Getting Irish health insurance: A complete guide

21.11.17
12 minute read
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Ireland boasts a thorough public health system, with heavily subsidised care for almost everyone in the country. But some complex aspects to the system can make the difference between care that costs almost nothing, and care that can end up costing quite a lot. If you’re planning a move to Ireland, our guide to health insurance will talk you through the options you face.

What kind of healthcare system does Ireland have?

The basics of the Irish healthcare system are very simple. Everyone who lives in Ireland permanently is eligible for public healthcare. It’s not dependent on taxes or any decisions you make: if you live there, you’re covered by public healthcare.

There are two different levels of public healthcare, though. If your income is below a certain level, you qualify for a ‘Medical Card’, which means free services. If you don’t have a Medical Card, some services - including a visit to the doctor - cost money. The amount you pay is subsidised through the public system, so it’s not the entirety of the real medical cost, but you’ll need to be prepared to face charges if you go to the GP or visit a hospital.

Around 40% of the population choose to take out private health insurance, for a higher level of coverage that may include treatment in private facilities. That percentage - 40% with private insurance - is the highest in Europe.

Who is covered by health insurance and what's actually covered?

Unlike in some countries, you don’t need to rush to take out a health insurance policy the moment your plane touches down in Ireland. If you’ve obtained the right to move to Ireland - either by being an EU citizen or by getting a visa - you’re probably entitled to public healthcare there, without signing up for a specific policy or scheme.

If you’re coming from outside the EU or Switzerland, you should check with the Health Service Executive (HSE) to see if you qualify as an ‘ordinarily resident’ in Ireland. This should be no problem if you can prove that you’re planning on living in Ireland for at least a year.

The exception to this is non-EU students, who don’t qualify for public healthcare. If you’re coming to Ireland from outside the EU to study, you’ll have to take out private insurance. You’ll need to show proof of this when applying for your student visa, so you need to get this sorted well in advance.

If you’re one of the approximately 37% of Irish residents who has a Medical Card, a good amount of services are provided for free, including GP services, inpatient and outpatient hospital costs, maternity care, dental and optical services. Drugs are included too apart from small prescription charges. A further 9% or so of the population have a GP Visit Card, which covers GP visits only: this is for those earning just above the Medical Card threshold, as well as everyone under 6 or over 70.

New arrivals in the country are assessed in just the same way as established Irish citizens, so if you’re moving there now you might qualify for a Medical or GP Visit Card straight away.

There are costs that apply for certain medical services if you don’t have a Medical Card or a GP Visit Card. Without a card, you’ll have to pay for GP visits and stays in hospital, although not for A&E if you’ve been referred there by your doctor. Surgery on the public system does exist, but you might face lengthy waiting times.

A lot of costs relating to maternity care are covered for all, and there are various other benefits available to everyone - see below for more details.

All this means that for most people, private health insurance isn’t an absolute necessity. But a great many people choose to get it nonetheless. Private insurance can offer money back on the GP and hospital charges you face, as well as contributions towards treatment at private hospitals - which might mean that you’re able to avail yourself of their high quality of care and shorter waiting times.

What are the costs of heathcare in Ireland?

The good news is that Irish public healthcare is mainly funded by taxation, so people don’t make regular payments that go specifically towards their statutory healthcare.

If you have a Medical Card, there’s more good news: most services you’ll need are free. There’s a small cost on getting prescription drugs: €2.50 per item, up to a maximum monthly bill of €25 per family. That may well be the only bill you’ll face. With a GP Visit Card, seeing your GP is free, but other medical costs are the same as for those with no card at all.

Everyone else in Ireland has to pay for healthcare. The fees are subsidised, but can still be considerable. GP visit costs vary significantly because they can set their rates themselves. In some Irish counties the average is around €40 per visit, while in others it’s over €50, with Dublin being the most expensive area. Hospitals, however, have flat fees across the country. A trip to A&E costs €100, unless you have a referral note from your GP, in which case it’s free. A night in hospital costs €80 (up to a yearly cap of €800). You may encounter other charges too. You also have to pay for prescription drugs, although they’ll never cost you more than €144 per month if you sign up for the Drugs Payment Scheme. Unlike the medical cards, this scheme isn’t means-tested - everyone is eligible.

