HEALTH INSURANCE IN IRELAND
Let’s start this journey through “Hibernia” (Land of eternal winter) as Ireland was called by the ancient Romans.
Who is eligible for health care services?
The health care eligibility is primarily based on residency in Ireland, not by your tax contribution or PRSI. Every person, regardless of nationality, with residency in Ireland has automatic entitlement to one of these categories:
Category 1 Medical Card Holders or Category 2 Limited Eligibility, which means that the population of Ireland have been divided into two groups, those who have and those who do not have a MC (medical card). Depending on your income, you may be eligible for a medical card, which entitles you to the full range of following medical services at no cost:
- Free GP services
- Prescribed drugs and medicines subject to a charge per item prescribed
- Public hospital services
- Dental,Optical and Aural services
- Maternity and infant care services
- A range of community care and personal social services.
The GP Visit Card for those who do not qualify for a medical card, as its name suggests, allows you free visits to your GP but you are still required to pay all other services, like those who do not possess the medical card.
I’ll come back to how to register for a Medical Card and GP Visit Card in a moment
What is a GP (General Practitioner)…?
There are around 2,500 GP’s (GP is a general practitioner, a doctor) in Group Practices, Primary Care Centres, Independent Practices and Health Centres, according to the HSE (the department in charge of Ireland’s healthcare). A GP plays the central role in the health care system and often is the first stop if you feel unwell. Patients generally can choose a GP (doctor) from the list of authorized GP’s, who have a contract with the HSE. Some General Practitioners do not accept patients with a medical card. Doctors who are in the authorized HSE program must provide the same quality of service to patients with health cards as to those who pay for the service. Most GP’s in Ireland have private practices and also provide services according to the contract with the HSE to patients with Medical Cards and GP Visit Cards.
GP’s medical services:
- Consultation on the GP’s premises or in your house.
- Immunisation and vaccination of children.
- Medical documentation for absences from work and for Social Welfare payments from the Department of Social Protection.
- Drug prescriptions, referrals for additional tests.
As an Irish resident you are either entitled to free medicine or to pay for prescribed drugs, medical supplies and surgery.
If you own a medical card you pay a Prescription Charge of €2.50 per drug up to the maximum of €25 monthly per family. In the case of being over charged, you are entitled to a refund from the HSE.
More you can find here Prescribed Drugs and Medicines
Category 2 limited eligibility
If you belong to the Category 2 group, those who do not have a medical card, you have to pay for medical services and medicines. For example you’ll have to pay €50 to €60 for an examination by a GP. If you have to re-visit the GP for the same illness you will not be charged an additional fee, or you will be charged half price.
Public Out-Patients. A visit to the hospital because of illness or an accident without a GP referral letter (as an out-patient), will cost you €100 for the first time. If you have to come back because of the same disease or issue you will not need to pay again. A hospital will not charge an additional fee even in emergency when special medical attention needs to be provided by an ambulance vehicle (verified by personal experience).
Public In-Patients. If you stay in a hospital for tests and treatments overnight you are required to pay an overnight In-Patients services fee of €75 per day, up to €750 within a 12 month period.
The €100 Out-Patient fee does not apply to the following groups:
- Medical card holders
- Children up to 6 weeks of ageChildren who have certain diseases and disabilities
- Children referred for treatment from child health clinics and school health examinations
- People who are entitled to hospital services because of EU Regulations
- Women receiving maternity services
- People who are admitted to hospital as an in-patient as a result of attending the casualty department (as you will then be subject to in-patient charges)
- People with Hepatitis C who have a Health Amendment Act Card
- People receiving treatment for prescribed infectious diseases
Long Stay Patients:
Long stay patients, in a hospital for more than 30 days during the last 12 months, must participate in the payment under these rates (Long Stay Charges). This includes all patients, even those who have a medical card. The maximum amount in the Long Stay Care is €175 per week and patients are divided into two groups:
- Class 1: those receiving in-patient services in premises where nursing care is provided on a 24 hour basis. The maximum weekly charge for care will be the lesser of €175.00, or their weekly income less a sum of between €33.00 and €37.99
- Class 2: those receiving in-patient services in premises where nursing care is not provided on a 24 hour basis. The maximum weekly charge will be the lesser of €130.00, or the person’s weekly income less a sum of between €64.00 and €68.99A nil charge applies to all patients with a weekly income below €69.
*( A nil charge ) applies to all patients with ( Weekly Income ) below 69 eur.
Free GP services for children under 6 are part of almost every practitioner.
