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6 Challenges Related To Health Insurance For Senior Citizens

Team AckoJan 17, 2024

Buying health insurance has become a necessity owing to the sky-rocketing costs of medical treatments in India. Typically, a policy will have a few conditions that one needs to fulfill before he/she is approved for getting insured by a certain insurer. This may not feel like a big deal in normal situations. However, it can be a challenge while buying health insurance for senior citizens.

In this article, we will discuss such challenges faced by potential policyholders while buying specific health coverage for senior citizens and then shed light on the exclusion of the policy.




#1 High Premium

The risk related to insuring a senior citizen is much more as compared to youngsters. This may lead to higher costs of the health insurance premium. To try and avoid this situation, one can buy health insurance for senior citizens as early as possible. Consider buying a long-term plan that will help in avoiding any further price hike as well. These plans are different from family health insurance plans.

#2 Mandatory Health Check-ups

Buying fresh medical insurance for senior citizens may require a full medical checkup. This is a risk as an insurer may reject an application if the risk is too high. Otherwise, a higher premium is charged. Here, any pre-existing conditions suffered by the insured are revealed. These conditions may or may not be listed in the coverages.

#3 The co-payment clause

Individual health insurance for senior citizens typically has a co-payment clause. Under which you need to share a certain part of the hospital bill. One can opt to pay a certain percentage of the hospital bill. However, remember that the higher the co-payment lower will be your premium amount. But this may also backfire at the time of claims where you may have to pay a major portion of the hospital bill in case of a medical emergency.

#4 Entry Age

An individual health insurance policy has a certain age limit that would make a person eligible or non-eligible for availing insurance. This could cause a problem for people who have crossed the limit of entry age. Compare suitable plans before selecting the one and check the entry age if applicable.

#5 Ancillary services

These include all the services related to treating a medical condition apart from hospitalization. They can include ambulance services, lab test done for diagnostic purposes, etc. These expenses can increase the overall cost of a medical emergency. Insurance companies may not always cover ancillary services under their health policy in India. Thus, you should always be clear about the coverage and make a claim accordingly.

#6 Waiting Period

Every good health insurance policy has a waiting period clause. Be it health insurance plans for family or a senior citizen plan. Here one needs to wait for a period of a few years before he/she can claim against a certain medical condition. This might not be an issue for younger individuals, however, it can be stressful with respect to a senior citizen. One may have to wait for a period of 2 to 3 years to be able to avail treatment for certain pressing situations.

Learn more about waiting period in health insurance

Exclusions of Medical insurance for senior citizens

These are situations which are usually not covered under a good health insurance policy for senior citizens. These exclusions could also apply to health insurance plans for family.

  • Certain pre-existing diseases

  • Cost of treatment related to AIDS

  • Self-inflicted injuries

  • Any ailment that has affected the person within the first 30 days of buying the health policy in India

  • Injuries caused due to the act of a foreign army or war

  • Treatment as a result of drug abuse

  • Cosmetic surgery or dental treatment that not a result of an accident

  • Costs of lenses or spectacles

  • Non-allopathic treatment

  • Certain replacement surgeries

Disclaimer: *Except for exclusions like maternity benefits, undisclosed diseases, etc. Please check policy wordings for more details.
**The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.

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