The Insurance Regulatory and Development Authority of India (IRDAI) recently removed the cap of 65 years on insurance policies, enabling seniors above 65 to buy health coverage. This move is in the right direction to encourage more senior adults to purchase comprehensive health insurance. While the market had a few insurances that covered seniors above 65 even earlier, seniors now have a broader range to choose from. However, the fact remains that the older one gets, the trickier it becomes to choose a policy that offers the best cover without a lot of riders.

From being aware of pre-existing conditions to understanding what a waiting period would mean to paying attention to the co-payment caveat, there are many finer aspects a senior should evaluate before selecting a policy. Let us first understand the various facets and their challenges specific to health insurance policies for senior citizens.

• Pre-existing health conditions: When a senior already suffers from an ailment or a condition that poses a high risk, such as diabetes, hypertension, or cancer, most insurance policies do not provide coverage. And, even if they do, there's a long waiting period of 3 or 4 years -this means you cannot claim insurance for a health emergency due to the pre-existing condition within this period.

• Premium rates: The longer you wait to purchase insurance coverage, the higher the premium you pay since the risks associated are more. Some insurers hike the premium with advancing age, posing a financial constraint for the insured.  

• Co-payment: Co-payment or shared cost clause requires the insured to pay a percentage of the insurance cost. While this could be a tempting offer because a high co-payment percentage reduces the premium proportionately, it can be a drawback when the hospital bill is high.

• Ancillary services: Medical bills often consist of sundry costs not covered by insurance policies, like ambulance, lab tests, post-operative care expenses, treatment at home, etc. These costs can add up to a significant portion of the medical expense.

One needs to be aware of the above factors that can compromise the efficacy of health insurance for senior citizens. That brings us to the next aspect of ensuring maximum benefit from health insurance for seniors.

Top 7 factors seniors must consider while choosing a health insurance policy.

1. Shorter waiting period: As discussed earlier, pre-existing conditions fall under a waiting period or a no-claim phase. Generally, the period is 3-4 years. However, many policies have a shorter waiting period. It is crucial to remain updated about these and choose from ones with a shorter waiting period.

2. Policies without a co-payment clause: Shared costs put undue pressure on the insured in case of a critical and expensive treatment. Always choose from ones without a co-payment clause or those with a minimal shared cost factor.

3. Plans that offer health check-ups: Most diseases can be prevented or reversed if detected early with regular full health check-ups. It is prudent that seniors choose insurance coverage that offers annual health check-ups as part of their plans.

4. No-claim bonus points: Look out for plans that offer a reward system for years without a claim in the form of better or more coverage for the subsequent year. These are beneficial as they lower the premium rate and act as a catalyst for a healthier lifestyle.

5. Domiciliary and day treatments: Domiciliary refers to home treatments. Some patients prefer getting treated at home. Then, there are day procedures like kidney dialysis that do not require an overnight stay at the hospital. Go for plans that cover both of these options.

6. Alternative treatment: Alternate forms of medicine like Ayurveda are gaining popularity. Patients often shy away from Ayurvedic medication because they believe insurance policies do not cover such treatments. The good news is that many insurance policies cover treatments under AYUSH.

7. A good network of hospitals: Seniors must take extra care to check the hospitals listed in the insurance plan. Good insurance plans have a good network of reputed hospitals under their list for cashless payments.

We hope these tips offer good insights into choosing the right health insurance plan for seniors.