Depending on where you're returning from, it may take time to readjust to the Irish two-tier healthcare system.
Unless you enjoyed robust – and expensive – cover in the US, you're likely to find the Irish system compares favourably, but if you've been used to cheap prescriptions and doctor visits on the continent, or Canada's comprehensive free system, you may find that the Ireland you're returning to is lacking, with its two tier private and public system.
The public health system is open to all who are “ordinarily resident” in Ireland. To prove this, you may need to show evidence of paying rent or a mortgage or a statement from an employer. This means that you can attend the A&E unit of your local hospital (for a fee of about €100) and can be admitted for treatment to a public hospital (but a nightly fee of €75 applies). GP fees start at around €50 and free maternity care is available for all.
If you're entitled to a medical card (see citizensinformation.ie), you can get free GP services, prescriptions, public hospital and dental services.
And, one positive change to the health system is the introduction, in July 2015, of free GP care for the under 6s and over 70s – provided that enough GPs sign up to the contract. This is due to be extended to all children under the age of 12 in September 2016.
Secondly, you can opt to pay for private health insurance, and given the length of waiting lists it may be an option you would prefer.
However, it's likely that you'll have to incur waiting periods when joining a private health insurer if your cover has lapsed for more than 13 weeks. There are now four operators in the Irish market: Vhi, Laya, Glohealth and Aviva, and while it makes sense to shop around for the best policy, it also makes sense to shop around for an insurer that my waive the waiting periods for you.
From May 1st 2015, you have to wait six months to get cover once you take out an insurance policy, which is not too long to wait. The problem arises however if you need cover for pre-existing conditions (those which you had in the period six months prior to starting insurance), as you'll have to wait for five years. A waiting period of 52 weeks is imposed on maternity related claims.
“This is why a lot of Irish people with dependents abroad keep them on an Irish policy while away,” says health insurance expert Dermot Goode of Totalhealthcover.ie.
However, there may be a way around it. Taking out a Vhi International policy when traveling for example is one way of keeping your Irish health insurance.
According to a spokeswoman for Vhi, with such a policy when you return home, there will not be a break in cover, so you can avoid these waiting periods.
And there are other options. According to health insurance expert Dermot Goode of Totalhealthcover.ie, if you have another international policy such as that offered by Allianz Worldwide Care or Bupa, or even a good quality local product, your insurer may agree to waive the waiting periods.
“I've had quite good success with that, but it is predicated on someone having good cover in place right up to their return to Ireland,” he advises. “Insurers are under no obligation to accept them back, and strictly speaking waiting periods apply but they tend to look at it on case by case basis. You'll have to prove to one of insurance companies here that you've had very good cover while abroad and are still in good health.”
According to Goode, insurers impose the waiting periods in fear that someone will take out a policy, get an operation that costs €50,000 and then cancel it after a year. Having proof that someone has had alternative cover while away can mitigate against such a scenario.
However, if you're over 45 with no cover abroad, “your chances of getting it waived are very remote”, he says, adding that a recent client's request to get the waiting periods waived was turned down, because they had an underlying medical condition.
If you are hoping to get these waiting periods waived, Goode's advice is to avoid people answering phones at the insurance company's call centre and instead seek out a claims manager or go through an intermediary.
You may also be tempted to take out an Irish policy now, if you can afford it and if you have plans to move home in the near future. However, you should be aware that such policies should only be taken out by permanent Irish residents.
Something else to be aware of if you've been living abroad is the introduction, on May 1st 2015, of a new regime known as Lifetime Community Rating. This means that the older you are, the more you will pay for health insurance, as anyone aged over 35 who does not have insurance already will have to pay a loading on the cost of their policy.
So, if you’re 35 and taking out a policy after May 1st that costs €1,000 (net of tax relief at 20 per cent), the actual cost to you will be €1,020, based on a loading of 2 per cent. If you’re 40, the policy will cost €1,120 (loading of 12 per cent), and €1,320 if you’re 50 (loading of 32 per cent). The maximum loading that can apply is 70 per cent for someone aged 69 or over and you will have to pay the loadings for as long as you have the policy.
But there is a way around this too. If you're living abroad, you'll have nine months upon your return to Ireland to take out private health cover and avoid the aforementioned loadings.
"A lot of people aren't aware of this," says Goode, noting that many people living abroad took out health insurance ahead of the May 1st deadline in order to avoid the loadings.
“But they didn't have to,” he says.
This environment means that it can be difficult for people hoping to retire to Ireland to get private health cover – which they can avail of immediately.
As a result, people coming from the UK for example, can find themselves keeping their old cover in place and returning to the UK to get essential treatment, or taking out an international policy, which can be expensive.
If you're looking for an Irish private health insurance policy, the best place to start is www.hia.ie, which has a comparison tool which can help you work through the huge number of options out there and find the best product at the best price for you and your family.
While every effort is made to ensure the information provided is correct at the time of update on May 25th, 2016, readers are advised to check the official websites linked to for the most up-to-date information.