application. This will be carried out by HSE staff who were not involved in the original decision.

If you have any queries regarding medical cards, please get in touch with our helpline 1890 252 846. The helpline is manned by volunteers who have arthritis and is open on Monday to Friday 10am-4pm. 

 

 

 

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