What is the Maximum Age limit for Health Insurance?

by SMCIB on Tuesday, 02 January 2024

What is the Maximum Age limit for Health Insurance?

Recent years have taught us a great lesson that life is unpredictable. Even if you eat the right food and exercise regularly, you can never guarantee that you will never get sick. Despite our best efforts, our bodies still develop health issues over time.

A situation like this calls for a health insurance plan. It will take care of your medical costs - while letting you concentrate on your health. Although there is no mandatory rule regarding when to buy health insurance, delaying the purchase comes with its own downsides. This is because you become more prone to illness as you age - increasing the risk for insurers.

Having said that, what is the maximum age limit to buy health insurance? And, what are the drawbacks of taking health insurance at a later stage in life? Let’s see.

First, What is Health Insurance?

Health insurance is the financial safety net that protects you against unforeseen medical expenses. It covers expenses related to in-patient hospitalisation, pre and post-hospitalisation, daycare procedures, health check-ups, domiciliary and home care treatments, etc.

It is basically a contract between you and the insurer. The insurer covers your healthcare expenses according to the sum insured you’ve chosen and the policy T&Cs. In return, you need to pay regular premiums.

What is the Maximum Age to Buy Health Insurance?

The maximum entry age for health insurance plans varies from insurer to insurer. Some insurance companies in India offer health insurance policies to people aged 65, whereas some insurers even offer plans to people over the age of 65 years.

However, if you're buying a policy at an older age, you might find it challenging to get a health insurance plan that's both affordable and effective. Let’s see why

Why Should You Avoid Purchasing Health Insurance Later?

In today's world, where focusing on health and well-being is paramount, ensuring you have ample health insurance coverage is a fundamental aspect of financial planning. It might be tempting to put off this decision, but there are some really good reasons why you should steer clear of procrastination. Let's dig into the key factors that highlight how important it is to enrol in a health insurance policy on time -

  • Health Emergencies Can Occur Anytime
    Life has its share of surprises, and health emergencies don't wait for an invitation. When you don't have a health insurance policy, the costs of medical treatments can be downright overwhelming. Getting a health insurance policy on time acts like a safety net, making sure you're covered for those unexpected health twists that life throws your way.
  • Ever-Changing Health Needs
    Your health is a journey full of twists and turns; it's bound to change over time, impacting your eligibility for health insurance coverage. Choosing health insurance when you are young and healthy is a smart decision. It not only increases the chances of approval but also ensures you've got your coverage sorted before any unexpected health hurdles come your way.
  • Losing On Valuable Benefits
    There's a widespread belief health insurance plans solely cater to hospitalisation expenses. So, you may delay purchasing a health insurance policy, assuming you'll never require hospitalisation. However, the reality is that it encompasses much more than just hospital stays, including coverage for daycare procedures, treatments at home, outpatient expenses, and more. Many plans also offer crucial maternity benefits, especially significant for women during major life milestones. Additionally, some plans cover expenses related to newborns, including vaccination charges, etc. Therefore, if you opt for a health insurance policy at an older age, you might miss out on valuable benefits that could have been essential for your well-being.
  • Financial Limitations May Apply
    Opting to invest in health insurance early on is a wise decision that comes with the advantage of enjoying comprehensive and well-rounded coverage. Securing a policy in your youth means avoiding financial constraints like co-payments, deductibles, etc. On the contrary, obtaining coverage later in life might subject you to mandatory financial limits like co-pays and other restrictions.
    Moreover, starting the health insurance journey at a young age provides you with a more extensive array of options. Waiting to obtain health insurance at a later age may significantly limit your options, as age-related constraints often reduce the availability of comprehensive plans. And, you may have to settle for less extensive and inclusive plans.
  • Waiting Periods May Be Applicable
    When you purchase a health insurance policy, it's important to note that the coverage doesn't kick in immediately; there are several types of waiting periods applicable. Some common types of waiting periods include -
  1. Initial Waiting Period
    Health insurance policies come with a 30-day initial waiting period, during which you’ll receive no coverage for medical conditions except those related to accidents.
  2. Pre-existing Diseases Waiting Period
    Pre-existing diseases, diagnosed or treated within 4 years before applying for a health insurance policy, typically have a waiting period of 2 to 4 years.
  3. Specific Waiting Period
    Apart from initial and pre-existing waiting periods, insurers may impose a waiting period for specific conditions like hernia or chronic kidney disease, generally lasting 2 to 4 years.

