Health Insurance

Factors To Consider Before Buying Health Insurance For Senior Citizens

by SMCIB on Monday, 19 February 2024

Factors To Consider Before Buying Health Insurance For Senior Citizens

We are never too old to set a new goal, or to dream a new dream. The second inning of life gives people the opportunity to live all the moments they could not before. And worrying about health complications and finances should be the last thing on the list.

A health insurance plan is the best gift you can give to your ageing parents. It will offer financial aid for medical treatments in their hour of need. In short, it is a gift of health, while they enjoy the beauty of life.

Why buy health insurance for senior citizens?

Ageing is a natural phenomenon, and with increasing age, the human body becomes more vulnerable to several diseases. Senior citizens (people who’ve attained the age of 60 years and above), thus, are more prone to certain health complications as compared to younger people.

From the common cold and arthritis to critical illnesses, such as cancer and cardiovascular conditions - the magnitude of every illness increases with age. The treatment of such health problems is not only expensive but also long-term. And with limited or no income, hospitalisation can be mentally and financially challenging for them.

Hence, buying health insurance for senior citizens becomes a must. It tackles hefty medical costs, protects their savings, and helps them live a comfortable post-retirement life.

Factors to consider before buying Health Insurance for Senior Citizens

Here are some points you should keep in mind, so you can make a well-informed purchase -

The first and foremost thing you should check is whether the senior citizen is eligible to buy the health insurance plan.

  1. Check the eligibility
    Next, you can either buy an individual health insurance plan for senior citizens or you can buy a floater policy.
    Deciding on the type of plan to buy is one of the most important factors you must consider before buying health insurance for senior citizens.
  2. Decide the type of plan to buy
    • Individual Health Plan: As the name implies, it is a type of health insurance that covers a single individual. The whole cover is dedicated to one person. So if your parents are suffering from certain health conditions and they would need frequent hospitalizations/check-ups, go for an Individual Health Policy. This will provide them adequate coverage.
    • Family Floater Health Plan: It is a type of health insurance where family members share a single cover under a single policy. It is a ‘one cover for all’. If your parents are healthy individuals and don’t need frequent treatments, go for this plan. It can be shared across family members, making it very convenient to manage.

      Health Insurance for senior citizens is usually more expensive because of the higher risk. Other factors that affect the rate of the premium are - lifestyle choices, overall health, family medical history, etc. So before buying one, take time to compare and contrast the various health plans offered by different insurance companies at varying rates. And choose the one that fits your parents’ needs and your budget.
  3. Keep in mind the budget
    Medical inflation is outpacing regular inflation, and consultations, tests, and treatments are getting costlier by the day. Considering the medical inflation, a Rs. 15-20 lakhs individual cover should be good. Otherwise, buy the maximum protection you can afford.

    Do not compromise on the coverage, because you don't want the medical expenses to be a big burden for them, despite having health insurance.
  4. Take adequate coverage
    Health insurance offers coverage for several types of ailments, surgeries, etc. Carefully go through the policy wordings and understand the coverage offered by your plan.

    Almost all plans cover expenses, like -

    Additionally, if your parents need to undergo an organ transplant in the future, you should go for an organ donor. Or if Ayurveda, Unani, or any other homegrown AYUSH treatments are helping them, you should go for a policy that covers the costs of those alternative treatments. Customize the policy as per need.
  5. Understand what the plan covers
    • Inpatient care: Covered only if the person undergoes a continuous hospitalisation of 24 hours or more.
    • Daycare treatments: Treatments performed under general or local anaesthesia and take less than 24 hours to complete.
    • Pre and post-hospitalisations: The expenses incurred before and after hospitalisation will be covered.
    • Domiciliary charges: Incurred when medical treatments are done at home due to lack of hospital beds, or severity of the patient’s condition.

      There will be certain exclusions, i.e., certain conditions and treatments that the policy will not cover. There are certain standard exclusions set by IRDAI that health insurance plans will not cover at all. Besides these, there may also be certain diseases/treatments excluded by the insurer. It is important to be aware of these exclusions.
  6. Understand what the plan does NOT cover
    Most health insurance plans also have waiting periods - periods during which the insurer will not offer coverage for specific situations. It is important to understand these nuances.

    Check all these waiting periods for your particular plan. In case your parents have been diagnosed with any such conditions, like diabetes or high blood pressure, opt for plans with a low waiting period. This way you can get them covered, at the earliest.
  7. Understand the waiting period
    • Once you purchase a policy, the insurer will apply an Initial 30-Day Waiting Period for all treatments - except for accidents.
    • If the senior citizen needs to undergo treatments for some specific medical conditions, like - hernia, haemorrhoids, chronic kidney disease, etc. - the insurer will apply 2 to 4 years waiting period. This is called the Specified Disease/Treatment Waiting Period.
    • The IRDAI defines a pre-existing disease (PED) as any medical condition that was diagnosed or treated in the 4 years prior to policy purchase. All insurers impose a waiting period of 2-4 years for such PEDs. This means the coverage for those diseases will begin only after the waiting period has been served.
  8. Check the policy limits
    Health Insurance comes with various kinds of restrictions, like -
    • Room-rent limits: It is the limit up to which your health insurance will cover the per-day hospital room charges. If you pick a room with a rent that is more than what you are eligible for, insurers won’t only deduct the difference in room charge, but also proportionately deduct all associated expenses.
    • Sub-limits: Sub-limits on surgeries for frequent or major lifestyle diseases ensure the claims are under control for insurers. Some financial limits may be implemented on cardiac treatments, or the payments may be standardised for high-frequency surgeries, like cataracts and hysterectomy.

      It’s important to look for a plan with no or least room rent capping, and sub-limits. This way the policy can be utilised to the utmost.
  9. Beware of Copayment
    Copay is the portion of the approved claim amount that you’ll have to pay on your own before the insurer pays the remaining amount. While buying a health insurance plan for senior citizens, look for the ones without the copay clause, or with a less copay% - so that there are fewer out-of-pocket expenses. However, you can consider buying a plan with a copay clause if want lower premiums
  10.  Zone-based copayment on claim
    Insurance companies may sometimes apply zone-based copayment. Generally, if you buy a health insurance policy from Zone II cities or beyond, the insurance company may impose zone-based copayment. The copayment limit and premium discount may differ depending on the city you live in, the city you pay the premiums in, and the city you get hospitalised in for treatment.

    If you buy a plan and pay the premiums in Zone II, but want to get treated in Zone I, the insurer may apply, say, a copay of 10%. So, in this case, you'll have to pay 10% of the approved claim amount and the remaining 90% of the claim amount will be paid by the insurance company.

So, in case you live in a lower zone and are planning to seek treatment in a higher zone, you should check if a zone-based copayment is applicable under the plan - and also check how much zone-based copay is applicable

And that’s all! If you diligently keep the above factors in mind, you will be able to get a good health insurance plan for your parents, or any elderly member of your family. Every day is a good day to invest in a healthier, more comfortable future. We hope you make a good choice today!

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