Irish public health insurance is paid for out of taxation and subsidies. You must pay out-of-pocket for some services: for example, a €100 fee for a visit to A&E if you have not first seen a GP. This was introduced to prevent time-wasting in hospitals, although it has come under some criticism.

The state scheme does not yet cover everyone for all medical contingencies: as we outline below, under What is covered by the state health insurance system? the system is divided to cover different categories. If you are retired or on a low income, you will be entitled to a greater range of healthcare than higher earners in less vulnerable categories.

Even if you are prepared to make out-of-pocket payments, you will usually need to produce some evidence of your entitlement to healthcare in Ireland, such as proof of property rental or ownership.

State healthcare in Ireland is run by the Health Service Executive, or HSE. If you apply to the HSE for a Medical Card and are refused, you may apply for a GP Visit Card and the HSE will assess whether it might cause you ‘undue hardship’ should you be refused.

Currently, around 31% of the population are entitled to a Medical Card and can access healthcare that is free at the point of delivery. Around 68% of the Irish population do not have full coverage, however, and must pay out-of-pocket for some medical treatment.

If you come from an EU state, you will be able to use your EHIC card, although this is recommended to be used for emergencies only. If you are from the UK, you can either present your NHS card or your NHS number in order to receive care. If you do not have your NHS card or number to hand, you can present proof of ID, such as a driving license, instead: Ireland and the UK have reciprocal medical agreements under Common Travel Area (CTS) legislation. In this case, you will be able to access some outpatient services as well as emergency care.

Contact the HSE to determine your eligibility for your national health coverage. If you think that you might be eligible for a Medical Card or a GP Visit Card, you can apply via the HSE website.

To apply for a Medical Card, you will need to send your application to the HSE and include a recent pay slip, or a P45 if you are no longer employed. If you are retired and receiving a state pension, you will need to include proof of the amount you receive, as well as bank statements to back this up. If you are retired and receiving a private pension, you will need to include a photocopy of a recent pension payslip. If you are self-employed, you will need to include a copy of your most recent Income Tax Return Form and your Notice of Assessment.

Regardless of your employment status, you will also need to include bank statements showing the current balance of your accounts, as well as certificates of interest for any accounts you have. You will also need to show any income you receive from investments.

As well as proof of income, the HSE will also need proof of your expenditure to decide your eligibility for a Medical Card. You will need to include:

• your rent book or tenancy agreement, or documents showing your mortgage payments
• a letter from your childcare provider (if applicable) giving their contact details and showing how much you pay them on a weekly basis
• the address of your office (if you are employed or self-employed) and a note detailing the distance you travel to work
• copies of your tickets, if you travel to work on public transport
• a photocopy of the invoice from your home, if you live in a nursing home or care facility

If you are not eligible for a Medical Card, you can apply for a GP Visit Card instead. You will need to go to the government’s Citizens’ Information website to find out whether you are in an income bracket that is covered for GP Visit Cards.

The application process for a GP Visit Card is the same as for a Medical Card, and you will need to send all of the same items along with your application. You can download an application form via the government’s website, or call 1890 252 919 to request a form to be sent to you in the post. You can also apply by visiting your local health office.

If your application is rejected, you will need to pay upfront for any medical care.

The HSE Medical Card currently covers:

• general practitioners’ services
• public health nursing
• children’s health services
• community welfare
• chiropody
• ophthalmic services
• speech therapy
• social work
• addiction counselling and treatment
• physiotherapy
• occupational therapy
• psychiatric services and home help

The medical care which you are entitled to access depends on the category that you are in. If you are not deemed to be entitled to a Medical Card, you will have to pay. In addition to the A&C fee, some costs are roughly as follows:

• GP visit: €45–75 (some practices charge €25-35 for over-65s and students)
• Hospital charges: €80 per day up, to a maximum of €800 in any twelve-month period, although this can be rescinded by the HSE if you genuinely cannot afford to pay

Specialist assessments are free and so are diagnostic assessments.

Some GPs will offer free maternity care. The Maternity and Infant Care Scheme provides an agreed programme of care to all expectant mothers who are resident in Ireland. This service is provided by a family doctor of your choice, as well as a hospital obstetrician, and you are entitled to it even if you do not have a Medical Card.

