A Guide to Buy Health Insurance for Senior Citizens

Various health conditions can crop up during old age, and treating them may be costly, considering the rising costs associated with healthcare services. Here, Health Insurance for Senior Citizens come into the picture. These plans address the unique healthcare needs and challenges faced by individuals above 60 years. They offer benefits that cater to age-related conditions and potential health risks.However, before looking at some key features of such plans, let’s see which Health Insurance plans are best suited for senior citizens. Also Read: Why Health Insurance policy is necessary for senior citizens?

Individual Health Insurance:

These policies are suited for all individuals, including senior citizens. They cover pre- and post-hospitalisation, medical treatments, and a host of other features, all catered to address the needs of a single individual.

Group Health Insurance:

It is common for many employers to provide extra benefits to their employees in the form of Group Health Insurance plans . These plans typically cover your family and parents or in-laws (including senior citizens) under a single Health Insurance policy. Sometimes, if the company does not provide a cover, you can pay an additional premium to cover your parents. However, limited coverage and fewer customisation options are why many buy additional insurance policies over and above their Group Health Insurance plan.

Family Floater plans:

Family Floater plan provides financial cover for all family members. They protect individuals, spouses, children and parents (senior citizens). However, there are some caveats attached to doing the same. Firstly, as people age, the rate at which they develop health conditions tends to rise. If a senior citizen covered under a Family Floater plan develops a serious health condition and requires treatment, it might exhaust the coverage for other family members. Secondly, the premium under these policies is calculated based on the age of the oldest member, implying that you must dish out a relatively high premium amount should you include senior citizens under Family Floater plans.

Senior Citizen Health Insurance:

These plans are for senior citizens, have relatively low waiting periods, and provide comprehensive coverage for various pre-existing diseases. Read below to learn more about their features.

Here are some of the features that will support you during your times of need:

Age eligibility:

While some insurance plans cease offering coverage beyond 65 years, Senior Citizen Health Insurance plans go one step further. You can get coverage even later in life; some plans allow renewal for the rest of your life (generally 80 years).

Coverage for pre-existing illnesses:

You may have certain pre-existing medical conditions when you reach 60. These conditions may require expert attention and even treatment beyond a point. In such cases, Health Insurance providers typically mandate a fixed waiting period after this medical condition gets covered under the insurance plan. However, some policies allow the insurance cover to kick in as soon as you pay your first premium.

Comprehensive coverage:

Both pre- and post-hospitalisation expenses are covered by these Health Insurance plans. These are inclusive of ambulance charges, daycare, and doctor’s fees. This feature proves exceptionally beneficial during retirement age.

Cashless facility:

During emergencies, there is seldom any room for calm thinking, and there is a need for immediate action. Health Insurance companies have tie-ups with numerous hospitals, where you can get immediate medical attention, and your bills get settled by your insurer with these hospitals.

AYUSH treatment coverage:

Many senior citizens steer clear of allopathic treatments and gravitate towards relatively healthier options. Ayurveda, Yoga, Unani, Siddha, and Homeopathy (AYUSH) are some options covered by certain Health Insurance plans. Also Read: Factors to consider while buying Senior Citizen Health Insurance

Hospitalisation expenses:

The plans cover room charges, nursing expenses, ICU charges, surgical fees, and other medical procedures during hospitalisation.

Pre-existing conditions:

These plans also cover pre-existing medical conditions after a waiting period, which can be important for senior citizens with chronic health issues or at risk of developing them.

Day care procedures:

Medical procedures that do not require overnight hospitalisation but are needed to treat a senior citizen’s health condition are covered under these plans.

Ambulance services:

The policy covers ambulance charges during emergencies.

Doctor’s fees:

These plans also cover consultation fees charged by medical practitioners.

Diagnostic tests:

Costs related to diagnostic tests, such as blood tests, X-rays, MRI scans, etc., are covered under these plans.

Domiciliary treatment:

Regular visits to the hospital or staying there for several days can be cumbersome for some senior citizens. Sometimes, treating their conditions at home can be a win-win situation for the medical provider and the insured. Fortunately, these plans provide coverage for medical treatment taken at home when hospitalisation is not possible.

