21 year old with heart condition, medical card??

dmg11234

Hi,

I have a question about medical cards. My fiancé had a heart attack 2 years ago at the age of 19. It was totally out of the blue and he had a very healthy lifestyle before that, he was doing a leisure management course in college. Obviously after the heart attack he had to give that up. He had to have surgery to place a stent in his heart to keep his artery open. As a result, he is now on medication for life. Aspirin, Plavix and Lipitor.

He had a medical card which covered his medication and his rehabilitation, hospital visits and doctor visits which are quite frequent. However his medical card expired a couple of months ago and he has appealed the decision, which was refused. Last month I went to collect his Lipitor, as he already had an extra months supply of Aspirin and Plavix so he didn’t need more of them. In the chemist collecting his prescription of 28 days of Lipitor, I was charged €107. Now I know he may be entitled to a drugs repayment scheme card, but should he not be entitled to a full medical card? We rent an apartment together and he pays 500 a month, we are saving for a house and he has travelling expenses, he cannot afford to pay for his medication. Surely someone with a long standing illness should be entitled to a medical card. He works 40 hours a week and gets paid €12 an hour. So he earns just under 25K per year, before TAX.
He is at his wits end and he is so stressed out about this. The man in the medical card office is so rude to him and he keeps raising his voice at him which is unnecessary. Now my fiancé is saying he is just going to stop taking his medication full stop because of the situation. He didn’t ask to be sick. He could give up work tomorrow on health grounds, get his rent paid for him, get disability benefit, and get the medical card, but he is just an honest decent person and doesn’t want to do that. He needs to be on medication for life.
Can someone advise me, should he be entitled to the medical card? Sorry that is was long winded... Thanks in advance!

GhostInTheRuins

Have a look at the citizens information site to see for yourself - http://www.citizensinformation.ie/categories/health/entitlement-to-health-services/medical_card

It doesn't look like it, I think you earn too much money to qualify. How do you know he could get disability benefit if he stopped working? As far as I know that's only if you receive an injury at work.

Whatever you do, don't let him stop taking his medication, that's just stupid.

andrewh5

GhostInTheRuins wrote: »

How do you know he could get disability benefit if he stopped working? As far as I know that's only if you receive an injury at work.

Whatever you do, don't let him stop taking his medication, that's just stupid.

I agree. My mother couldn't work because of a heart condition but was not entitled to disability benefit.

Stopping his meds would be tantamount to suicide!

dmg11234

i know - i get very stressed out about him taking his medication, he can be careless about taking it sometimes. He is just being stubborn about the situation but he knows it will be the end of us if he stops taking them. He was off work for about 6 months after the attack, and got disability benefit for that time. then after he went back to work, he became sick again and was very faint all the time and he had to stop work for another couple months, and he got the benefit then as well. Im not saying he is going to give up work because there is no chance of him doing that! I guess what i was trying to say was that there are plenty of "disabled" people who get disability when there is nothing wrong with them, i know of a few. BTW, he actually works 37 hours per week and he comes out with 23K per year, before tax, so about 20K after tax. Thanks

GhostInTheRuins

dmg11234 wrote: »

i know - i get very stressed out about him taking his medication, he can be careless about taking it sometimes. He is just being stubborn about the situation but he knows it will be the end of us if he stops taking them. He was off work for about 6 months after the attack, and got disability benefit for that time. then after he went back to work, he became sick again and was very faint all the time and he had to stop work for another couple months, and he got the benefit then as well. Im not saying he is going to give up work because there is no chance of him doing that! I guess what i was trying to say was that there are plenty of "disabled" people who get disability when there is nothing wrong with them, i know of a few. BTW, he actually works 37 hours per week and he comes out with 23K per year, before tax, so about 20K after tax. Thanks

I think the best you can do is probably the drug payment scheme, it's €90(?) a month for a family. It's not great but it's better than nothing I suppose.

tbh

Moved to state benefits, where you may get a more informed response (no offence to the responders so far! ) Mods - feel free to move back if necessary.

GhostInTheRuins

Cheek! :P

The_Conductor

dmg11234 wrote: »

In the chemist collecting his prescription of 28 days of Lipitor, I was charged €107. Now I know he may be entitled to a drugs repayment scheme card, but should he not be entitled to a full medical card?

