Get help Medical Cards What is a medical card? What will a medical card cover? Assessing your financial situation How much can I earn and still qualify for a medical card? What happens if I don’t automatically qualify for a medical card? How do I apply for a discretionary medical card due to medical hardship? Medical card application checklist What does it mean when my medical card is under review? How will I know if my card is up for review? Will my card be taken away? I have been refused a medical card. What should I do? When appealing you should: What happens next? 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? A medical card entitles you to receive free health care services from the HSE. What will a medical card cover? If you have a medical card, you don’t have to pay to see your doctor. A medical card also covers: Prescription medications – subject to a charge of €1.50 per item, up to a maximum of €15 per month, per person or family. For the over-70s, the prescription charge is €1 per item, up to a maximum of €10 per month, per person/family. Public outpatient and in-patient services Eye and ear tests Dental checks Some dental, ophthalmic (eye), and aural (ear) services Maternity and infant care Some community personal and social care services Short-term counselling for mild to moderate psychological difficulties, using the counselling in primary care services A maternity cash grant of €10.16 on the birth of each child (apply to your Local Health Office) Assessing your financial situation A quick assessment of your finances will be carried out during the online application process. This will let you know if you might qualify for a medical card or GP visit card. It is based on basic income and expenses information. A full assessment is carried out later in the application process. For this, you will need to upload documents showing income and expenses. For example, payslip, proof of social welfare payment, childcare costs, etc. How much can I earn and still qualify for a medical card? Your qualifying financial threshold is the amount you can earn a week and still qualify for a card. What happens if I don’t automatically qualify for a medical card? Many people do not qualify for a medical card based on the means test i.e. their 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 and medical expenses, you may qualify for a discretionary medical card. The HSE will assess your medical or social situation to establish whether you are suffering ‘undue hardship’ because you do not have a card. A discretionary medical card gives you the same services as a means-tested medical card. How do I apply for a discretionary medical card due to medical hardship? 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 these below questions: What is your condition(s)? 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)? For example, adaptations, orthotics, specialist footwear? Do you incur 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 them all. When did you last see them and when will you see them again? Include other visits to the hospital here, such as appointments for blood tests, rheumatology nurse, occupational therapist, physiotherapist, etc. Do you require inpatient/day treatment for your condition(s)? For example, infusions, joint injections, etc. Copies of letters of attendance/detailed medical reports. Download your doctor's letter of support form 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? For example, people 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? For example, blood monitoring. Do you require extra items that place a financial burden on you? For example, 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 such as poor money management, addictions, limited finances etc. Is there a loss of earnings as a result of taking time-off work for appointments or due to being 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. The HSE cannot assume to know your situation unless you provide as much information as possible to fully assess your application and condition. It is 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 did not have one what are the implications of this on you and your family? Medical card application checklist Preparation Either completing the form online at 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 If you are applying under hardship grounds, it may be best to send by post as all the relevant information can be forwarded and any additional information can be added to the original submission easier than online. Complete 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 and hold on to these for your own records. Send your application by registered post to ensure that it arrives to the correct location. Proof of payment – wage/salary slips (showing deductions) or social welfare payment slips dated within the last three months stating year-to-date figures. 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/vehicle licensing certificate), parking fees (if essential) or bus tickets, if public transport is used. Childcare costs – if you are paying someone privately you will need a statement of confirmation of payment. Maintenance payments – if you pay maintenance to another person Bank statements – people tend to ignore answering the savings questions. It is ok 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, such as 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. Nursing home costs 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 send your application, what you send and who you speak to. What does it mean when my medical card is under review? 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: There are any changes in your circumstances A medical card is still required? Do you still have this medical condition(s)? Is the cost of this condition 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 is 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 renew 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 is 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 have been refused a medical card. What should I do? Even if your application is unsuccessful do not be afraid to appeal the decision. 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’s Office. You have a right (under 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. Do not forget, if you do not 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 did not 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 0818 252 846. The helpline is manned by volunteers who have arthritis and is open on Monday to Friday 10am-4pm.