Standard Medical Coverage

Category One Coverage

Category One eligibility is the complete works - a 'medical card' which covers all ordinary and hospital costs. It also covers dental, opthalmic (eye) and aural (ear) services and appliances like glasses and hearing aids. Maternity and infant care services, including visits to doctors before and after birth are all covered. Prescribed drugs and medicines are also free.

You'll qualify for a medical card if your total income is below a certain threshold. There are various adjustments based on age and number of dependents.

There are extra allowances for children under 16 and for travel and housing expenses. People who have a higher income than these allowances may still qualify for a Medical Card if the the Health Board considers that they are unable to provide adequate health care to themselves and their families.

A medical card would normally cover the applicant and his/her dependent spouse and child dependants. A plastic card (similar to a credit card) is issued. All people over 70 are entitled to a medical card regardless of means.

The full ins and out of the programme are available on the government's information site: citizensinformation.ie

Category Two Coverage

Everyone else in the Republic qualifies automatically for Category Two eligibility. Every resident of Ireland is entitled to all in-patient hospital services in public wards and all out-patient public hospital services subject to an annual maximum charge of a few hundred euro. Accident and emergency departments are covered if you have a referral note from your doctor. If not, they are subject to a charge. Maternity and infant care services such as doctor visits are covered for up to six weeks after birth.

The full panoply of exceptions and exemptions is available on Citizensinformation.ie hospital charges page.

Children

For complete coverage of children's health services (and most are free!), check out the children's health services page of citizensinformation.ie

All children are entitled to new eyeglasses every two years, free dental work, and free orthodonture if the child's teeth are crooked enough to justify such work purely on medical grounds. Cosmetic straightening does not qualify. All such visits are arranged through the public health service and the child deals with a health service professional staff member, doctor, dentist, or nurse. Such free services are available to all children in the Republic as long as they are in Primary School (until fourteen years of age). After that age, usually only those children whose parents have medical cards (Category One coverage) qualify for such free services.

That said, there are advantages to paying for some of these services yourself. First, waiting lists can be weeks to months long for some of these non-critical procedures. Applying for free orthodonture, in particular, can result in several year delays before your child is seen. Click here for further discussion of this issue.

And despite the adjective "free" you're still likely to dig into your wallet for some of these services. For example, eyeglasses are free. The health service optometrist who checked our daughters' eyesight was competent and professional. The wait to access her free services was not lengthy. At the end of her eye exam, we were handed a prescription and form that entitled us to pick up "free" glasses for our girls.

But, the free glasses were decidedly "uncool" - big plastic frames that went out of style in the early 60's. Our girls would rather go blind than wear them in public. So, we plunked down extra cash to "upgrade" to stylish frames the girls picked out for themselves. Mind you, if we didn't have the money, we'd be grateful indeed for all that was on offer for free. But, the entreaties of your youngsters will likely find you checking the contents of your wallets for folding money when some of these free services are on offer.

Similarly, the free dental services are quite excellent. But, our private dentist has the gentlest hands in dentist-dom and we found ourselves paying for his services when fillings were required. Thus does the money depart.

Drug Subsidies and Long Term Illness

Another great scheme that really is a boon is the Drugs Payment Scheme. An individual or family only has to pay a maximum of 85 euro a month for all prescribed medicines or appliances. All such additional expenses will be reimbursed if you submit a claim to have the excess refunded. So, an unusual bout of illness won't end up making too big a dent in the family finances.

Anyone certified as having a long term medical condition requiring on-going medications totalling more than 85 euro a month can apply to join the new Drug Cost Subsidisation Scheme which has been in effect since 1999. If you qualify, the hassle of filling out reimbursement forms is eliminated.

You qualify for the Drugs Payment Scheme if you have a long-term illness or have a prescription that requires regular monthly refills. Heart and cholesterol drugs would be a prime example of such prescriptions. Local pharmacists all carry the necessary forms to apply for these programmes.

People suffering long term illnesses may apply for a special card which entitles them to free drugs and medicines for the treatment of that illness.

Long-term illnesses recognised under the scheme:

• mental handicap
• phenylketonuria
• cystic fibrosis
• spina bifida
• hydrocephalus
• diabetes mellitus
• haemophilia
• cerebral palsy
• epilepsy
• multiple sclerosis
• muscular dystrophies
• parkinsonism
• acute leukaemia
• mental illness for under 16's

Private and Semi-private rooms in public hospitals, however, can cost plenty for Category Two folks. This is one of the areas which private insurance covers.

The Elderly

Elderly people who have certain social security pensions in another EU country qualify automatically for a medical card in Ireland, regardless of their actual income.

Places in both state-run and privately run nursing homes are in high demand. If an elderly person requires care in a residential nursing home, and can prove that they are unable to pay some or all of the costs, they may qualify for Subvention - assistance in paying the costs of the nursing home.

The elderly person applying for subvention is quite rigorously assessed by the Health Board. This includes interviews with the person and their nearest relatives and an evaluation of how well the person is able to carry out every-day tasks.

There are three levels of subvention available:-

• Medium Dependancy
• High Dependancy
• Maximum Dependancy

To qualify for maximum dependancy ther person would have to have no other income than the Old Age (Non-Contibutory) Pension or an income equal to or lower than they would recieve from the pension. They must need constant care and have no children who are able to contribute towards fees.

Among other health services available to the elderly are home help, meals-on-wheels, day care services, physiotherapy, occupational therapy, chiropodist services, and hospital services.

Guidelines to your Entitlements & The Health Service

So, what exactly are you entitled to under the Public Health system? And how do you prove your qualifications?

The answers can be found on the government information site citizensinformation.ie health section. They have dozens and dozens of different pages detailing all the benefits and ins and outs of the health system. These are regularly updated and they have specialists whose sole job is just to track health system changes.