Private health insurance in Ireland works the same as anywhere else, with a range of options on monthly premiums and different levels of excess (deductible). Costs therefore vary. The cheapest policies can be around €430 per year (€36 per month), and research by Money Guide Ireland has found the highest available cost per single adult to be €7,964 per year (€664 per month). According to the same research, the average is €1,925 per year (€160 per month). Most private schemes won’t cover 100% of all bills though, so your sum total of medical costs might end up above that.

Whether you’re looking at a private scheme or planning to use the public system, then, it might well be that you need to have money ready to use in Ireland at the beginning of your trip or even before. TransferWise can offer the real exchange rate - the rate you’ll find on Google or XE - and only charges a simple, upfront fee. So when you’re moving money into Ireland to cover costs for healthcare, as well as for everything else, you needn’t suffer the higher exchange rates and hidden fees that banks often charge. If you might be living between countries for a while, a Borderless multi-currency account from TransferWise lets you hold money in euros and up to 27 other currencies while you get set up with a local Irish bank account. You can get your own virtual account in euros, GBP, Australian dollars or US dollars, and you can convert between all supported currencies whenever you need or when the rate is favourable. From 2018 people with a borderless multi currency account can get a debit card connected to is as well, but you can also simply transfer the money to a local bank account.

What are the differences between public and private health insurance?

First of all, remember that you have a certain amount of public healthcare whether you choose it or not: if you live in Ireland permanently, you automatically have some coverage. However, it’s vital to look at the system in a bit more detail. There are two key questions: firstly, if you’re eligible for a Medical or GP Visit Card, and secondly, if you should take out private insurance.

The Medical Card

Only some people are eligible for a Medical Card - around 37% of the population have one. Eligibility is means-tested so it depends on your personal circumstances.

You’re eligible for a Medical Card if:

  • You make less than a certain amount per week. The exact figure varies. For a single person living alone it’s below €184; for a couple aged over 70 it’s below €900. The amount goes up, meaning there’s more chance you’re eligible, if you have children. The calculation isn’t simply what you’re paid: your ‘assessable income’ factors in savings and other sources of wealth, as well as essential costs such as rent and mortgage payments, work-related travel expenses, and childcare. So if you have a higher salary but you have to pay a lot each month on rent and childcare, you might end up being eligible after all.
  • Your medical costs would cause ‘undue financial hardship’. A range of factors might be involved here, from an ongoing medical condition requiring frequent doctor or hospital visits, to issues such as addiction.
  • You’re affected by Thalidomide, or you’ve had a surgical Symphysiotomy.
  • You’re insured with a different EU country. If you already pay towards the health insurance system of another EU country or Switzerland, you can get an Irish Medical Card and hence avoid paying twice for healthcare. Of course, this is somewhat dependent on the terms of your insurance in your native country. Bear in mind that if you’re moving to Ireland from the EU permanently, this might not be much of a long-term solution.

The official Irish authority, the Health Service Executive (HSE), has more information on whether you’re eligible for a Medical Card. It also has instructions on how to apply for one.

If there’s any chance you’re eligible for a Medical Card, you should apply to get one. It doesn’t cost money, and could end up saving you a fortune.

The GP Visit Card

People who earn slightly more than Medical Card holders may be eligible for a GP Visit Card, which entitles you to free GP visits but not free hospital care or other services.

The application process for this is the same as for the Medical Card - fill in the same form, and the HSE will respond by telling you if you’re entitled to receive either type of card. Again, if you might be eligible, you should apply.

Everyone aged over 70 or under 6 is eligible for a GP Visit Card.

Public healthcare without a card

Everyone else in Ireland has to pay for medical costs from GP visits up to emergency care, at subsidised rates. That’s some 54% of the population.

As already discussed, fees can be quite high, even to visit a GP. Bear in mind that fees for hospital stays are capped per year, though, and also that the public healthcare system should cover operations if you need them.

Other public schemes

There are a few more schemes to reduce costs for those not covered with a card. Everyone, regardless of income, is eligible for the Drugs Payment Scheme, which caps the amount you spend on prescriptions at €144 per month. And if you have a long-term condition, the Long-Term Illness Scheme can cover your medication costs completely. Last but not least, the Maternity and Infant Care Scheme entitles expecting and new mothers to many related costs, free of charge.

All of these schemes are free and open to all, but you do have to sign up to them.