This waiting period can pose a significant challenge when you look for health insurance coverage later in life. You should not delay purchasing a health insurance policy until old age, as this may result in having to wait for the applicable waiting period just when you need coverage the most.

  • Possibility Of Application Rejections
    When you buy a health insurance policy, insurers evaluate your risk profile. As you get old, the likelihood of developing health issues increases, making the underwriting process more stringent. Consequently, there's a higher probability of insurers declining your application or applying loading if they perceive a higher level of risk associated with your health.
  • Missing Out On Tax Advantages
    It's not advisable to view a health insurance policy solely as a way to gain tax deductions. However, it's worth noting that the premiums paid under this policy are eligible for tax deductions as under Section 80D of the Income Tax Act 1961. Furthermore, you can also claim deductions on health insurance premiums covering your parents, spouse, and children. Buying a health insurance policy at an early age allows for annual tax savings throughout the years of coverage. Even though there are still benefits to obtaining a health insurance policy later in life, doing so earlier ensures more significant net tax savings over the span of your career.

Can You Buy Health Insurance For Your Senior Parents?

Yes, you can acquire health insurance for your senior parents. When exploring suitable health insurance for your parents, you'll likely come across two primary choices - family floater health insurance and individual health insurance. Integrating your parents into your family floater policy may result in a notably higher premium, influenced by their age and any pre-existing conditions. Consequently, you should either enrol both your parents in a distinct family floater policy or opt for individual health insurance policies tailored to their specific medical history.

Typically, when purchasing health insurance for senior citizen parents, it's advisable to seek –

  • Comprehensive Health Insurance
    Many health insurance plans offer extensive coverage without significant financial restrictions, often with upper health insurance age limits of around 60 - 65 years. If your parents fall within this age range, you can opt for top-tier plans, albeit at a higher cost due to their age, and may encounter limitations like mandatory co-pay, etc. However, if your parents surpass this health insurance age limit, fret not. There are also several health insurance plans available that allow enrollment for up to 99 years or even impose no age restrictions. While these plans may be on the pricier side, they can be a fitting choice if your parents are generally in good health.
  • Senior Citizen Health Insurance Plans
    If your parents are facing health challenges or have developed medical conditions or age-related ailments, securing coverage under comprehensive plans might pose difficulties. In such situations, considering a senior citizen health insurance plan is a practical choice. Tailored specifically for elderly individuals aged 60 and above, such plans may not require pre-policy medical tests. However, it's essential to be aware that they may come with specific financial constraints like copay, room rent limits, sub-limits on treatments or illnesses, etc. These are specialised plans designed to address the unique health needs of older individuals, with a few financial considerations to keep in mind.

Can I Get Tax Benefits Under Senior Citizen Health Insurance?

Yes, you can avail of tax advantages if you or any senior members of your family are enrolled in a senior citizen health insurance policy. Individuals aged 60 years or above have the opportunity to claim deductions of up to Rs 50,000 on the annual premiums paid under section 80D of the Income Tax Act, 1961.

To avail of tax benefits under section 80D, it's crucial to make premium payments through recognised payment channels such as your bank, credit/debit cards, cheques, demand drafts, etc. Cash payments are not considered for tax exemptions, except when it comes to preventive health check-ups.

Under Section 80D, you can also claim tax deductions for payments made towards preventive health check-ups aimed at identifying potential illnesses or diseases. The deduction for preventive health check-ups is capped at Rs 5,000, and this is within the overall limit of Rs 50,000 mentioned earlier. Importantly, this deduction can be claimed even if the payment for preventive health check-ups is made in cash.