Preventive healthcare:

Some plans might offer coverage for preventive healthcare services like health check-ups and screenings. Also Read: Disease Covered Under Critical Under Health Insurance

Purchasing a Health Insurance at retirement age has its own set of challenges. It is much harder to get the right coverage than it is during your youth.These are some factors that you should look out for when buying a Health Insurance as a senior citizen:

Plan your coverage well

It is always better to go for a higher sum insured in the case of Senior Citizen Health Insurance, as the chances of recurring health emergencies are higher. Health Insurance policies have different premium amounts based on the benefits. You should self-evaluate your present financial standing and coverage requirements when choosing a policy for yourself at that age.

Evaluate pre-existing illness coverage and waiting periods

Health Insurance policies can be tricky regarding pre-existing conditions such as diabetes, thyroid, hypertension, etc. Usually, Health Insurance policies include a waiting period for pre-existing conditions. Usually, the waiting period ranges from six months to four years. However, in the case of Senior Citizens Health Insurance, you may find plans with a shorter waiting period of one year.When you pick an insurance plan for a senior citizen, choose one with the shortest waiting period, enabling you to get immediate medical support without burning a hole in your pocket.

Carefully read through the exclusions

You may miss the exclusions while focussing on what you need from the policy. A Health Insurance plan for senior citizens do not cover certain expenses, including cosmetic surgery, dental treatment, ailments diagnosed within 30 days after buying the policy, treatment cost of STDs, AIDS, etc.Also, insurers usually reimburse your expenses after being discharged from the hospital. These expenses include postoperative treatment, follow-up check-ups, medical tests, chemotherapy, dialysis, etc. Depending on the type of policy you hold, you can get compensation for the expenses incurred up to 90 days after discharge.However, some insurance companies may offer only up to 10% of the claimed amount as post-hospitalisation coverage. Look for policies that offer 100% post-hospitalisation coverage.Knowing what is not covered can help avoid filing wrong claims or facing hassles at the last minute.

Keep an eye out for the co-payment clause and sub-limits

As you grow older, you become a higher-risk customer for insurance providers since they have to cover your rising medical costs. Because of this, many insurers include a ‘co-payment clause’ in Health Insurance plans for senior citizens, which requires you to bear a portion of the total medical expenses from your pocket. Typically, the insurance company will give the flexibility to opt for a specific co-payment percentage. In Senior Citizen Health Insurance policies, this percentage usually ranges between 10% and 30%. Be prudent when finalising the co-payment percentage. A higher percentage may reduce your premium but will put more burden on you during a claim. Similarly, if you choose a lower co-payment percentage, your premium may increase, but the insurer will bear most expenses during settlement.If there is no co-payment, then insurers generally impose a cap on treating certain diseases, meaning they can only provide limited financial assistance.These limits are for specific illnesses, hospital rents or post-hospitalisation expenses.

Look for policies with domiciliary care

Taking old patients to the hospital may not always be possible. In such cases, they may require home treatments. If your policy covers domiciliary care, the insurer covers the expenses arising from home treatment, including medicines, doctor's visit fees, nurse charges, etc. Since this form of treatment is common among the older population, looking for Senior Citizen Health Insurance with domiciliary care coverage is beneficial.

Evaluate the claim settlement ratio and claim process well

Insurance providers have simplified the claim process over the years, and most even offer a cashless settlement, which means that the insurer will directly settle bills with the hospital that treated you. Pick the insurance provider with the best CSR because it tells you how many claims they have successfully processed. It indicates their customer friendliness, an important factor in the process. Also Read: Cashless Health Insurance for Senior Citizens & Its Benefits

• If you plan to buy a Senior Citizen Health Insurance plan, it is advisable to opt for a higher coverage amount, even if it means a relatively higher premium.
• Carefully review the pre-existing disease coverage, waiting periods, co-payment clause, sub-limits, post-hospitalisation coverage, and exclusions.
• Look for policies that cover domiciliary care when you have restricted physical movement due to health conditions making it difficult to visit a clinic or hospital.
• Check the network hospital list to ensure cashless facilities are smooth.
• Health Insurance plans also cover non-allopathic treatments (AYUSH).
• Ease of claim settlement and the Claim Settlement Ratio (CSR) are very important when purchasing Health Insurance policies.