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28-04-2023

Guarantees of compulsory health insurance for seniors have been listed

Iliustracija

All residents covered by compulsory health insurance, regardless of their age, receive medical services in Lithuania paid for by the Compulsory Health Insurance Fund (CHIF), if they go to medical institutions that have concluded agreements with health insurance funds, and if they have a referral to see a specialist or undergo tests. However, seniors, who make up 30% of the population, have access to a wider range of free services than other age groups.

Dental prosthetics

People of retirement age, as well as several other groups of residents, have their costs for dental prosthetics reimbursed; doctor’s work, materials for making dentures, fitting (insertion) of dentures, and other measures to restore minimal chewing function are all paid for by the CHIF.
According to Jurgita Grigarienė, Chief Specialist of Services Management Division of Ministry of Health, it has been several years since people do not need to make dentures for their own money and wait for compensation, procedure for receiving services is rather simple.

“Firstly, a person needs to visit a doctor odontologist at a treatment facility, where he is registered, or an odontologist at another institution, if it has a licence to provide odontological care services and has signed an agreement with the health insurance fund. If a doctor establishes, that a patient must receive compensated dentures, he is registered in the system. Then, a person may immediately apply for dental prosthetics at a preferred treatment institution, which has signed an agreement with the health insurance funds. Services shall be provided within 3 years as of the date of entitlement and registration in the system. Services can be obtained again 3 years after the date of reimbursement of dentures,” a representative of the health insurance funds explains the procedure.

She mentions that there are more than 1000 institutions providing services of reimbursed dental prosthetics in Lithuania. The list is provided on the website of the health insurance fund.

People of retirement age and the disabled are reimbursed up to EUR 670.39 for the costs of dental prosthetics. In some more complex medical cases or after treatment of oral, maxillofacial oncology, up to EUR 2062.70 may be reimbursed with the approval of doctors’ consillium. Patients do not need to pay the amount by themselves and then apply to the health insurance fund for compensation, because a reimbursed amount is transferred by the health insurance fund to the prosthetic institution. People only have to pay additional amount at their own expenses, if factual costs for dental prosthetics are higher than the amount reimbursed.

Statistics show that these services are very needed by senior people. For instance, more than 80 thousand people benefited from this service in 2022, 83 pct. of them are retired people. Over EUR 50 million for dental prosthetics has been paid last year from the CHIF.

Disease prevention

It is important not only to be able to get treatment, but also not to fall ill. Scientific research has shown that people of a certain age are at increased risk of getting some critical diseases, such as cancer. However, serious consequences of a disease may be avoided if the risk to fall ill is established early or if a disease is diagnosed at an early stage. Therefore, five disease prevention programmes are aimed for early diagnostics, three of them for both pre-retirement age and retired people.

Women aged 50-69 (inclusive) may and must be screened for breast cancer every 2 years, men aged 50-69 (inclusive) (from 45 years, if a father or brothers had this disease) for prostate cancer – every 2 or 5 years and men and women aged 50-74 (inclusive) shall be screened for colorectal cancer every 2 years. A person shall visit his family doctor, if he wants to get free screening under the programmes.

Preliminary data of the health insurance funds show that almost half of people screened under these programmes were over 60 years old.

J. Grigarienė also reminds that once a year a doctor must check blood pressure, weight and height of adult patients, prescribe electrocardiogram, determine cholesterol amount in blood, check patient’s mouth as well as examine and palpate breasts for women. People over 65 years old should have an additional annual preventive visual acuity test, a general urine test and a blood glucose test, while for younger people it shall be done every 2 years. If a doctor determines the need for other services, they must also be provided at no extra cost to the insured.

Reimbursed medicines

One of very important guarantees to senior people is reimbursement of costs for medicines and medical aids. Reference price of the most of compensated medicines prescribed by a doctor is compensated by 100 pct. to all the patients, i.e. so-called List A medicines for treatment of oncological diseases, tuberculosis, diabetes, epilepsy, asthma, multiple sclerosis, blood coagulation disorders and similar. List B medicines are prescribed to people of certain social groups, with lower financial abilities than of other insured people, with pensioners, disabled people etc. among them. Reference price of these medicines to the disabled is compensated by 100 pct., pensioners and people with 30-40% reduced capacity to work are reimbursed by 50 pct.

“People over 75 years old should not pay for compensated medicines and medical aids (MA) at all – premiums for medicines are compensated to them as well. They are covered for retired residents and the disabled, whose income (pensions, social pensions, compensations and rents) is less than EUR 354 per month,” says Irma Medžiaušaitė, Advisor of the Pharmaceuticals Reimbursement Division of the NHIF.

Based on the data of the health insurance funds, almost EUR 300 million for the costs of reimbursed medicines and MA as well as premiums have been compensated to people over 60 years old. Costs for medicines and MA were compensated to more than half a million people of this age and premiums were reimbursed to almost 300 000 people.

(Freepik photo)

The NHIF invites you:

Last updated: 09-08-2023

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