This page sets out some information which you will find useful with your or your family member’s diagnosis of epilepsy. The page aims to set out various entitlements which you may qualify for and signposts to where you can obtain further information.
Long Term Illness Scheme
This is arguably the most important scheme to be aware of for a person with epilepsy. This is because qualification for the scheme is condition specific and is not means-tested meaning you do not have meet certain income thresholds to qualify. Epilepsy is a qualifying condition for eligibility for the Long-Term Illness scheme.
Once you have a confirmed diagnosis of epilepsy, you are entitled to the Long-Term Illness scheme. The scheme ensures that all costs of medications prescribed for your epilepsy are covered the state. Prescription charges do not apply these medications. Therefore, even if you have a Medical Card (see information on that below), it worth getting a LTI card as you will not have to pay prescription charges. You can avail of the LTI card even if you have a full medical card or a GP visit card.
Note: Even though there is automatic entitlement for the Long-term Illness scheme because of having epilepsy, you still must apply for the benefit. The HSE will not be sending you an LTI card automatically at the point of your or your family member’s diagnosis, so you need to apply directly.
Medical Card & GP Visit Card
If you hold a medical card, you can receive certain health services free of charge. Normally, your dependent spouse or partner and your children are also covered for the same range of health services. A GP visit card allows you to visit a participating family doctor (GP) for free.
Often, we are asked whether there is automatic entitlement for a Medical Card or a GP Visit card because of a diagnosis of epilepsy. The short answer here is no – there is no automatic entitlement. However, you may qualify for a card provided you meet the income thresholds. These thresholds change depending on your circumstances – number of dependent children, whether you have a spouse or partner etc. Additionally, discretionary Medical or GP visit cards can be awarded in certain cases even if income limits have been surpassed due to medical need.
If you are unsure of your eligibility, you can see further information below at the links below. If you feel you are exceeding income limits, our advice would be to apply anyway and have your information assessed. This is worth doing as a discretionary decision could be made given your or your family member’s diagnosis of epilepsy.
The Medical Card and GP Visit card are assessed under the one application form and take account of the entire household as part of the application process – i.e, if you have a family of four (two parents and two children; one child with epilepsy), you will need to include details of the entire household, even if you are only applying with the view to establishing your child’s eligibility for a Medical or GP visit card. Those over 70 automatically for a GP visit card but can have their eligibility for a full Medical Card assessed under the form.
Children with epilepsy and Medical & GP visit cards
There is no automatic entitlement to a medical card or GP visit card for children with epilepsy. However, if you are availing of Domicialliary Care Allowance for your child, there is an automatic entitlement for a full medical card. Further information on DCA is contained under the “Disability and other allowances” in this section of our site.
Furthermore, as previously mentioned, there is the possibility that your child could be entitled to a discretionary card even if your household do not quality. Again, this is why we recommend that you apply and have your eligibility assessed.
Finally, all children up to the age of 5 are entitled to a GP visit card. In the most recent budget, it was announced that this eligibility will be extended to children aged 6 & 7. There are no further details on when this will come into force to date, but this page will be updated with details when they do become available.
Note: As with the LTI scheme, even if there is automatic entitlement to a GP Card (child aged up to 5, aged over 70), you still need to apply directly to the HSE for the card.
Drugs Payments Scheme
While people with epilepsy are entitled to free epilepsy medication ion the Long-Term Illness Scheme they will have to pay for other prescribed medication unless they have a full medical card. Some people with epilepsy can be living with other conditions and the LTI scheme may not cover prescriptions for this as it is unrelated to their epilepsy. If you do qualify for a medical card, then the Drugs Payment Scheme help to ensure that no individual or family pays no more than a certain amount for an approved prescribed medication. As of Budget 22, this maximum amount is €100 per month.
We know that people with epilepsy can be regularly admitted to hospital due a seizure and should they not qualify for a medical card, we often field questions about how much this may cosy. The current cost of public inpatient bed charges is €80 per night. However, the maximum amount payable for a year is €800 – i.e, if your bill begins to surpass this amount, you will not be charged.
Should you self-present to A&E without a medical referral, the charge is €100.
Dental care can often be an issue for many people with epilepsy due to the nature of their seizures. Medical card holders are entitled to certain dental treatments such as a dental exam, 2 fillings and extractions as necessary in a year. Medical card holders with certain medical conditions, including epilepsy, are eligible for additional treatments such as teeth cleaning, as well. Your dentist can advise on eligibility for these treatments. If you need dentures the dentist can apply to the HSE for approval to provide these.