Elizabeth* and John*, readers from the north-east, applied for a discretionary medical card after John was diagnosed with cancer in 2012. Doctors’ letters supported the application but they were turned down on the basis that their income was too high.

John’s cancer has now returned, and meeting medical bills has become increasingly difficult.

Elizabeth is 64 and has a small pension after working outside the home for some years.

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John, a semi-retired farmer, is 69, and retains some land, while their son now runs the main farm.

The couple have private medical insurance and this has covered the cost of surgery and hospital stays for John over the years, but month-to-month expenditure on health bills is very high – and paying the insurance is a big part of that, she says.

“People think that just because you have private medical insurance you’re sorted, but you’re not.

“We’ve been paying for private medical insurance for years and we’re on one of the higher levels of it, paying €270 per month (€3,240 per year) between us. We have paid for everything all our lives.

“I think the HSE should remember all the health-related costs we have when income is being assessed for a discretionary medical card at a stressful time.

“On top of the €270 a month, we pay €144 for John’s medication each month under the Drugs Payment Scheme (DPS) – that’s €414 a month already.

“Add to that the cost of a GP visit (€60), even one visit a month, and that’s €474 in total. It’s like a mortgage. Then add in money for petrol and parking when attending hospitals in Dublin.”

But it doesn’t stop there, she says, because their insurance doesn’t come near to covering the cost of all the consultants’ check-ups.

“John is now under the care of four consultants for his cancer – surgeon, oncologist, radiotherapist and plastic surgeon.

“Last week we paid out €240 in one day, for example, €120 to two consultants. Then there was the cost of petrol and parking as well.”

John’s four cancer-related check-ups take place every three months – that adds an average of €160 a month to the €474, totalling €630 that the couple have to find. But still it doesn’t stop there. John also attends a heart specialist and a lung specialist on a regular basis for medical conditions that he had prior to cancer – that’s more consultants’ charges.

It is vital to remember that your health insurance doesn’t cover all this, Elizabeth says.

“Firstly, you have to come up with the money for those visits upfront on the day, and you’ll get a bill for the blood tests as well, and, secondly, you only get a pittance back and you wait until the end of your insurance year to get that money.

“We have to pay the first €400 ourselves for these visits in a year (‘the excess’) – that’s money dead in the water straight away.

“After that we might get €40 or so back towards each visit – after we wait until the end of the year for it. It is honestly a struggle to come up with all this money. These hidden health costs aren’t being taken into account when you’re being assessed for a discretionary medical card.

“In our situation, even a GP visit card would have even been a help, but we didn’t get that either.

“At present, my husband gets a reduced old-age pension and no fuel allowance because of my pension. I am absolutely dreading the winter. He feels the cold dreadfully because he is so ill. The fire will be going and the oil on and it costs so much.

“We’re in that (medical card) grey period between the ages of 65 and 70. If I also need to see doctors in the future that will mean more money to come up with if I’ve to see consultants.

“The discretionary medical card would have been a big help to us. This issue of having to be terminally ill to get it isn’t right.

“People don’t even want to hear that they are terminally ill, never mind write it down on forms.

“We didn’t appeal the decision in 2012 because we thought John would put the cancer behind him, but we didn’t realise then that he was going to be diagnosed with secondaries. We may apply again, but I do think anyone with cancer should be given a medical card automatically.

“I know there are a lot of people a lot worse off than we are – you see so many younger people with cancer at the clinics – but no one needs the stress of worrying about medical bills on top of cancer or a very serious illness.” CL

•** Minister for Health James Reilly and the HSE have stated that it isn’t the case that only those who are terminally ill will get the medical card, but just that ‘there is no automatic right to a discretionary medical card if you are diagnosed with serious illness’.

PROFILE

Clare* is from Munster. She is 60 and her husband, Michael*, a retired farmer and factory worker, is 64. Michael is on long-term invalidity pension after serious back trouble some years ago, as well as lung and hearing problems.

His discretionary medical card was taken away this March.

Clare tells us how they have coped with this change to their financial situation.

“When we got the medical card seven years ago, it gave us great peace of mind knowing we didn’t have to come up with money for doctors and medication all the time.

“We applied each year for it and it was always renewed until this year.

“We were turned down in March because we were outside the income limits. We appealed the decision based on our GP’s advice, but we were turned down again.

“We did get the GP visit card though, which does help a bit. But my point is that even on basic social welfare you seem to be outside the income limits.

“Michael gets his invalidity pension of €188 per week, plus what he gets for me as a dependent, and he earns €70 a week doing a clerical part-time job. I also earn €114 a week doing a couple of days work outside the home which gets me out and about.

“We do have free travel and so we have tried to find a way of cutting down on medication costs by going to the North of Ireland to get some of it.

“At the moment, Michael’s inhalers cost €70 a month. We have to buy the branded ones as there are no generic equivalents available, so we buy that locally.

“We have a DPS card, but, because you have to spend €144 each month before medication costs are covered, we don’t get any of that €70 back.

“Michael is on generic drugs for cholesterol and blood thinning and we get a six-month supply of those two drugs in Enniskillen for £54.

“Here it would cost us €104 to buy it for one month (€624 for six months). By going to the North every six months, we save €1,000 a year.

“Luckily, we are in reasonably good health now and we are able to travel to do that.

“What I’d like to point out is that they (the HSE) don’t seem to make allowances for the fact that some people never had a big income. We have no savings. We only have a house now. We have a very modest lifestyle and drive a small 03 car between us, but health costs are now a worry.

“I’m afraid that the €144 DPS limit will rise in the budget as well, which would mean finding even more money every month if I need medication for osteoporosis in the future, like our doctor says I will.

“We’re lucky in that our GP was prepared to write out the six-month prescription. He is cross that some over-70s with big incomes are still getting medical cards, yet the likes of us with less income and more medical problems aren’t.

“It doesn’t seem right to have anomalies in the system. I’m realistic – I know the country is in trouble, but I feel that the income limits for discretionary medical cards shouldn’t have been raised.

“Our income is very basic, yet we are now outside the limit and have been turned down, even with the GP writing letters to support our case.”

•* Names have been changed but are known to editor.