Private insurance

Around 40% of the Irish population has private insurance - an unusually high proportion by European standards. This isn’t just because the costs under the public system can mount up - it’s also because private coverage can pay towards treatment in private facilities, leading to shorter waiting times.

It’s fairly common for employers to pay full or partial costs for private health insurance - you should check at your job if any such schemes exist.

There are only four private health insurance companies operating in Ireland, so you don’t face the labyrinth of competition you do elsewhere. Plenty of different options are available, though.

The Health Insurance Authority (HIA) is the state’s regulator for private health insurance. Its website has a very helpful private healthcare comparison tool so that you can pin down the private policy that’s right for you. The key criteria aren't just costs, but also what sort of hospital care you want to be covered for - public, private or high-tech hospitals, and your own room or a ‘semi-private’ one.

The companies offering full private insurance are:

Irish Life used to be called Aviva. It took over a fourth company, GloHealth, in 2016.

Cash plans

Cash benefit plans are another sort of private insurance option. Cash plans allow you to claim a fixed amount back for various medical services, but this amount isn’t tied directly to your hospital bill. These plans can go some way towards the cost of outpatient expenses or hospital stays, although they’re unlikely to be as thorough as a full insurance policy. Amounts towards dental and optical cover are also often included.

Because they offer significantly less coverage than full health insurance, cash plans can cost as little as around €135 per year, or as much as just over €1,000.

A fourth insurance company, HSF, provides cash plans in Ireland, as do Laya and VHI. The HIA has a separate tool for comparing cash plans - you can see exactly what’s on offer there.

Irish healthcare for students

Non-EU students are the only category of people who might be living in Ireland for a year or more, but aren’t eligible for public healthcare. If you fall into this category, you’ll need to get a private policy even before you get your student visa.

EU students should also check if they’re fully covered - you may need to show some paperwork, and confirm details with the insurance policy you have at home.

The official Education in Ireland website has further details on health insurance for students.

Do I need to choose a family doctor / GP?

Yes, you do. You can find one near you via the HSE’s GP finder tool. It’s important to check whether you’re eligible to see a particular GP (general practitioner): most, but not all, GPs accept patients with Medical or GP Visit Cards. Most commonly, GPs are part of the private system - hence the fees you’ll have to pay if you don’t have a card.

If you’d like to see a consultant, you’ll need to be referred by a GP the first time.

Are pre-existing conditions covered?

Under the public system, you might find that you’re eligible for the Long-Term Illness Scheme, which will cover the cost of your medication. This includes conditions such as cerebral palsy and epilepsy. If you have a pre-existing condition, it might also be worth investigating the Medical Card, even if you’re a higher earner: you might qualify for one under the ‘undue financial hardship’ rule described above.

With those exceptions, however, you might still find that you’re not fully covered by state healthcare if you have a pre-existing condition, so looking at private options may be the way forward. Even with private policies, you could find yourself facing waiting periods of up to 5 years before your condition is covered.

Are there any deductions I can make for medical expenses in my Irish taxes?

Yes there are. There’s a range of tax relief options available on the cost of healthcare. The Irish Tax and Customs site explains the options for tax relief on general health expenses and tax relief with private insurance policies. You have to put in claims for the former, but tax is taken off your private insurance premiums at source, so the amount you’re quoted by a private insurer should be after tax.

If you’re on a private healthcare scheme paid for by your work, however, tax won’t be taken off at source. You can still claim it back, though - make sure you remember to do so.

How do I sign up for medical insurance?

Your first stop should be to check if you’re eligible for a Medical or GP Visit Card - you can do this, and apply to get one, via the HSE. They process most requests within 15 days.

To investigate private insurance options, use the HIA comparison tool to find the right one for you. Do check with your employer, too, in case they have any workplace plans.

Don’t forget to avail yourself of any of the government’s free schemes that you’re eligible for: the Long-Term Illness Scheme, the Maternity and Infant Care Scheme and the Drugs Payment Scheme - for which everyone has the right to sign up.

Irish healthcare starts from a very simple premise which is subsidised healthcare for all. But the reality is a system with plenty of twists and turns, and it’s important to know what you’re eligible for - especially because for many of the government’s free schemes, you have to sign up yourself. If you do your research, though, with luck you can find a system that works for you.

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