It's important to note that the tax benefits outlined by the tax authorities are subject to certain terms and conditions.

Myths About Health Insurance Policies For Senior Citizens

Here are some misconceptions revolving around health insurance policies for senior citizens -

  • Myth #1: Senior Citizen Health Insurance is unnecessary for those in good health.
    Fact: Although seniors may currently enjoy good health, the future is uncertain. While being healthy is a positive aspect, it doesn't rule out the possibility of unforeseen health challenges. Accidents or unexpected medical issues can emerge at any stage of life, and the associated costs can be substantial. A senior health insurance policy offers financial protection against potential health-related expenses, ensuring a sense of security for elders in their later years.
  • Myth  #2: Senior citizens with pre-existing conditions cannot obtain health insurance coverage.
    Fact: Contrary to the myth, senior citizens with pre-existing conditions can obtain health insurance. However, in case of a severe pre-existing condition, whether the insurer will offer coverage or not, will depend on the underwriting. If the proposal is accepted, the pre-existing condition will be covered after a waiting period of 2-4 years or less, depending on the plan. Once this waiting period is completed, all medical expenses related to the pre-existing conditions will be included in the coverage.
  • Myth #3: Savings alone is sufficient to manage healthcare expenses.
    Fact: Although savings play a crucial role in covering various expenses, healthcare costs, particularly for seniors needing frequent medical care, can be significant. The escalating cost of medical services due to inflation may outstrip the growth of your saved funds. And unexpected health issues and emergencies can swiftly exhaust savings, introducing financial stress during retirement. A health insurance policy serves as a vital financial cushion, allowing you to fully savour the best moments of life without financial worries.
  • Myth #4: Being covered under employer health insurance is sufficient.
    Fact: While your employer may offer health insurance coverage for senior citizen parents, it's essential to understand that such coverage may not be comprehensive. Employer health insurance policies often have limitations on coverage, including room rent/category eligibility, copays, network hospitals, etc. These policies typically aim to provide minimal coverage and may not suffice for substantial medical expenses. Moreover, employer policies are tied to your employment and cease upon retirement or if you leave / change jobs. To ensure comprehensive and long-term financial security against medical bills for elders, investing in a personal health insurance policy is crucial.
  • Myth #5: Senior citizens may encounter challenges when raising health insurance claims.
    Fact: Times have evolved significantly. Previously, waiting in queues was the norm, but with technological advancements and streamlined procedures, the claim process has become more accessible and efficient for people of all ages, including seniors. They can successfully navigate the claim process by gaining a thorough understanding of and adhering to the terms and conditions outlined in their health insurance policy. The introduction of cashless treatment options has added another layer of simplicity, offering them enhanced convenience and peace of mind when accessing medical care.
  • Myth #6: Health insurance policies for senior citizens come with a hefty price tag.
    Fact: Age and health status are factors that impact health insurance premiums, but they do not excessively strain your finances. The costs of senior-specific health insurance plans are quite reasonable. By comparing different health insurance options, you're likely to find the perfect policy that meets their requirements without being overly expensive.

Pro Tip: If these plans seem costly, consider voluntarily choosing copayment or deductible options. This can effectively reduce the premiums. Copayment involves paying a specific percentage of the approved claim amount out of pocket before the insurer contributes, while a deductible is the amount you must pay from your end before your health insurance coverage begins to cover your medical expenses.

