Dáil Éireann Debate, Thursday - 19 February 2026
649. Deputy Ken O'Flynn asked the Minister for Health whether her Department has conducted any review, audit, or policy assessment since 2020 of trends in the exercise of discretion in medical card eligibility decisions affecting persons aged over 70; and if she will provide details of any such review. [13801/26]
View answer651. Deputy Ken O'Flynn asked the Minister for Health whether her Department has assessed the financial impact on older persons who are refused discretionary medical card eligibility but granted a GP Visit Card; and if she will outline any policy considerations arising from such assessment. [13803/26]
View answerI propose to take Questions Nos. 649 and 651 together.
Medical Card provision is primarily based on financial assessment. 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 a 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. Detailed guidelines are available at: www2.hse.ie/services/schemes-allowances/medical-cards/applying/assessment/
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.
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.
Information provided by the HSE indicates that there have been increases over recent years in the number of medical cards held by persons 70 years old and over, as outlined in the table below.
Separately, since 2015, every individual aged 70 and over has automatic eligibility for a GP visit card.
|
Year |
Number of Discretionary Cards held by 70-year olds and over |
|
1st January 2021 |
21,306 |
|
1st January 2022 |
24,692 |
|
1st January 2023 |
28,702 |
|
1st January 2024 |
32,048 |
|
1st January 2025 |
35,566 |
|
1st January 2026 |
38,509 |
Furthermore, under the 2023 GP GMS Agreement, GP visit card eligibility was expanded in 2023 to all children under 8 years of age, and to all those who earn up to the median household income. Over 400,000 additional persons, who otherwise would have attended their GP on a private basis, are expected to become eligible for free GP care under this expansion.
It is important to acknowledge that the administration of the 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:
• 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.
• 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, in order to ensure the medical card system is responsive and sensitive to people's needs, my Department keeps medical card issues under review and any proposals are considered in the context of any potential broader implications for Government policy, the annual budgetary estimates process and legislative requirements arising.
