James Browne (Wexford, Fianna Fail) | Oireachtas source

I thank the Senator for raising this important matter of what annual savings are made from periodic reviews of medical cards for over-70s versus the cost of carrying out those reviews in light of the increased income and means test thresholds. I have experienced the same situation in my office. Often, even those who have them removed get them back on review or appeal. I welcome the opportunity to update the House on this matter. Eligibility for a medical card is primarily based on a financial assessment conducted by the HSE in accordance with the Health Act 1970, as amended.The HSE assesses each medical card application on a qualifying financial threshold. This is the amount of money that an individual can earn in 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.

Persons aged 70 or older are assessed under the over 70s medical card income threshold, which is based on gross income. In November 2020, the weekly gross medical card income thresholds for those aged 70 and over were increased to €550 per week for a single person and €1,050 for a couple. Since 2015, every individual aged 70 and over has automatic eligibility for a GP-visit card.

The HSE is required to ensure that all applications for new medical cards and all renewals of existing medical cards are issued in accordance with the Health Act 1970, as amended. For the majority of individuals this involves ensuring that the relevant financial thresholds are satisfied. It is important to note that the implementation of a review of medical cards upon reaching their expiry dates is not undertaken to deliver savings, rather it is carried out with a view to ensuring that the HSE is complying with Government policy and legislation on medical card provision. The granting of eligibility through means-testing is considered an objective, fair and equitable approach to providing eligibility to persons with lower incomes. The qualifying threshold calculation takes into consideration the applicant’s particular expenses as well as their income as information regarding these is necessary to validate the applicant’s eligibility for medical card or GP-visit card.

The HSE has given the Department of Health the following information regarding medical cards for people over 70. Any medical card approved for an individual over 70 is usually provided for four years. A total of 194,770 of such cards for individuals over 70 were due to expire in 2023. Of those expiring cards, 89% were extended for people based on information available to the HSE without the need to contact those people directly and only 11% of expiring cards required direct client engagement. Of the 19,347 full applications assessed fewer than 1,000 did not retain medical cards. Any individual not retaining a medical card would retain a right to an over 70s GP-visit card.

Insofar as it can, the HSE seeks to limit the number of people over 70 who are asked to formally engage with the application process. It does this based on a data-driven approach, while also ensuring that it complies appropriately with its statutory responsibilities regarding financial assessments.

To ensure the medical card system is responsive and sensitive to people's needs, the Department of Health keeps medical card issues, including the current medical card income thresholds under review. Any changes are considered in the context of Government policy, the annual budgetary Estimates process and other issues which may be relevant.