Points To Consider While Buying A Health Insurance Plan

Here are some of the things to keep in mind before you invest in a health insurance plan -

  • Compare Various Plans -
    A health insurance policy isn't a one-size-fits-all product. Every individual has a unique health history, age, and specific coverage needs. It's crucial to really understand your requirements before diving into the sea of available plans. With numerous options out there, it's important to take your time, compare them thoroughly, and choose the right policy that aligns perfectly with your specific needs.
  • Read The Terms And Conditions -
    Before sealing the deal, make sure to thoroughly read and comprehend the terms and conditions of the policy. Take the time to understand all the inclusions and exclusions so that you aren't caught off guard when you actually need the coverage.
  • Evaluate The Scope of Coverage -
    When you're considering a health insurance policy, it's crucial to think about the extent of coverage it provides. Look for a policy that goes beyond just covering hospitalisation expenses. Check if it includes features like daycare procedures coverage, domiciliary treatment coverage, organ donor coverage, etc. It's also important to opt for a policy with minimal limitations, such as low or zero room rent limits, no or low copay, etc. This ensures that you and your family have comprehensive protection, giving you peace of mind in times of medical contingencies.
  • Check For Financial Limitations -
    Be mindful of room-rent limits in your health insurance policy, as they might result in deductions if your chosen room exceeds the set limit. This could impact other hospitalisation costs associated with the room. Choosing a plan without room-rent restrictions is a wise move to prevent hefty out-of-pocket expenses.

Watch out for the co-payment clause, where you're required to chip in a portion of the approved claim amount. To minimise your financial responsibility, steer clear of policies with co-payments or, if necessary, opt for one with the lowest co-pay. Take note of policies that set sub-limits on coverage for specific diseases or treatments like cataract joint replacement surgeries, etc. Before making a decision, carefully review the policy for any disease or treatment-specific coverage limits. Choosing a policy without such limits ensures that you won't have to dip into your hard-earned savings in case of medical emergencies.

  • Include Riders If Needed -
    Check whether your health insurance plan offers any add-ons or riders. These are extra benefits that you can include in your base policy for an additional cost, enhancing its overall coverage. For instance, if there's an add-on available to reduce the pre-existing disease waiting period, you can consider adding it to your health insurance plan. Riders allow you to personalise your coverage to better suit your specific needs and circumstances.
  • Future-proof Your Health Coverage -
    Considering the swift rise in healthcare costs today, it's vital to keep in mind that a sum insured that feels adequate now might not be sufficient in the future. As you age, upgrading your health insurance coverage can become challenging due to factors like age and health conditions. Therefore, it's crucial to invest in a sufficiently large cover that will continue to support you, especially as you enter your older years. By doing so, you ensure that your health insurance policy remains robust and meets your needs as they evolve over time.
  • Pay Premiums Diligently -
    Paying your health insurance premiums is crucial to maintaining the coverage you receive from the insurance company. It's like a commitment you make in exchange for the protection the health insurance policy offers. When choosing the premium amount, make sure it aligns with your budget so that you can comfortably manage the payments.


Disadvantages Of Delaying Health Insurance Purchase

Here are five drawbacks of delaying buying a health insurance policy -

  1. Rising Medical Costs
    The cost of medical care is rising due to a number of factors, including medical inflation, increasing cost of medications and medical equipment, advanced treatments, and demand for medical care. So, accidents and health issues can cost a fortune these days. Moreover, when you are older, health conditions often accompany other complications that prolong hospital stays. So, the resulting hospital bill can wipe out your savings, leaving you with nothing to fall back on.
  2. Lose Out On Benefits
    The general perception is that health insurance plans only cover hospitalisation expenses. Therefore, many people put off the decision to purchase health insurance, thinking that they’ll never need hospitalisation. But the truth is that health insurance plans cover much more other than hospitalisations, such as daycare procedures, outpatient expenses etc. Most of the plans also provide maternity benefits, which can be crucial for women during such a major life milestone. Furthermore, a newborn baby is also covered from birth without additional premiums. So, if you buy health insurance at an older age, you may miss out on benefits that would have otherwise been valuable to you.
  3. Waiting Period
    A waiting period is a period during which the insurer may not cover you for certain medical conditions and illnesses. Health insurance policies generally have a waiting period that can last from a few months to years. So if you purchase a policy in your early years, the waiting period will be over by the time you need to make a claim for medical needs.
  4. Medical Examination
    If you are young and healthy, insurers may not ask you to undergo medical examinations. However, most insurance companies require individuals above 45 to undergo a medical examination. If your test results indicate any medical issues, they may either reject your health insurance application or charge loading or additional premiums to compensate for the risk.
  5. Financial Restrictions
    When you buy a policy at a young age, the insurer may not impose any financial restrictions. On the other hand, if you purchase coverage at an older age, they may apply mandatory financial limits, such as co-pays.

