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Contributory ESA and prescription charges

enterprise22

Hi, Could someone please explain to me why my son who is in receipt of contributory ESA is not entitled to exemption from prescription charges while people who are on income related ESA are? Thank you if anyone can advise I would appreciate it.

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JennysDad

Hello @enterprise22 and a very warm welcome to the community. Glad you have found us.
Unhappily, I'm not qualified to answer your question, but there are plenty of people in the community who are and if you can bear with us, they will get back to you as soon as possible.
You might like to have a look in the Employment and Support Allowance forum, where you may find relevant resources and conversations, and you could try out the benefits calculator on your son's behalf.
Hope some of this helps,
Warmest best wishes to you and to your son,
Richard

enterprise22

Thank you @JennysDad.

Sam_Alumni

Hi @enterprise22

As you have found Contribution Based benefits do not automatically entitle you to free healthcare, only Income Related benefits do.

If you qualify for contribution based ESA, you might qualify for free prescriptions, depending on what your total household income is or what conditions you need medication for.

In order to get free prescriptions because of low income, you need to complete form HC1. You can get the HC1 form from some healthcare settings or jobcentres, or by phoning 0845 610 1112.

If you qualify for full prescription costs, you will receive a HC2 certificate.

If you qualify for some help towards prescription costs, you will receive a HC3 certificate.

If he isnt able to get free prescriptions, he could apply for a Prescription prepayment certificate.

Prescription prepayment certificates (PPC) are available in England and can save you money.

current prescription charge – £8.80 per item (£17.60 per pair of elastic hosiery)
three-month PPC – £29.10; this will save you money if you need more than three prescribed items in three months
12-month PPC – £104.00; this will save you money if you need more than 12 prescribed items in a year

PPCs are available by 10 monthly direct debit instalment payments. The certificates allow anyone to obtain all the prescriptions they need for £2 a week.

Find out more about the prescription prepayment certificate.

enterprise22

Hi Sam, thank you very much for your reply.

I now understand that Christopher does not qualify for free prescriptions as he is on contribution based ESA, what I can't understand is, that being in the ESA Support Group (an acknowledgement of his disability and vulnerability), never having worked, and his only income being his ESA and PIP, why he does not, but people on income related ESA do.

I would like to know how the distinction is made and the reasoning behind this policy decision

Having disputed a penalty charge notice, received recently, because we mistakenly believed Chris was exempt (our mistake not Chris'), Chris, despite repeated requests by us as his carers to refer all correspondence to us, and Chris authorising this, has just received notice through the post that he is not entitled to free prescriptions and that he therefore is liable to pay the outstanding charges; the prescription charge and a penalty charge £51.60 in total.

This to a person who because of his autism does not understand the world, the additional irony being that the prescription was for Sertraline to treat his anxiety.

[Deleted User]

Hi enterprise 22

I'm really sorry to read about this. As you say, what an irony that the prescription was for Sertraline.

The "reasoning behind it" I think, is that people who have means-tested benefit have little money behind them, whereas someone who gets contributory benefit only may have lots or at least some money in the bank which the state expects them to draw on, before they claim free prescriptions paid for by the public.

The department that deals with these fines for incorrect prescription fee exemption claims is quite firm in enforcing the charges, but occasionally, you would have the fine quashed, if for example you could show that your son had the income related benefit after all.

A possible avenue, if your son doesn't have mental capacity, may be appointeeship, so that formal letters are sent to you rather than to him. This may not be what you'd like to happen, but might be in everyone's interests if your son currently handles his finances, but without understanding.

As Sam says, you can apply for exemption on the grounds of low income.

Good luck

Gill_Scope
Benefits and Finance Specialist Information Officer
Scope helpline

enterprise22

Hi Gill,

thanks for your comment. Chris does not fall into the category you describe he has never worked and therefore never paid any National Insurance Payments himself, he has had them paid for him by the Government, I presume because of his inability to work and pay, this is why he is in the support group, therefore we cannot understand why he is classed as being in a better position to pay for his prescriptions.

Chris does not handle his own financial affairs, he is not capable of doing so because of his autism, his mam is his carer and appointee but despite us pointing this out to the prescriptions pricing people and sending them proof, they still sent all subsequent correspondence to Chris, including the fine (which I paid because it would have been half of one weeks ESA payment).

We have applied for the exemption on the grounds of Chris's low income but, if he gets this, what was the point of charging him in the first place?

We have arranged to speak with our MP Helen Goodman about this also.

Thank you

[Deleted User]

Hi enterprise 22

I'm really glad that Chris has an appointee and that you've applied for exemption from prescription charges on the grounds of low income.

