10 Factors to Consider Before Buying Health Insurance Policy for Senior Citizens

Approaching your 60s and seeking a suitable senior citizen health insurance plan? In India, where healthcare costs continue to rise, having a dependable senior citizen health plan is a necessity. From regular doctor visits to managing chronic health conditions like diabetes, arthritis, or heart disease, medical expenses can quickly add up as we grow older.

A 2024 report by the National Statistical Office (NSO) shows that the population of elderly people (aged 60 and above) in India is likely to reach 194 million by 2031. This significant demographic shift can substantially increase the demand for health insurance among senior citizens in the future. So, having medical insurance for senior citizens is not a straightforward process. There is a maze of fine print to pass, including co-pay clauses, waiting periods, room rent limits, and, of course, the list of exclusions.

Senior Citizen Health Insurance - Why is it Important?

Do you know? A day's stay in the hospital can drain years of savings, especially if you are a senior citizen. Post-COVID-19 Pandemic, the healthcare inflation in India is growing at an alarming rate of 12-14% per year, quite higher than general inflation.

Here are some of the main reasons why a dedicated senior citizen health plan is crucial:

• Increased healthcare needs due to age-related conditions
• More frequent hospitalization
• Limited earning capacity after retirement
• Financial independence during medical emergencies

10 Factors to Consider While Buying Health Insurance for Senior Citizens

When planning to buy health insurance for senior citizens, they must know the right balance between coverage and affordability. Let's take a look at the crucial aspects to weigh in:

Age Limit and Eligibility: Most insurance providers prefer offering health insurance plans for senior citizens (who fall under the age window of 60 to 80 years). However, there are only certain health insurance policies that have the lifelong renewability option, which is ideal. Ensure that the policy you intend to purchase allows for continuous coverage after a specified age.

Pre-existing Disease Coverage: It is probably the most key factor to keep in mind while purchasing a health insurance plan.  Most of the senior citizens are already suffering from various health conditions, such as hypertension, diabetes, arthritis, and cardiac ailments. So, you should look for policies that have a minimal waiting period. Also, make sure that the plan covers chronic illnesses after the waiting period. Go through the fine print to understand the inclusions and exclusions clearly.

Also Read: Benefits of Disclosure of Pre-existing Disease in Health Insurance

Co-Payment: Even if you have to shell out a bit more on the premiums, it is a good idea to choose a plan that has low or no co-pay. Co-payment is a fixed amount that the policyholder (you) needs to pay. For example, if the co-pay is set at 20% and the hospital bill reads INR 2 Lakh, you have to pay INR 40,000 from your end.

Room Rent Limits: Many health insurance policies have a cap on the room rent. It means - if your room cost goes beyond this limit, you are likely to pay extra. To avoid this, choose a plan with a higher room rent limit or no limit at all. It is especially useful if you prefer getting treated at private hospitals.

Daycare Procedures: With advanced medical technologies in place, many treatments do not require you to stay in the hospital for more than 24 hours. When deciding on the best mediclaim insurance, you should check that at least 500 daycare procedures, such as cataract, dialysis, chemotherapy, etc., are included in your policy.

Cashless Network Hospitals: Always go for a plan that offers a wide range of network hospitals to choose from. Cashless hospitalization is a lifesaver during emergencies.

Pre and Post-Hospitalization Coverage: A good medical insurance for senior citizens should cover expenses incurred before (diagnosis, tests) and after (medicines, follow-up visits) hospitalization. Ideally, it falls in the range of 30 days before and 60-90 days after the hospital stay.

Annual Health Check-up: Health risks are likely to increase with age. Many health insurance policies offer free annual health check-ups. Do look for such plans.

Exclusions: Do not avoid reading your policy wording. If you are unable to understand any technical words or clauses, get in touch with a reliable Point of Sales Person (POSP) insurance agent for assistance. The following are some typical exclusions:

• Cosmetic surgeries
• Dental treatments (unless due to an accident)
• HIV/AIDS
• Non-allopathic treatments

Waiting Period: It is a must to have an understanding of the waiting period in health insurance concerning specific health conditions. It may vary from 12 to 48 months, based on the policy you choose.

Tips to Lower Premium Without Compromising Coverage

Here we have listed some useful tips to help you lower your premiums:

• You may opt for higher voluntary deductibles.
• Go for a family floater plan if your spouse is also a senior citizen.
• It is better to avoid unnecessary add-ons.
• If possible, prefer buying insurance early before you reach in your 60s.
• Choose and compare policies using IRDAI (Insurance Regulatory and Development Authority of India)-approved portals, such as Policybazaar.

Bottom Line

When we are dealing with medical emergencies involving senior citizens, the emotional & financial strain is already high. If you do not have a good health insurance plan, it will be an overwhelming situation for you and your loved ones. Investing in the right senior citizen health plan is not just about saving money - it is about ensuring peace of mind.

Online, there are many best health insurance companies available. You can check with customer-friendly and reputable online portals, like PBPartners, a brand of Policybazaar, for transparent policy comparison and purchase.

Frequently Asked Questions (FAQs)