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Benefits Blog

by Tombenefits

news and thoughts from the world of welfare rights
31 July 2017 at 19:04

Prescriptions & Other Health Costs

A look at help with prescription, why no-one with a cancer diagnosis should have to pay them and help for others and help with other health costs

This blog was inspired by a recent post to raise awareness of free prescriptions for those with a cancer diagnosis. Here I explain how that works but ake it a little further.  

A cancer diagnosis can bring a whole new array of paper bags full of new pills, potions and embrocations into your life, just at a time when finances might be stretched :-)

In this Benefits Blog I will take a look at:

  - how do I go about getting that exemption certificate?

  - what about others in my household who may still have prescriptions to pay? who else might be exempt?

 - and what about other health charges that can apply across the UK?

So gentle readers in Wales, N. Ireland and Scotland, who may be tempted to wander off as prescription charges are not an issue for you, pray bide a wee while :-).

This blog is not just a look at strange English practises. For I will also disgress into the related areas of other health costs which apply across the UK.

 

1. What are prescription charges? 

Prescription charges currently stand at £8.70 an item in England, with eg a pair of surgical stockings counting as 2 items.

If you do have to pay them and have regular prescriptions you may be better off with a Pre-Payment Certificate at £29.10 for 3 months (so once you need 3 or more items you are better off) or £104 for a year - 12 items and you are quids in:-)

But if you have a cancer diagnosis you can get an exemption certificate and do not have to pay them. End of :-) Read on to find out more. 

However, nearly 90% of prescriptions are filled free of charge so you may not have to pay them anyway.

Exemptions are available for:

  - Age: e.g the over 60s

  - Benefits - if you qualify (or may be missing out on) certain low income benefits or apply via the NHS Low Income Scheme.

  - Certificates: if you have one of a number of long term illnesess, which since 2009 includes cancer. 

With Wales leading the way in 2007, all the other UK nations have abandoned prescription charges, but they still have charges for other health costs e.g. dental, optical charges.

And with the list of exemptions from those charges being being similar to those for English prescription charges, you can see why this blog is going to develop “mission creep” :-)

 

2. Free prescriptions for people living with cancer

Since April 2009, anyone with a cancer diagnosis has been eligible for free prescriptions across the UK. However, other health costs remain. And others in the household - at least in England - may face prescription costs of their own.

To apply for an exemption certificate you need to complete a short FP92A form like the one here.

It just involves ticking the box inserting your basic details and getting it countersigned by your GP, a member of their practise staff or another clinician.

The form should come with a pre-addressed envelope, but if you can’t find it the address to send it to is : NHS Business Services Authority, Medical Exemption, Bridge House, 152 Pilgrim Street, Newcastle Upon Tyne, NE1 6SN.

You will then receive an exemption certificate - usually within 10 days or so - giving you exemption from prescription charges for 5 years.

This does not though exempt any others in your household from prescription costs, but they may get an exemption for other reasons.

Nor does it help anyone with other health costs, but help may be available with those by other means. Hence the rest of this blog.

 

3. Other routes to free prescriptions charges 

The NHS England leaflet - here - takes you through the potential exemptions and points the way to help with other health costs. They helpfully suggest an ABC approach to exemptions: Age, Benefits and Certificates

3.1 Age:

The big one :-)  60% of free prescriptions are for the over 60s and some 6% for the under 16s. Just tick the box

 

3.2 Benefits

These are exemptions because you receive certain income- related benefits. In the case of the basic “safety net” benefits for the lowest incomes, then just being in in receipt of any amount of that benefit will be enough. These include: Income Support, Income-based JSA, Income-related ESA and Pension Credit (Guarantee)

Others reach further up the income scale, so exemption only applies to some who receive them: 

 - tax credits - HMRC will provide you with an annual exemption certificate, if you are on an income of under £15, 275 a year

 - Universal Credit (UC) - this will depend on your last UC monthly statement showing either: no earnings or earnings under £435 a month. The earnings limit increases to £935 if you have a child or have a UC limited capability element in your assesment. It's because UC income is assessed -monthly - often with wildly different amounts - that your exemption is only as good as your last statement. 

Now you may not currently be receiving one of those benefits, but it may well be that you should :-) see under checking benefits below. 

If you cannot access one of the qualifying benefits you might still get some help with other health charges through the NHS Low Income Scheme (see below).

 

 3.3 Certificates

Well that’s the same FP92A route described above. The other conditions where prescriptions are free regardless of age or income include: a permanent fistula, epilepsy, diabetes mellitus, hypothyroidism, diabetes insipudus, hypoadrenalism, myasthenia gravis and forms of physical disability that require help for another person.

All of these have some qualification so not everyone with a diagnosis may meet the conditions, but your GP can advise.

It has been recognised that this list was ripe for revision and updating and there was promise to do so when cancer was added to the list in 2009, but this has got a little lost along the way

 

4. What are the “other health care charges”?

These apply across the UK for dental treatment, glasses and in England only for NHS wigs and fabric supports. You can get further information from

  - NHS Wales- here
  - The Scottish Government - here
  - NI Direct for Northern Ireland - here
  - NHS England - here

You will often see references to the NHS Low Income Scheme that can offer either full or partial help with these. In England, full help will also cover free prescriptions.

This might apply if you are on other non-means tested benefits or low wages and don't have much other income coming in. You fill in an HC1 form - there is one for each home nation so see the links above to find yours. 

This financial assessment allows a little more than allows a means tested benefit sums, so you may still get full help with all health costs and be issued with an HC2 Certificate to prove entitlement.

