Dáil Éireann Debate, Tuesday - 16 December 2025
1008. Deputy Ken O'Flynn asked the Minister for Health the reason her Department issued no updated circulars, guidance or interpretative instructions for the assessment of discretionary medical card applications for people aged over 70 since 2020, despite sustained medical inflation and rising household costs; and to outline the process used by the Department to ensure fairness and consistency during this period. [71981/25]
View answer1009. Deputy Ken O'Flynn asked the Minister for Health if her Department conducted any equality, vulnerability or impact assessment on the treatment of discretionary medical card applications for people aged over 70 during 2020 to 2025; and if not, to state the reason such assessments were not carried out. [71982/25]
View answerI propose to take Questions Nos. 1008 and 1009 together.
In accordance with the Health Act 1970 (as amended), eligibility for a medical card is determined by the HSE, which assesses each application on a qualifying financial threshold. This is the amount of money that an individual can earn per week and still qualify for a card. It is specific to the individual’s own financial circumstances.
Persons aged 69 and under are assessed under the general means tested medical card thresholds which are based on an applicant’s household income after tax and the deduction of PRSI and the Universal Social Charge. Certain expenses are also taken into account. Persons aged 70 or older are assessed under medical card income thresholds which are based on gross income. However, it should be noted that those aged over 70 can also be assessed under the general means tested scheme where there are particularly high medical costs. Detailed guidelines are available at: www.hse.ie/eng/staff/pcrs/medical-card-and-gp-visit-card-assessment-guidelines.pdf
Every effort is made by the HSE, within the framework of the legislation, to support applicants in applying for a medical card and, in particular, to take full account of the difficult circumstances in the case of applicants who may be in excess of the income guidelines. In such circumstances, the HSE may exercise discretion and grant a medical card, for example:
• Discretionary medical cards issued to patients with significant medical expenses but who do not satisfy the means test.
• Emergency medical cards are issued to patients that are terminally ill, or are seriously ill, and in urgent need of medical care that they cannot afford.
Where a person's sole income is derived from a Social Protection payment, he/she will be awarded a medical card.
The Deputy may wish to note that the provision of medical cards by the HSE on a discretionary basis is not specific or limited to people over 70 only and the arrangements in place are applicable to all people applying for a medical card, taking account of the specific individual circumstances of applicants who may be in excess of the income guidelines.
Information provided by the HSE indicates that there have been increases over recent years in the number of discretionary cards held by persons 70 years old and over, as outlined in the table below.
|
Date |
Number of Discretionary Cards held by 70-year-olds and over |
|
Jan 1st 2021 |
21,306 |
|
Jan 1st 2022 |
24,692 |
|
Jan1st 2023 |
28,702 |
|
Jan 1st 2024 |
32,048 |
|
Jan 1st 2025 |
35,566 |
|
Nov 1st 2025 |
38,076 |
It is important to acknowledge that the administration of medical card exists within a wider eligibility framework, and that a range of other measures have also been implemented over recent years to help increase access to and the affordability of healthcare services, for example:
• since 2015, every individual aged 70 and over has automatic eligibility for a GP visit card.
• under the Long-Term Illness Scheme, patients receive drugs, medicines, and medical and surgical appliances directly related to the treatment of their illness, free of charge.
• under the Drugs Payment Scheme (DPS) no individual pays more than €80 a month towards the cost of approved prescribed medicines. The DPS is not means tested and is available to anyone ordinarily resident in Ireland. The DPS significantly reduces the cost burden for families and individuals with ongoing expenditure on medicines.
• In 2023, GP visit card means-tested eligibility was extended to those who earn up to the median household income.
• GP visit card eligibility was extended from all children under 6 to children under 8
• Public in-patient charges in public hospitals have been abolished.
• Individuals may also be entitled to claim tax relief on the cost of qualifying health expenses, including medicines prescribed by a doctor, dentist, or consultant. Relief is at the standard tax rate of 20%.
I can assure the Deputy that, to ensure the medical card system is responsive and sensitive to people's needs, my Department keeps medical card issues under review and any changes are considered in the context of Government policy and other issues which may be relevant.