Is it possible that Chris was initially awarded Severe Disablement Allowance? He might have got this if he left school before about 2001, and wasn't in a position to go to work. SDA as it's called behaved like a contributory benefit, in other words, it was paid irrespective of the rest of your circumstances. It has been abolished now and almost everyone who got it has been transferred onto ESA. If Chris did have this, then he should be considered for income-related ESA as he was moved across, and this might not have been done - the DWP is currently undertaking an exercise to pay arrears to those people to whom this applies.

You can read about this in a range of places. Here is one of them:

https://www.theguardian.com/society/2018/mar/21/disability-claimants-receive-20000-after-being-underpaid-dwp

In case it's relevant.

Best wishes

Gill_Scope

SethLaa

I am on Contribution Based ESA and get 'free' Prescriptions, the reason for this is because I cannot go out alone, please try again using (I think) the HC1 form, hope this helps and good luck

[Deleted User]

Hi enterprise22 again.

Another thought...

As his appointee, Chris' mother should be receiving all the DWP post about benefits to her address. If this isn't happening then I suggest that this might be a good argument for disputing the "overpaid" prescription charges and the fine. Worth a try, for sure.

Gill_Scope

enterprise22

Thanks Gill, we applied for (HC1 claim) and have been awarded a HC2 Certificate for full help with health costs. This was based on Chris' income and savings, which obviously prompts the question in our minds as to why he was not exempted in the first place and why are the prescriptions pricing bureau targeting people in this vulnerable group and completely disregarding the appointee issue.
(It was Chris who was fined!!!)

I would imagine that many other people in the ESA support category who are paid contribution based ESA are in the same situation.

Thanks for your help and support, we will keep you posted re disputing the 'overpaid' prescription.

[Deleted User]

Hi again
The technical answer to your question is probably that there has to be an income-related benefit in place in order to qualify for automatic full exemption. Otherwise, the person, or their appointee, has to apply for an exemption certificate, in order to prove their entitlement to free prescriptions etc..

This doesn't tackle the moral question you raise though (why one group of vulnerable people but not another?), nor the fact that the DWP were corresponding with Chris at his address rather than with his mother, at hers.
Gill_Scope

enterprise22

Thanks gill will raise these points with our MP.

kevin52

Move To Scotland ! You Get It All Free !!!! If Scotland Can Do It , Why Cant All The Others ????????????????????????

enterprise22

Hi Gill,

We spoke to our MP (Helen Goodman) about the following Issues:

Chris being sent the penalty Notice re non payment of prescription charge because he was on contribution based ESA (support group, surely amongst the most vulnerable of people in our society?)

The prescription Pricing Bureau seeming to be actively targeting vulnerable disabled people within this disadvantaged group.

We queried why Chris had to pay when those on income based ESA did not despite the fact that Chris's only income is PIP and ESA.

The Prescriptions Pricing Bureau addressing all correspondence, queries and the fine to Chris despite our requests not to do so and our explanation re Chris's autism and his mam being his appointee.

The disproportionate fine (half of one weeks ESA).

The fact that we subsequently applied for help with prescriptions and other medical matters HC1 and were awarded an exemption certificate HC2, so why did he have to pay in the first place?

Our concern that many other people may be finding themselves in the same situation, and our additional concern that some people in the support group, on contribution based ESA, might not be able to afford the prescription charges and might be going without their medication as a result.

Our MP undertook to look into all these matters for us. Will keep you posted.

[Deleted User]

Thank you enterprise22, I will be very keen to hear what the result is.

Gill_Scope

jaycee6

Hi this whole thing is driving me crazy .Income related on the website says free prescriptions as you have never worked,,contribution related because you have worked so NI stamps count. .In that case a young disabled that has never worked as no NI stamps so surely they should be income related and prescriptions free. I really don't get it .What is the answer even government web site confusing..HELP

enterprise22

Hi jaycee6, we are trying to work this out ourselves but, you may qualify for contribution based ESA and depending on your income, it seems you may also qualify for income based ESA and therefore free prescriptions.

You can also apply for help with prescriptions and other medical issues such as dental care by filling in form HC1 and, depending on your income, receive an exemption certificate HC2. Hope this helps.

jaycee6

HI Ive just found some good info on downs syndrome site.You must have no more than £16000.. in savings (for income related Esa),.Also Some people that were on incapacity benefit (which is contribution based),then were moved over to contribution based Esa. Where they might be better of on income based,,You can ask to be put on income based Esa,,by asking for Esa 3 form which is a means test form.You cant do this if you have £16000,if you have between £6000 to £16000 it will decrease by £1 for every £205 over £6000,,Well it helped me understand a bit more,But I wish it was still easier to understand,Maybe if we all add our bits of info the puzzle will get solved ,