If your income is a little bit higher again,  you won't get free prescriptions (in England),  but may qualify for some help with other health costs across the UK. You would be sent an HC3 Certificate.

 

4.1 Dental charges

Dental check ups are free in Scotland and for under 25s and over 60s in Wales

Otherwise there are charges for check ups  and in all cases for treatments in bands according to the extent of the treatment ranging from £20.60 to £244.

Exemptions from these charges include:

Age: under 18 (or 19 in full time education

Benefits: one of the qualifying benefits mentioned above or  a full HC2 exemption under the NHS Low Income Scheme. You may need to make a contribution if it is an HC3 Certificate.

Other: if you are pregnant or have had a baby in the last 12 months, are an in-patient in hospital, or an outpatient of hospital dental services

 

4.2. Optical charges.

Sight tests are free in Scotland. Elsewhere there is a charge, unless within a hospital ophthalmology department

Sight test charges are waived and you will get a vouchers across the UK towards your glasses if:

Age: you are over 60 or under 16 (or 19 if still in full time education)

Benefits you get one of the qualifying benefits mentioned above or have an NHS Low Income Certificate (HC2) You may need to make a contribution if it is an HC3 Certificate. 

Certification: you are registered blind/partially sighted, or have diabetes or glaucoma, are 40+ with a family history of glaucoma, are at risk of glaucoma, are eligible for an NHS complex lens voucher,

 

4.3 Wigs and Fabric Supports

These are free in Northern Ireland, Scotland and Wales if spied through a hospital

Charges in England are: £28.45 for a surgical bra, £42.95 for abdominal/spinal support and from £70.15 to £271.70 for an NHS wig

These are waived for:

Age: Under 16 or under 19 and still in full time relevant education

Benefits: one of the low income benefits above or have an NHS Low Income HC2 Certificate; if its an HC3 then you will have to pay part of the cost

 

4.4. Travel Costs:

These are not charges as such, but similar arrangements apply across al four nations to refund costs to get to hospital. These can mount up for people going through cancer treatments as the visits may be more frequent and may also be to regional cancer centres or specialist hospitals rather than their nearest one.

You can claim a refund of fares to hospital or petrol money. Taxis are allowed, but only by prior agreement with the hospital. You claim refunds from the hospital and the clinical staff will be able to tell you where to go.

If you need a carer or escort - if your health professional says you need one to attend- then there costs can also be refunded.

There is no help generally with accommodation costs, if you want to stay nearer the hospital eg during a course of daily radiotherapy.

However, there are local schemes in further flung areas such as the Isle of Wight or the Highlands and Islands in Scotland, where day journeys may not be possible. Some hospitals also have patient hostels if commuting is going to be really difficult for you. It is worth asking.

You qualify for help with travel costs purely on low income grounds: being in receipt of one of the low income benefits above or by having a certificate under the NHS Low income Scheme.

 

5. Always check your Benefits

However, don’t give up -on help with travel costs or any other health benefit - if you don’t currently get such a benefit :-)

Benefit Advisors in Maggie’s Centres across the land are full of tales of people wandering in just to see if they might get help with what can be a big new expenditure in their life.

Some may emerge re-assured that they do qualify right now, others that they could do with a new benefit claim or by an application to the NHS Low Income Scheme.

But even if we can't find an immediate route to help with these costs directly, we may well suggest another benefit that may be even more helpful than just covering these costs alone. And some of those benefits are not relted to savings or income at all.

And other times, claiming them can bring you into entitlement to a qualifying benefit for help with health care costs too. We may then get those fares back by a roundabout route, or offeryou something even shinier and sparklier instead :-)

For a "see the woods for the trees" overview of benefit for people affected by cancer,  see the Maggies Find Out More About ... series on the page here

If in doubt talk to your friendly local Benefits Advisor or Mssage me :-)

 

6. Why are there prescription charges and other health care costs?

The founding principle of the NHS may have been “free at the point of delivery” , but while that remains generally supported for the core service, there is a lively debate as to whether it is right to make some charges at the fringes

The basic crude reason is that it was possible to make a case based on these areas being a bit at arms length from the main NHS service. And that once in place, the Treasury is not keen to let go of e.g. some £450 million a year in prescription charge income.

But leaving the institutional and financial reasons aside, there are a range of arguments as to whether as to whether e.g.  prescription charges might not also be the most wonderful - or most loathsome - thing since sliced bread :-)

Might paying something encourage people to value things more? But might not charges prevents some from accessing the prescriptions they may need, with risks to their own health (and much greater costs to the NHS down the line)

You can see a selection of arguments for and against prescription charges in this article aimed at pharmacists. The only bit of jargon though that may be puzzling is OTC for “over the counter” . You can read it here

 

And so…

The starting point of this blog was to join in raising awareness that if you have cancer diagnosis you do not have to pay the England prescription charges at all, regardless of your income and savings. 

But others in your home are not exempt, but they may meet other criteria for free prescriptions to help what may be a more stretched household budget. 

Those same income criteria (alongside some other specific exemptions) also entitle both people with cancer and other living with them, to help with other health costs that apply - with some variations- across the UK nations. 

But while you are wondering whether you might qualify for some help with any of these health costs, wherever you may live or stay, please do a wider benefits check with a Benefits Advisor. Just drop into your local Maggie's Centre, message me online or seek out a range of other local advisors. 

Please feel free to join the Conversation - here -to share your experiences, general queries or comments around health costs

And even if for some it may feel a rather day to day thing, my best wishes for the best of Iechyd Da / Good Health at the lowest cost to you :-)

Tom



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