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Health Insurance For Senior Citizens – The Why, How, and What

Being a retired bank manager from a reputed PSU bank, Mr Sudarshan understands how senior citizens’ needs are transformed over the years.

With lifestyle diseases and medical expenses at an all-time high, it can become increasingly difficult for senior citizens to afford basic healthcare. Mr Sudharshan by virtue is a meticulous person, always looking to educate himself on various topics.

In his quest to find the perfect insurance for himself, he made a few observations:

Even though many health insurance companies offer senior citizen plans as part of their product offerings, there are plenty of senior citizens who aren’t beneficiaries of such policies. 

Some important questions to be asked here are: 

  1. Why should senior citizens have health insurance?
  2. How to select the best senior citizen insurance policy? 
  3. What are the best health insurance plans for senior citizens in India?

What is a Senior Citizen Insurance Plan? 

A senior citizen plan refers to a health insurance policy that provides medical coverage to citizens over the age of 60 years. As per the IRDAI (Insurance Regulatory and Development Authority of India) individuals up to the age of 75 years should be able to purchase senior citizen plans. 

Under this policy, older men and women can schedule free medical check-up regularly, and avail financial protection against pre-existing ailments. Having faced his share of health challenges in his retirement years, it seemed to be a must-have for Mr. Sudarshan.

6 Reasons to Buy a Health Insurance for Senior Citizens

Here are the 6 reasons why senior citizens must have their medical needs insured:

  1. Medical Coverage: Senior citizen plans generally cover the medical needs of individuals between 60 to 80 years of age; standard plans only cover upto 65 years. They are also eligible for lifetime renewals.
  2. Treatment Expenses: This includes expenses associated with Pre-hospitalization, Post-hospitalization, Domiciliary hospitalization, Ambulance charges, In-patient & out-patient needs, mental health care, and more.
  3. Pre-Medical Test Policy: Senior citizen plans do not require pre-medical screening; pre-existing illnesses are covered by default. This makes enrollment easier.
  4. Cashless Treatment: If a patient is hospitalised for a minimum of 24 hours at a hospital in their insurer’s network, their medical fees, day care expenses, room charges, etc are covered under the insurance policy. 
  5. No-Claim Bonus: Insurance companies offer No-claim bonuses for claim-free years. Some insurance plans offer an increased sum insured while others offer lucrative discounts on premiums. For health insurance for senior citizens in india, a claim-free term is typically eligible for discounts ranging from 20% to 100%.
  6. Income Tax Benefits: Section 80D of the IT Act 1961 offers tax exemption benefits of Rs 50,000 or more on the cost of premium. Preventive check-ups make the elderly eligible for an additional rebate of Rs 5,000 per year.


8 Points to Consider When Buying Senior Citizen Health Insurance Plans

Mr Sudharshan found out that senior citizen plans are usually accompanied with a set of constraints when it comes to premiums, copayments, coverage limits, and waiting periods. He believes it is important to look out for some key points before you buy a senior citizen plan: 

  1. Entry Age: For better coverage, it is advisable to buy a plan at an early age. Generally, the entry age of senior citizen plans falls in the 60 to 80 years range. 
  2. Medical History & Coverage: Opt for comprehensive coverage, keeping past illnesses, current conditions, and potential health risks in mind. Preventive health check-ups, new-age diseases, etc are other factors to consider.
  3. Co-Pay & Deductibles: Look for plans with the lowest coinsurance, deductibles, and copayments. With no regular income, it can be difficult to afford a large claim sum otherwise. A 10% copayment is standard on average. 
  4. Waiting Period: An ideal plan would be one where the waiting period for pre-existing conditions is the shortest. There are 2 to 4 years waiting periods in most insurance plans.
  5. Sum Insured: Someone with a medical history requires greater coverage. – If you live in a metropolitan area, your expenses will be higher.- Consider the number of insured persons.
  6. Exclusions: Every policy comes with certain exclusions such as self-inflicted injuries, sports injuries, non-allopathy treatments, etc. Go through the policy terms carefully before making a decision.
  7. Hospital Network: Pick a plan whose network of hospitals are nearby and offer cashless treatments. This is beneficial in cases of emergencies, plus transportation is easier.
  8. Claim-Settlement Ratio: Analyse the claim-settlement ratio of insurers in the last 3 to 5 years to assess their performance. 


5 Best Health Insurance Plans For Senior Citizens in India

Name of Plans Entry Age Max Sum Insured Waiting Period Claim Settlement Ratio Benefits
Bajaj Allianz — Bajaj Allianz Silver Plan 46 to 70 years 5 lakhs Covered from second year onwards 92.24% 5% family discount on adding new members
HDFC Ergo — Health Insurance Plan For Senior Citizens Above 45 5 lakhs Covered after two years 86.52% Tax benefits upto Rs 75,000,Free health checks
Star Health — Senior Citizens Red Carpet Insurance Plan 60-75  25 lakhs Covered from second year onwards 78.62% Coverage for new-age treatments like robotic surgeries, deep brain stimulation
Tata AIG General Insurance — Medi Senior 61 and above 50 lakhs Covered after 12 months 76.04% Tax benefits upto Rs 75,000,Organ donor coverage
Oriental Insurance — Hope 60 and above 5 lakhs Covered after 24 months 93.96% 20% copayment

Things to Keep in Mind While Buying Medical Insurance for Senior Citizens in India 

Apart from the things listed previously in the article, there are some other things to keep in mind while buying medical insurance for senior citizens in India. Following these tips will help you get the best financial protection by buying the best senior citizen health insurance plan for yourself or your parents.


