Given the chasm between the public and private healthcare sectors, getting quality health care services at affordable rates has become rather difficult for the common man. In such a scenario, Health Insurance has become a necessity, especially for the elderly.
The risk of being confronted by a sudden medical expense increases as one’s health becomes more fragile with age. Thus, if you are a senior citizen or are looking for health insurance for one, you should consider these 5 factors before you make your purchase:
- Pre-existing Illnesses
Elderly people are at a higher risk of falling ill and getting hospitalized, the insurers charge a higher premium. Moreover, it is also possible that the insured is already suffering from an illness and thus you must check the terms regarding pre-existing illnesses. You should be mindful of the types of illnesses covered, the waiting period, the co-payment terms, etc.
Whenever the insured is suffering from a pre-existing illness, the insurer imposes a waiting duration during which the insured cannot make any claims. You should, therefore, choose a policy with the lowest waiting period.
- Ancillary Expenses
Treating an illness is a process; it does not start and end with the patient’s hospitalization. Diagnosis, medication, post-hospitalization care and many other things contribute to a patient’s treatment. Similarly, the expenses do not end with just the ones incurred in the hospital. Thus you should ensure that the ancillary expenses are covered by the policy.
Most insurers have a stipulated period for which they cover post-hospitalization expenses ranging anywhere from 60-90 days. Senior citizens can require specialized care for long durations post-hospitalization, thus you should choose a policy which covers the same for the longest.
- Co-payment Clause
Normally, an insurer is not the sole bearer of the medical expenses, a portion of it is paid by the insured. In an 80%-20% clause, for example, 80% of the expenses are paid by the insurer and 20% by the insured. The burden on the insured can go up to 40%.
Given the high costs of hospitalization, operations and healthcare in general, even a percentage of the medical expenses can amount to a large sum. As mentioned, since the risk of hospitalization and large bills is greater in the case of senior citizens, insurers tend to keep a higher co-payment percentage for the insured than they do for others and thus, you should opt for a policy that relegates the smallest percentage to the insured.
- Excluded Illnesses
Insurers are more likely to exclude a few illnesses from a senior citizen’s health insurance policy. Thus, in case the insured suffers from the said illness, then they would have to incur the whole or the majority of the expense.
Illnesses often come unannounced, meaning, you can never predict if someone is or isn’t going to suffer from one of the excluded illnesses. You should, therefore, read the fine print in your policy’s terms and conditions and opt for one with the least number of exclusions.
The individual limit on the subcategories in your policy is called the sub-limit. You might have a policy cover of Rs. 5 lakhs but it can include a sub-limit on cataract surgery, for example, of Rs. 20,000, in which case the insurer will only pay Rs. 20,000 and the rest will have to be paid by the insured.
A senior citizen’s health insurance will have more sub-limits than a younger person’s would. Thus, you should opt for health insurance with the least number of sub- limits.
The policy premium is another important factor that you should consider. However, the reason why it isn’t included in the list is that a senior citizen’s health insurance will most likely come with a high premium and thus you should be prepared for that.
While you should look for insurance with a lower premium, you should never compromise on the above-mentioned factors or any other benefits. As buying health insurance would be futile if the illness ends up to be one of the excluded ones, or if you have to shell a massive account from your pocket to pay for the bills.
While buying insurance for an elderly person you should carefully read the fine print, because insurers can curb a few benefits because of the risk involved. Thus, you should do a cost-benefit analysis of all the factors before you commit to a policy.
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