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Returning emigrants worry about meeting cost of medical care

Q&A: Ensuring you have basic things, such as GP care, can be very worrying for older people returning home after a working life abroad

Ensuring access to basic things such as GP care can be very worrying for older people returning home after a working life abroad. Photograph: iStock

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Dominic Coyle
Sun Jan 21 2024 - 14:52

We are in the middle of moving to Ireland after spending 50 years in UK. We would like to know if we can get a UK medical card as cost of medical care is so expensive. I am over 70 and my wife coming up 70.

We do know people who have returned and have a UK card which covers all medical costs paid for by UK but we don’t know how to apply for it?

Mr P.M.

Many Irish people who moved to the UK for work look to return home later, either for a job or in retirement. And medical costs can suddenly become an intimidating prospect, especially since Brexit, which put so many of the common accords people took for granted across EU countries under threat.

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The biggest part of the challenge is the two-track nature of the Irish health system. While Britain certainly does have a private health sector, it is nowhere as pervasive a part of the healthcare scene as it is in Ireland.

However, there are several paths than can give access to medical care here for returning emigrants, people immigrating to the State and those travelling here for shorter-term breaks.

Common Travel Area

The Common Travel Area is a unique construct between the UK and the Republic that allows for the free flow of people between the two jurisdictions. Among other things it provides for access to public healthcare in each state for citizens from the other.

It dates back to 1923 and was reaffirmed as part of the post-Brexit negotiations.

So, any UK passport holder coming into Ireland is entitled to access the public healthcare system. That right does not automatically extend to their families. Each person looking to avail of Common Travel Area rights must hold either an Irish or a UK passport.

The provision seems to be that you have access to healthcare on the same basis as the people of the other country. The issue here, for you, may be that it would not allow automatic free access to GP care among other things, which, in Ireland, is means tested.

Global Health Insurance Card

This replaces the European Health Insurance Card (EHIC) – know as the E111 to those of us of an older vintage – which is what Irish residents and those from other EU countries would use to access health services in other EU states.

Following Brexit, understandably, UK residents no longer qualify for the EHIC, which is why the British authorities have put the Global Health Insurance Card (GHIC) in place.

One of the key things, as with the EHIC, is that you have to be a resident of the state providing the card. It is designed specifically to provide some medical cover for people who are visiting other countries or staying there for a limited period – say to study or to work on a particular project.

The same applies for the GHIC: you must be ordinarily and legally resident in the UK. So, to apply for one of these cards, you will have to supply a British home address.

You will also have to give your full name, your date of birth and, if you are based in England or Wales, your national insurance or NHS number. That’s a CHI (community health index) number if you live in Scotland or, for Northern Ireland residents, a Health and Care number, which is the unique NHS identifier north of the Border.

The card entitles you to access to medically necessary care in the public health system here that cannot reasonably wait until you return to the UK. That would obviously include A&E care for emergencies but also routine medical care of ongoing long-term or pre-existing medical conditions. It also covers routine maternity care for expectant mothers while travelling, though not the cost of going abroad to give birth, apparently.

What you don’t get is access to private healthcare, nor are you covered if you are travelling abroad for pre-planned procedures – dental care in Hungary comes to mind.

The EHIC version of this card covers you for stays of up to three months abroad (or up to a year for a student). I’m assuming the GHIC is similar.

S1 Form

For people like yourselves who plan to stay in another country for a longer term than that covered by the GHIC/EHIC, another option is the S1 certificate. I suspect this is what you are referring to when you say you “know people who have returned and have a UK card which covers all medical costs paid”.

The S1 is certificate that entitles you to healthcare in a country other than the country where you are insured – in your case, the UK. It is not unique to the UK and Ireland but applies across the EU. Where costs arise, they would be covered by the UK, which is paying your state pension.

The certificate is designed to cover people who will be abroad for longer periods than that normally covered by the EHIC/GHIC. That can include people posted abroad for longer periods, people who work across the border from the country where they live, and people like yourselves, pensioners who have relocated to a new country in retirement.

It gives you the same access to health services here as would be available to Irish citizens. Again, that is access to public healthcare, not the private healthcare system.

The main advantage of the S1 system over your Common Travel Area entitlements is that it covers healthcare for your family as well as yourself, regardless of their passport status.

On the flipside, being accepted for S1 cover will mean you are no longer eligible for standard NHS cover with your GP if you return to the UK. And if you receive a state pension in the country to which you are moving as well as from the country you are leaving, you may not be eligible for S1 cover.

As a UK resident, you need to apply to NHS Overseas Healthcare Services at s1applications@nhsbsa.nhs.uk. This can be done up to three months before you move from the UK. You will need to provide an address in the country you are moving to. That can be a temporary address, but you will need to give details of your permanent address when you settle.

You also need to register the S1 in your new country of residence.

The advantage of this over the Common Travel Area, as far as I can see, is that the UK government, which pays your pension, agrees to meet basic medical costs arising. This would not cover the cost of private procedures but I expect it would cover GP and others fees that are means tested in Ireland but not in the UK. It should also cover medicine costs, which are capped at €80 a month in Ireland

Irish medical card

Finally, it is always open to you to apply for an Irish medical card though, again, this is a means-tested service. However, the means test for people older than 70 is less restrictive.

A single person over the age of 70 can have weekly income of up to €550 – including pensions, earnings, interest from capital and all other sources of income – and be eligible for a medical card. For couples, where at least one person is 70, the weekly limit jumps to €1,050.

In reaching that assessment, no regard is taken of the first €72,000 of your savings (half that for a single person). A notional HSE rate will be applied to savings above this figure but you can opt instead to have the actual interest such savings earn to be used where that is lower.

In relation to property, the only issue is any actual rent that is earned – so if you have a holiday home that is not let out, it will not affect your position. On rent, allowance is made for “necessary expenses” such as insurance premiums, mortgage repayments and maintenance costs.

If a couple is in receipt of a medical card under those rules and one dies, the widow(er) retains entitlement for a further three years as long as their income remains below the cap for couples. After that, they are assessed as a single person.

If you are earning more than those income limits, it is possible to apply instead under the regime that applies to people under the age of 70. Why would you do that when the limits are tighter? Two reasons really.

First, even though the income limits are lower, the means test allows for certain costs that the over-70s test does not – for instance, rent or mortgage expenses as well as nursing home fees.

Second, there are grounds under this test for a hardship appeal, where you can make the case that you would have difficulty meeting the cost of significant and ongoing medical expenses without a medical card.

Please send your queries to Dominic Coyle, Q&A, The Irish Times, 24-28 Tara Street Dublin 2, or by email to dominic.coyle@irishtimes.com. This column is a reader service and is not intended to replace professional advice

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