He should apply for the DPS card immediately- as he has a long term medical condition he probably will qualify for it. Its now EUR100 a month- but it covers all prescriptions. You haven't really given any reason why he would necessarily be considered for a full medical card however......? Unfortunately there are lots of people with longterm, lifelong medical conditions- the vast majority of whom are not entitled to medical cards (unless they meet very specific criterion).

dmg11234 wrote: »

We rent an apartment together and he pays 500 a month, we are saving for a house and he has travelling expenses, he cannot afford to pay for his medication.

Unfortunately a lot of people are in similar situations. He has to learn how to prioritise properly- and you really should try to encourage him in any respect you can.

dmg11234 wrote: »

Surely someone with a long standing illness should be entitled to a medical card.

There are several different schemes out there- not just the monthly DPS scheme- for example, for example the Long Term Illness Scheme- which entitles holders to free medication (but not free doctor visits or other treatments). Unfortunately it has a very strict list of qualifying conditions- which isn't really fair- as conditions that can be equally as debilitating or serious, are randomly covered....... Its unlikely that in the current financially straightened times any other conditions or illnesses will be added to the scheme- but it is worth lobbying the Minister for Health nonetheless.

dmg11234 wrote: »

He works 40 hours a week and gets paid €12 an hour. So he earns just under 25K per year, before TAX.

In all fairness- he shouldn't be paying very much in tax at all- given his income, but he is most probably above thresholds.

dmg11234 wrote: »

He is at his wits end and he is so stressed out about this. The man in the medical card office is so rude to him and he keeps raising his voice at him which is unnecessary.

Your fiancé has the right to be treated in a civil manner- however the rules regarding medical cards are tight and if you do not meet the criteria, the discretionary powers of the deciding officers are limited. There is no point in going back and arguing with them- both you and they will be going around in circles. Unless there is a material change in circumstances regarding the case- once you have exhausted the appeals process, that it.

dmg11234 wrote: »

Now my fiancé is saying he is just going to stop taking his medication full stop because of the situation. He didn’t ask to be sick. He could give up work tomorrow on health grounds, get his rent paid for him, get disability benefit, and get the medical card, but he is just an honest decent person and doesn’t want to do that. He needs to be on medication for life.

First of all under no circumstances should your fiancé give up his medication- that is just plain crazy. I know it can be frustrating beyond all belief- but its not a solution. Regarding giving up work and claiming benefits- he is not automatically entitled to disability benefit or other social welfare entitlements, if he gives up his job. The fact that he needs to be on medication for life, does not enter the equation- his ability to work would be accessed by doctors employed by the DSFA, its simply not the case that he, or I, could give up work tomorrow and claim benefits (despite what the media would have you believe)

dmg11234 wrote: »

Can someone advise me, should he be entitled to the medical card? Sorry that is was long winded... Thanks in advance!

There are strict qualifying criteria for the medical card. When first diagnosed with a list of conditions you may be entitled to a medical card until such time intervention occurs and you return to work etc. For the purposes of determining eligibility for either the medical card, the GP visit only card or other schemes- both his income and also your income, as a couple, will be assessed- its the joint income, and not just his income, which is enumerated.

From a medical perspective- he needs regular prescriptions- and would most probably qualify for the DPS scheme- but from the information you've posted above, I can't see why an exception would be made for him, over many other people with other life long conditions/illnesses.

It is difficult living with a lifelong condition- but providing its monitored and prescribed medication is taken in an appropriate manner, there is no reason that someone cannot have a long and satisfying life. Of course there will be things that other people accept as normal that cannot be done- but you learn to work around these things. Its not nice, and its not something that anyone should have to live with- but we all have to play the hand of cards we are dealt to the best of our abilities.

Best of luck to your fiancé.

angeldelight

Go back to the pharmacy where you got his meds with his PPS number and yours, and ask to register for the Drug Payment Scheme. It's 90 euro a month until the new tax year so you'd get 17 euro back this month. While not ideal - it covers any prescribed medicines in a month that anyone registered for the scheme may need so e.g. if you are on the pill or if he requires an antibiotic they will be free as you have already reached the 90 euro threshold. You need to go to the same pharmacy each time