    A co-pay is a specific percentage of the claim amount that you need to pay from your end. The remaining amount is paid by the insurer. It is true that a co-pay can help you reduce premiums, but remember you will incur out-of-pocket expenses when filing a claim.

    Let’s understand the concept of co-pay with an example:
    Samantha buys a health insurance policy with a sum insured of Rs 5 lakhs. Two years later, she undergoes hospitalisation and the medical expenses come to around Rs 50,000. Her health insurance policy includes a co-pay option, under which she is responsible for 20% of the bill. Therefore, when she filed a claim, she was responsible for paying Rs 10,000 from her own pocket (20% of 50,000). The insurer paid the remaining amount of Rs 40,000.

Wrapping up!

As lifestyle diseases increase, medical expenses rise as well, making it all the more necessary to invest in a good health insurance plan. The upper limit for buying health insurance varies from insurer to insurer. Some insurers offer health insurance policies for individuals over 65, while others may even cover those over 65. However, it is always recommended that you purchase health insurance at an early age - if you want to maximise its benefits.


  • What is the maximum health insurance age limit for purchasing a health insurance policy?
    Entry age criteria vary among insurers. While some comprehensive health insurance plans usually set maximum entry ages in the range of 60-65 years, others extend eligibility up to 99 years. The maximum age limit for health insurance for senior citizen-specific plans also varies, depending on the insurance provider.

  • Is it possible for a 75-year-old to get health insurance?
    The possibility of a 75-year-old obtaining a health insurance policy is influenced by factors such as medical history, pre-existing conditions, etc. If there are no significant medical issues, securing a health insurance policy is likely. However, if serious medical conditions exist, it may pose challenges to obtaining coverage. In essence, eligibility is influenced by an individual's health status.

  • Why is it essential for senior citizens to purchase health insurance?
    As you grow older and experience signs of declining health, such as knee pains, weakness, vision issues, etc., the likelihood of being diagnosed with serious illnesses increases. The expenses related to treating these illnesses can be substantial and may jeopardise your savings. Therefore, securing a health insurance policy for senior citizens becomes crucial. It provides a safety net, ensuring that they can access the necessary healthcare without undue financial strain.

  • What should you consider while buying a health insurance policy for senior citizens?
    When purchasing health insurance for senior citizens, here are some key things to consider –
    • Prioritise comprehensive coverage by selecting a plan with minimal or no restrictions on benefits like daycare procedures coverage, modern treatments coverage, domiciliary treatments coverage, organ donor coverage, etc.
    • Be attentive to financial constraints such as room rent limits, copayments, etc. and buy a policy with no or low financial limits.
    • Thoroughly examine waiting periods, exclusions, and other policy details to avoid any surprises down the line.
  • How much health insurance coverage is appropriate for senior citizens?
    If your parents or any elderly individuals are aged over 60, opting for an individual cover of Rs 10-15 lakhs is recommended, considering the escalating healthcare costs. If this amount proves financially challenging, prioritise purchasing the maximum protection that falls within your budget. You can use the following formula to calculate a suitable cover amount.

 Sum insured = (Current Hospital Bill X 1.06)^(60-Age)

  • What is the minimum age limit for health insurance to buy a health insurance policy in India?
    The specific age eligibility criteria can vary among insurers. The minimum health insurance age limit for adults is typically 18 years. For children, some insurers may offer the option for newborn babies to be included after 3 months.

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