Look for Critical Illness Benefit

Critical illnesses include life-threatening diseases such as cancer, heart attack, renal failure, etc. Expenses for the treatment of these illnesses are significantly higher compared to other types of illnesses. Since senior citizens are more prone to critical illnesses, it is better to look for critical illness cover while buying a policy for senior citizens. Furthermore, make sure that the insurance policy also covers life-threatening diseases like tumors, permanent paralysis, etc.

Seek Coverage for Domiciliary Care

Many a time the treatment needs to be conducted at home because of the patient’s inability to move or lack of accommodation at the hospital. Some treatments also call for prolonged and individualized care. In these cases the patient needs to be treated at home, also referred to as domiciliary hospitalization. Since senior citizens are more prone to such conditions, it is better to buy a policy that offers domiciliary hospitalization benefit.

The domiciliary hospitalization benefit allows policyholders to make claims for the expenses incurred during the treatment at home. This form of treatment is fairly common for patients of larger age groups. Make sure you buy a senior citizen insurance plan that provides coverage for domiciliary hospitalization.

Coverage for Pre-Existing Diseases and Waiting Period

Pre-existing diseases refer to the illnesses that the policy buyer has already been diagnosed with before the purchase of a health insurance policy. For instance, if you are diagnosed with high blood pressure before buying a senior citizen insurance plan for yourself, it will be considered a pre-existing illness under the insurance policy. 

These pre-existing illnesses are subject to a waiting period for coverage under the policy. The best health insurance for senior citizens in India have the shortest waiting periods for covering pre-existing illnesses. Remember that the chances of being hospitalized for pre-existing health complications are significantly higher. Make sure that you buy a senior citizen health insurance plan for yourself or your parents with the lowest waiting period for covering pre-existing illnesses.

Look for AYUSH Coverage

There are various alternative systems of medicine that are gaining wide popularity and proving to be effective in many cases. Ayurveda, Yoga, Unani, Siddha, and Homeopathy are some of those systems that come together to form AYUSH. You must also consider the coverage of these alternative methods of treatment while buying health insurance for senior citizens in India. There are many senior citizen insurance plans with comprehensive coverage that offer AYUSH coverage. They will help you get coverage for hospitalization expenses related to these alternative methods of treatment.

Seek Coverage for Day Care Procedures

While a health insurance policy does help you significantly in offsetting the towering costs of healthcare, you will be missing out on an essential layer of financial protection without daycare coverage. Hence it is very important to get coverage for daycare procedures along with major surgeries and hospital stays. A surgery or medical procedure that can be completed in less than 24 hours is known as a daycare procedure. Some popular examples of such procedures are cataract surgeries, nasal sinus aspiration, cancer chemotherapy, cancer radiotherapy, etc.

Many health insurance policies necessitate the hospitalization of at least 1 day for claim reimbursement against such expenses. It is very important to understand that while the hospitalization is less than 24 hours, these procedures are enough to drain your finances significantly. Thus, if you’re looking to buy medical insurance for senior citizens in India, make sure you go with the policies that offer daycare procedure coverage.

Higher Sum Insured at Lower Premiums

Medical expenses for individuals from larger groups are significantly higher. Naturally, they need greater coverage to be fully financially protected against health conditions and medical emergencies. Thus, it is better to look for senior citizen plans that offer a higher sum insured at affordable premiums. Another thing to keep in mind is that senior citizens are high-risk individuals for insurance companies and hence, have to pay higher premiums. So, you also need to make sure that you get the best value for money in terms of coverage, benefits, and additional benefits from the plan.

Huge Cashless Hospital Network

Cashless hospitalization is an essential benefit that you must properly research while buying a senior citizen health insurance plan. Check the network of hospitals of the senior citizen insurance plans that you’re considering for yourself or your parents. A huge network of hospitals has various benefits for the policyholders. 

To begin with, you can be sure that you will get the best possible treatment with so many options for hospitalization. In addition, finding a hospital in case of medical emergencies will also be much easier with a huge network of cashless hospitals. Furthermore, senior citizens are more likely to get critical in case of health conditions and medical emergencies. In those times, you’ll be grateful to yourself for buying a senior citizen plan with a huge cashless hospital network for your parents.

Compare Co-payment Ratios

Most senior citizen health insurance policies have a co-payment clause wherein the insured individual is liable to pay a specified portion of the claim amounts. The rest of the claim is settled by the insurance provider. While this decreases the premium amounts, if the co-payment ratio is too high, it can cause financial burden and instability. It is better to select a health insurance plan with low co-payment ratios.

Senior Citizen Insurance Plans: The Bottom Line

As an elderly person, Mr. Sudharshan realizes that old age is most prone to deteriorating health conditions. He believes it is best that your medical needs are insured when regular income is hard to come by. He’s determined to make an informed decision and encourages you to do so as well.

Do not wait; buy a policy much before you enter senior years. Even though health insurance is available for senior citizens at a late entry age, why wait until one reaches that age? Why not buy health insurance at a younger age? It is advisable that every individual buy health insurance as early as possible.

The reason: with age, the premium will increase. Therefore, if one buys a plan before entering senior years, it is not only more cost-efficient, it also reduces mental stress about health-related uncertainties and the financial burdens that it may bring with it.

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2 thoughts on “Health Insurance For Senior Citizens – The Why, How, and What

  1. I was thinking about buying insurance for my grandparents and this helped a lot. Thank you for publishing this awesome article.

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