Some optical and aural care is also covered under the HSE.

Ireland operates a Drugs Payment Scheme to cover some prescription medications. Under this scheme, individuals and families can be subsidized for approved prescription drugs and certain appliances. There is a cap of €124 per month for each household (set to be cut to €114 in 2020).

To be able to buy cheaper medication, you will need a Drugs Payment Scheme Card, and you will be eligible for this if you don’t have a Medical Card. If you do have a Medical Card, you will need to pay a flat rate of €2 per prescription, up to a cap of €20 per household per month. The levy has been reduced in 2019 for Medical Card holders over 70, however: it is currently €1.50, and due to fall again to €1 in 2020.

Retirees from EU countries, or those from nations which have a reciprocal healthcare agreement with Ireland, are covered in most cases. However, the extent of your coverage may depend on your income. If you have a low income, you will be covered, but if you are elderly and on a higher income, you may only be eligible for a GP Visit Card, which will entitle you to free appointments with your GP. The GP visit card is available to everyone aged over 70 without an income test.

If you are aged under 70, eligibility for the GP visit card is means tested: your income is assessed by the HSE as part of the application process.

However, in practice, expat retirees from EU states are not usually means-tested: check with the HSE first. The Citizens’ Information site has a list of income levels for the GP visit card.

If you are an international student in Ireland, you may be covered by state health insurance if you are from the UK. If you are from an EU nation, you will need to use your EHIC or sign up for private cover. If you are from outside the EU, you will need to take out private health insurance. Some institutions can provide advice on private cover. University College Cork, for example, have agreed a special rate with Study and Protect at a cost of €160 per year.

You will need to consult the HSE regarding your family’s coverage. All children under the age of 6 are eligible for a GP Visit Card. Carers will also be entitled to a GP Visit Card.

If you are over 70, your dependents (spouse, civil partner or cohabiting partner aged under 70) may qualify for a GP visit card if your income is below a certain level. If you have a spouse, civil partner or cohabiting partner, the limit for your combined income is a maximum of €1,400 per week, not including the first €72,000 of savings or similar investments.

If you do not have a spouse, civil partner or cohabiting partner, the income limit is €700 per week, not including the first €36,000 of savings or similar investments.

Some dental treatment is covered by state health insurance. If you hold a Medical Card or a Health Amendment Act Card, you and your dependents will be able to access free dental care. If not, you may still be able to get care for free or at a reduced cost via the Treatment Benefit Scheme or private insurance. If you pay the full out-of-pocket cost, you may also be able to claim tax relief.

Although you may need to make contributions into the social security funds (PRSI), which are calculated on your reckonable pay (your gross pay including any notional pay), these contributions do not directly fund your public healthcare, although they do go towards some benefits such as disability benefit. Your healthcare will be funded out of your taxes. As an expat employee, depending on your circumstances, you may be exempt from paying PRSI.

You may not be covered fully under the national schemes and may therefore choose to take out private cover. Ireland’s healthcare system is also overstretched and private insurance will speed up you access to treatment, as well as offering more comfortable facilities, so even if you are from a country which has a reciprocal healthcare agreement with Ireland, you may still choose private cover for added peace of mind.

Private cover will entitle you to a full range of primary and secondary healthcare. Some private insurers will subsidise medication costs up to the Drugs Payment Scheme caps.

The average rate of private health cover for an individual in Ireland is around €1,925 per annum.

The main international providers offer cover for Ireland. The Health Insurance Authority (HIA) is the independent statutory regulator for the private health market, including the evaluation of any new regulations or legislation for consumers. It administers a Risk Equalisation Fund: this pays health credits to insurance providers for people over 60 to help to meet their higher claims costs. The amount of health credits vary by age, gender and level of cover, and are funded by a community rating health insurance levy paid by health insurers.

All private health insurance providers must sign up to the HIA and also need to satisfy various prudential requirements relating to the Central Bank of Ireland. Providers include:

• Cigna Global
• HSF Health Plan (cash benefit plans but not in-patient health insurance)
• Irish Life Health (formerly Aviva Health)
• Laya Healthcare
• VHI Healthcare

Feidhmeannacht na Seirbhíse Sláinte - Health Service Executive