Can Senior Citizens get a Health Insurance Cover? Till What Age?

Age may be just a number, but when it comes to health and safety of our elderly ones, age is more than just a number. It is a valuable factor which deals with their old age days and how they utilize their savings to enjoy it. A healthy life becomes very important that begins fading away from them and clamps upon their life long savings. In this, senior citizen health insurance can be their companion. Considering the rising costs of healthcare in the country today, a proper health care policy becomes of utmost importance for individuals and specifically if those are your elderly relatives. 

With advancing age, ailments and risk of contracting diseases along with hospital visits increases. Given the current situation of the pandemic, we all have realized that the risk our elderly people face has amplified. Many expenses including medicines, hospitalization and illness treatment are rising on a daily basis. Another fact being their limited or maybe no source of income leads to no scope of increasing their income. This difficult situation makes retirement feel like a major hassle and challenge rather than spending golden days of their lives in peace of mind. 

Thus, a health insurance policy for senior citizens becomes a support for their old age. Even though there’s a group health insurance plan which has got your entire family covered, it becomes necessary for you to buy health insurance policy for the elderly separately. Health insurance companies provide many policies for senior citizens specifically customized and designed for them. But, before that first let’s try to know what a health insurance policy for senior citizens has got to offer-

What is a Senior Citizen Policy all about?

Usually, a senior citizen is a person who has crossed the age of 60 years, so it becomes clear that these health insurance policies are for people beyond 60 years of age. Similar to other health insurance policies, a health insurance policy for senior citizens is quiet similar process between insurer and the policyholder. Generally, the age limit is not something which is fixed as insurance companies provide insurance coverage to people up to the age of 75 years and even 80 years and also sometimes beyond these age limits in specific cases. It is a clear procedure; as long as their demand for these services in the markets there are insurance companies willing to fulfill them. However, these policies come with various terms and conditions which are to be met by both the parties. As part of the process, the policyholder pays a premium to the insurance company, against which the company pays for the medical expenses incurred in case of any illness or accidents to the insured – including hospitalization, day-care, post and pre-hospitalization among others. Though the premium amount for a senior citizen health insurance policy is much higher than that of their younger counterparts. 

Factors of a Senior Citizen Policy

Before buying health insurance policy for a senior citizen, following are the important factors to look upon:

Cover for in-patient hospitalization by the insurer: 

In the policy, in-patient hospitalization covers are given by the insurer for the medical expenses incurred by the insured when they are admitted to the hospital for more than one day time period, in case of any illnesses or even maybe an accident. This term covers all the hospital expenses including day care expenditure, doctor fees, diagnosis, medicine etc. In some health insurance policies for senior citizens, there are certain limits for some expenses, like – in most policies in-patient hospitalization is included, but there are limits on doctor and specialist fees. Also, as number of stays in hospitals could be high for a senior citizen, it is crucial to look for a senior citizen health policy that gives them maximum in-patient hospitalization coverage.

Check for any limitations on post-hospitalization bills: 

There’s a reimbursement to all the costs which are incurred by them that are directly linked to the illness or emergencies for which they were admitted. Also, to be eligible for post hospitalization is the time period 60-90 days. Most of health insurance plans for senior citizens, post hospitalization period has gone down. In many, the post hospitalization coverage can extend for about 7 to 10 percent of the total claimed amount. Remember to check for the terms and conditions which apply, before making any purchase.

Check restrictions on number of day-care hospitalizations: 

In a hospital there are procedures that can be completed with time limit of 24 hours. Operations like cataract, dialysis, chemotherapy, etc., are some of these procedures. Although many health insurance policies cover for senior citizens for their day care facilities, some restrict their cover. For some plans, the amount of day care facilities might go as low as 8 to 10. Before buying a health plan for, make sure that you are aware of the number day care facilities available under the policy. 

Check for all the terms and conditions for pre-existing illness: 

In many scenarios elderly people have many pre-existing illnesses. So, while purchasing any policy, always check for the terms and conditions related to pre-existing illnesses. Even though there might be pre-existing illnesses which are covered check for waiting period for each of them, co-payment clauses etc. 

Check for any waiting period, co-payments, exclusions: 

While purchasing health insurance policy for elderly people, make sure to read the policy to understand waiting periods, co-payment, exclusion and sub-limits if there exists any – 

• Checking for waiting period: In case there exists some waiting period in a policy, no claims will be entertained by the insurer till the waiting period is over. This is more likely if you have any pre-existing illnesses. Usually, for a health insurance policy in any scenario, the waiting period is between two to four years. In case of health insurance for senior citizens, many insurance companies, have decreased the waiting period to one year. This is due to the obvious reason that senior citizens need immediate hospitalization. Thus, lower the waiting period the better it is.

• Check for co-payment conditions: In this condition, the policyholder needs to spend a share of the medical costs from their wallets. So before getting health insurance for senior citizens, things to consider while looking forward to this condition would be – That senior citizen healthcare policy has a co-payment condition. And, that this clause is in accordance with the waiting period displayed in the policy. Also, It is said that when the waiting period goes down, the share of co-payment for the policyholders will go up. It is necessary to know what the policy is when it comes to the waiting period and co-payment clause. The percentage amount for the co-payment for a policyholder who tends to be a senior citizen is about 10-30%

• Check for exclusions: Almost all medical insurance providers for senior citizens offer exclusion in which the medical conditions or pre-existing healthcare expenses are not covered by your health plan. So, go through the policy to know about the diseases which are excluded from the plan. You must know the policy which has no or least exclusions.

• Check the sub-limits: A sub limit is a top limit as to how much a policyholder can claim for a particular expense. Many senior citizen health care policies have sub-limits like- a surgery might have a certain sub-limit per session, knee-cap surgery, kidney dialyses etc. One must know all the policy details to adopt to the nuances of what are the sub limits, and all the terms and conditions for each one of these. 

Claim settlement procedure for health insurance policy for senior citizens

Senior citizens can avail facilities by buying health insurance policies for health care benefits in case of illnesses or medical emergencies. Facilities such as cashless treatment can be availed by the policy holder that fall under senior citizen age limits, in this facility the policyholder gets all their expenses of pre- and post-hospitalization reimbursed to them in case of accidents and emergencies. Also, the bills might get settled by the insurer and their network hospitals in most of the cases under the same facility. However, in any such cases the insured has the responsibility to inform the insurer within 24 hours of such hospitalization.