Health insurance options for seniors have increased
While there was a time when almost no insurer wanted to offer health coverage to seniors, the situation has changed today. “A few years ago, it was almost impossible to think of taking out a health insurance policy once the person had reached the age of 60; however, the insurance landscape has changed over time. Seniors can get coverage at older ages to meet the rising cost of medical treatment, which is most common among seniors,” says Indraneel Chatterjee, co-founder of RenewBuy, an online brokerage firm. assurance.
You can get health coverage despite comorbidities
Often, an existing illness was reason enough for health insurers to reject a new policy application from customers. When it comes to people over the age of 60, a large portion of this segment suffers from one or another type of disease. This is why insurers were once reluctant to offer health insurance to this segment. However, things have changed. “Insurers are becoming more sophisticated in responding to these chronic conditions. Typically, if you have moderate well-managed health conditions, the insurer will issue you insurance,” says Kapil Mehta, co-founder of SecureNow Insurance Broker.
Common co-morbidities such as diabetes or high blood pressure are covered by many special senior policies. “There are insurance companies that allow health insurance for people over the age of 65 with comorbidities like diabetes and blood pressure. Although they may have to pay loading fees or incur a period waiting for a period of time to have their pre-existing conditions covered,” says Naval Goel. , Founder and CEO of PolicyX.com, an insurance comparison portal.
Beware of these limiting factors
Although insurers have started to offer health plans for the elderly, however, there are many limitations. “Most of these plans have certain common features in terms of the benefits provided. Some exceptions for health insurance for the elderly include capping the sum insured, a longer waiting period, and pre-existing clauses,” explains Chatterjee.
One of the shortcomings of many of these plans is the waiting periods depending on the illness. “Regular Mediclaim policies tend to have only one waiting period for pre-existing conditions, while seniors plans often list waiting periods by condition. These higher restrictions make it easier to issue insurance seniors with medical issues,” Mehta says. Similarly, many plans also have sub-limits per disease, which means they will not cover if expenses exceed these sub-limits for a specific disease.
Standard plan with a higher entry age or a special senior plan?
There are many new standard plans that have started to offer a higher entry age so that older people can also purchase these policies. Given the two choices, how should a senior decide which plan will work best?
Where the special seniors policy scores points: Being tailored to the requirements of old age, special seniors plans tend to tick more of the good boxes for seniors. “The basic coverage of seniors plans includes pre- and post-hospitalization costs, ambulance costs, intensive care costs, surgeon fees, etc. There are also plans for seniors that cover the cost of organ donation and transplantation,” advises Chatterjee.
The choice will mainly depend on the amount of health insurance you already have. If you were primarily dependent on your corporate plan and did not purchase an individual plan, the special senior plan may be a better option. “In case an elderly person has not applied for a health insurance policy after 60 years, it is suggested that he opts for elderly based schemes. Indeed, many benefits of the insurance scheme Seniors’ health depends on their age, and seniors can continue to renew policies into old age, which is not the case in a comprehensive health plan,” Chatterjee explains.
If you already have or have a higher risk of developing a chronic condition, then also having a special senior plan would be a better choice, “There are several pure seniors insurance available, and their main value proposition is to meet the needs seniors with chronic conditions.. Underwriting, pricing and benefits are geared toward these seniors,” Mehta explains.
When the standard policy might work: There are many standard policies that have a higher entry age and provide long-term coverage, which can be a good option for older people. “Over the past 2-3 years, insurers have shifted to regular products where the entry age can be over 65. Fewer plans are administratively easier for insurers to manage,” explains Mehta.
Standard plans offer broad coverage at a relatively higher premium. “Primarily, standard health insurance plans have features and benefits. And there is no co-pay in standard health insurance plans. %” said Goel.
Should we opt for co-payment or not?
Most senior special plans offer a lower premium than the standard plan, but that comes with a tradeoff. “In the plans for the elderly, the premium is lower than that of the standard health insurance, but there is a co-pay option in these plans as well as a fixed amount insured because the sum assured is given under limits in plans for the elderly,” says Goel. Each time you make a claim, you will have to pay part of it as agreed in the co-payment clause. Some plans give you the option of paying a higher premium for not having a co-pay obligation.
So how do you decide whether to opt for a plan with co-payment. “It entirely depends on the financial capacities of the insured. Health insurance without co-payments charges a little more than co-payments. If the premium does not weigh heavily enough on the pocket of the insured, he must take it without co -payment, because paying a higher premium is always cheaper than paying a hefty hospital bill,” says Goel.
There are also conditions under which the insurer will only issue a policy if you agree to co-pay, especially in the case of pre-existing conditions. “It’s good to opt for co-payment if you have chronic illnesses. Insurers are more willing to issue insurance if they know that you will pay part of a possible hospital bill. Co-payment completely aligns the insurer and your interest. For example, you would also like to reduce your hospital stay to a minimum if you have a co-payment because you are paying part of the bill. .
So if you don’t have a chronic condition, a non-copayment plan may be a better option. “If you are in good health, it is better to opt for a formula without user fees for the obvious reason that the entire hospital bill will be borne by the insurer. Keep in mind that even when “there is no co-payment, there are certain items such as administrative costs and toiletries that the insurer will not cover. These costs can represent between 10 and 15% of the total bill”, explains Mehta.
If affordability is an issue, having a co-pay plan is better than having no plan at all. “There is another reason you may opt for co-pay and that is to keep a low premium. Co-pay plans are less expensive. Some insurance offers you the option of paying a higher premium more later and remove the co-pay. It’s helpful because you can buy an affordable plan now and later, when you can afford to pay more, remove the co-pay,” says Mehta.