There are three types of hospital institutions:
- HSE hospitals (managed by the Health Service Executive)
- Voluntary public hospitals (those financed by public funds)
- Private hospitals
Public health care hospital services are provided by both HSE and Voluntary Hospitals and in practice there are very few differences between these two types.
There are a large number of private hospitals who are independent to the HSE. If you decide to go to a private hospital you are required to pay the full cost of services.
As a patient in a public hospital (HSE and Voluntary Hospitals), you do not have to pay for certain examinations and do not have the option of choosing a doctor. In many areas there are waiting lists for certain emergency treatments Waiting Times For In-patient Treatment. The HSE and Voluntary hospitals are subject to Freedom of Information Legislation,in other words they must publish the structure of their business, their type of services etcetera
To apply for hospital treatment:
You have to ask your GP for a written referral. In case of emergencies you can apply in most general hospitals and some specialised hospitals but in this case you will be subject to charge Hospital Charges.
The Health Service Executive (HSE) provides free dental services to certain citizens through the Local Health Offices in your area of residence and private dentists who have a contract with the HSE.
From June 2011, all dentists have had to clearly indicate the price of their services on a place where patients can easily have a look before consultation.
You can apply for a free examination through the Department of Social Protection.
What is included for medical card holders?
One oral examination per calendar year is covered by the medical card, as well as emergency dental treatment for pain relief and sepsis.
Most other medical card treatments require prior approval.
If you do not have a medical card and you had to pay for dental services, you have the right to claim refund for certain services under taxation and medical expenses.Taxation and Medical Expenses
Child health services
Children in Ireland under the care of a parent have the same entitlement as their parent, meaning if the parent has a medical card, the child has the same rights as the parent.
There are also certain services specifically for children that are free regardless of whether their parents have a Medical Card or not.
Children are entitled to vaccination and immunisation services free of charge. Importantly, the vaccination against the Human Papilloma Virus (HPV) is free for girls between 11-14 years of age.
Free GP services for children under 6 are part of almost every local practitioner.
Community care services are free of charge for those who are MC eligible and who are in need of the services. They include:
- Public health nurses
- Home help services
- Chiropody services
- Technical Aids
- Respite Care
- Day-care centres provide recreational, sporting facilities and facilities for rehabilitation
- Meal ServicesTransport Transport
How to apply for a Medical Card:
Anyone who is aged over 16 and resides in Ireland may apply for a medical card. The right to a medical card is based on multiple criteria including:
- Your financial income
- Your cost of living
- Certain illnesses and disabilities.
- EU regulations ( for those who receive a pension )
- You have the right to state-provided program
You can apply through your Local Health Office, , where you will be given a list of available doctors in your area together with a Doctor’s Acceptance Form. Then you choose a GP who is within seven miles of your place of residence. If no GP’s approve your application, the HSE will assign you a GP, after you make three failed attempts to register with one. General practitioners are not able to receive a new patient if they have more than 2000 registered patients under their practise already.
In the case of relocation, you are obliged to re-apply for a MC in your new local HSE Centre.
Below, Suzana, shares her pregnancy experience within the Irish health care system with us:
” Regarding the pregnancy, everything was free of charge once I proved that I resided in Ireland. My arrival at a hospital started with me being placed in a large hospital room, where I had a choice of music to play, the midwife massaged my back, led the conversation and had fun with me, she was very careful and controlled the entire situation. Then, suddenly without reason, complications began and I had to be taken to the ER. When I arrived two doctors quickly and professionally carried out the surgery. After giving birth, I was placed in a room with other women, similar to wards in other European countries but with one big difference, the baby was always with me and we were not separated for even a single moment. I really have no complaints about the overall treatment…
In Ireland, doctors have a completely different approach, for example during a lung examination they will never ask you to take off your shirt to the waist. In contrast, they will slightly pull the shirt collar as little as possible in order to perform procedure. I had an X-ray of my lungs, during which, believe it or not, I was given a dress. Compare that to the same procedure in Croatia where I had to be shirtless…
The Doctors in Ireland do not work in white uniforms, instead they work in suits.The emergency room (ER) is not that great, you have to wait hours for your turn, apart from that it is ok.
Ireland has a big problem with specialists, namely there are very few, and there are long waiting lists in a wide range of fields. There’s no dermatologist and gynaecologist on every step. The PAP smear test is free every three years and the procedure is performed by a qualified nurse. Also, Ireland has a shortage of radiologists, so the Irish struggle with getting proper results.
At the end, what I would like to highlight the most is the human approach above all, which is sincere, very warm and open.