As you age, your healthcare needs become more and more complex. This can be particularly true for senior citizens, where the financial burden of medical expenses can be overwhelming. This is where health insurance comes in and provides a safety net – offering financial support and access to quality medical care.
While there are many private health insurers out there, not all of their policies may be affordable for the common man. This is where the government steps in to provide health insurance for citizens. Among the options available, government health insurance plans specifically designed for senior citizens stand out for their affordability and comprehensive coverage.
In this article, let’s take a look at the features, drawbacks, and top government health insurance plans available in the market in 2024!
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What Are Government Health Insurance Plans for Senior Citizens?
Government health insurance schemes for senior citizens are programs designed to offer affordable or free health insurance coverage if you’re over 60 years old. These plans can be particularly beneficial if you do not have any other insurance policy. This is because government insurance schemes for senior citizens come with several advantages that make them a popular choice, especially among retirees.
Benefits of Government Health Insurance Plans for Senior Citizens
Here are some advantages of government health insurance plans for senior citizens:
- Affordable Premiums: Most plans are heavily subsidised or free, making them accessible to individuals from economically weaker sections.
- Financial Assistance: These schemes provide significant financial relief to senior citizens, particularly pensioners and people from low-income groups.
- Waiting periods: More often than not, standard health insurance policies have a waiting period of up to three years for pre-existing diseases. However, government health insurance plans do not have this waiting period.
Drawbacks of Government Health Insurance Plans for Senior Citizens
Despite their benefits, these plans have certain limitations:
- Limited Network Hospitals: Most schemes restrict treatment options to just government hospitals or a small number of empanelled private facilities.
- Lengthy Processing Times: Claim approvals and reimbursements may take longer compared to private insurance providers.
- Capped Benefits: The coverage limits on these plans may not be sufficient for advanced medical treatments.
Top Government Health Insurance Plans for Senior Citizens
Here’s a closer look at some of the leading government health insurance schemes available for senior citizens:
- ESIC Pensioners Scheme
- What is the ESIC Pensioners Scheme?
The ESIC Pensioners Medical Scheme provides medical benefits to retired employees of the Employees' State Insurance Corporation and their dependents.
- Who is eligible for the ESIC Pensioners’ Scheme?
Any employee who was covered under the ESIC Scheme prior to their retirement is eligible for this scheme.
- Central Government Health Scheme
- What is CGHS?
Central Government Health Scheme (CGHS) offers comprehensive healthcare services to central government employees and pensioners through a network of wellness centres and empanelled hospitals.
- Who is eligible for CGHS?
CGHS is exclusively available for central government employees.
- Ayushman Bharat
- What is Ayushman Bharat?
The Ayushman Bharat or Pradhan Mantri Jan Arogya Yojana (PM-JAY) is a flagship government health insurance scheme offering free coverage up to ₹5 lakh per family annually. It covers 3 days of pre-hospitalisation and 15 days of post-hospitalisation expenses, covers critical illnesses, and does not have pre-existing or specific illness waiting periods. While this coverage is modest, this health insurance plan is available free of charge for families that meet the eligibility criteria.
- Who is eligible for Ayushman Bharat Health Insurance?
The Ayushman Bharat Yojana has detailed conditions regarding who can enrol in this scheme. These criteria are based on the 2011 Socio-Economic and Caste Census data, where if you work in the unorganised sector and earn less than ₹10k per month, you are most likely to be eligible. Here is a more detailed article where we talk about the Ayushman Bharat Scheme. Note: If you’re eligible for CGHS or ECHS, you can choose between having this or switching to Ayushman Bharat. You can’t have both.
Top Senior Citizen Health Insurance Plans via PSUs
While the government offers Ayushman Bharat for senior citizens, here are some notable mentions that the government indirectly offers through PSUs:
- National Senior Citizen Mediclaim Policy
The National Senior Citizen Mediclaim Policy comes in two variants and caters to people in the 60-80 years age category. It provides more extensive coverage, with a cover amount of up to ₹10 lakh. An interesting feature of this policy is that it also covers certain mental illnesses up to the cover amount. However, if you have had any issues before purchasing the policy, there is a pre-existing disease waiting period of 2 years.
There is also a 5% no-claim bonus up to 50% of the base cover amount. Apart from this, the policy includes pre-hospitalization expenses for up to 30 days and post-hospitalization coverage for 60 days. Which, by today’s standards, could be better.
Another pitfall is that a restoration benefit is available only if you are admitted to a hospital due to road accidents. However, the hospital room rent is capped at 2% of the cover amount if you are admitted to a non-PPN hospital. This can be quite restrictive, especially because there is no restoration benefit involved for non-road accident hospitalisations.
- New India Assurance Senior Citizen Mediclaim Policy
The New India Assurance Senior Citizen Mediclaim Policy is crafted for people aged over 60 years. This policy comes with modest cover amounts of ₹1 lakh and ₹1.5 lakh. However, the premiums are also priced accordingly, which starts at ₹3,850.
While the premiums are low, this policy does come with certain significant restrictions – There is a 1% cap on the hospital room rent and 2% for ICU. Apart from this, the total room rent for one hospitalisation cannot exceed 25% of the cover amount. This policy has several such sub-limits on the already limited cover amount.
While it does have these restrictions, the policy has certain upsides. For instance, the insurer offers several add-ons that can boost your coverage. One such add-on covers diabetes and hypertension from day 1, this is a significant upside because there’s a good possibility most people in this age group will have either or both of these conditions.
- United India Senior Citizen Mediclaim Policy
The United India Senior Citizen Mediclaim Policy provides coverage options ranging from ₹2 lakh to ₹5 lakh, catering to the healthcare needs of older adults.
It offers pre-hospitalization expenses for 30 days and post-hospitalization expenses for 60 days. Pre-existing diseases are covered after a waiting period of 3 years, which is slightly longer than other plans in this category.
Although this policy includes good features such as domiciliary coverage, which can be particularly helpful for seniors, it lacks a restoration benefit, a loyalty bonus, a room rent restriction, and sub-limits for some treatments. This can be quite restrictive, especially for the older populace.
- National Varishtha Mediclaim Policy
The National Varishtha Mediclaim Policy, offered by National Insurance Company Limited, is for people aged 60 to 80 years. The policy provides only two cover options of ₹1 lakh and ₹2 lakh.
There is a mandatory co-payment of at least 10% for any claim other than cataracts or benign hyperplasia (which has sub-limits). The insurer covers pre-hospitalization expenses for up to 30 days before admission, while post-hospitalization costs are covered for up to 60 days after discharge. An interesting feature is the optional critical illness coverage, which includes conditions like cancer and organ transplants, available at an additional premium. However, we feel this would be a better option to take with a term insurance plan.
The insurer also offers a bonus of 5% of the cover amount up to 50% for every year without a claim. However, they do not offer restoration benefits, meaning the cover amount is not replenished after it is exhausted during the policy year.
Top Private Health Insurance Plans for Senior Citizens
Here are some of the top private health insurance plans in India in 2024:
| Top Health Insurance Pan | Waiting Periods | Other features | Insurer Metrics |
|---|---|---|---|
| Aditya Birla Activ One Max | PED WP: 3 years (add-ons can reduce it) SI WP: 2 years |
Pre & post hospitalisation cover: 90 & 180 days Restoration: 100% of base SI, unlimited times No-Claim Bonus: 100% pa, up to 500% |
Network Hospitals: 11k+ CSR: 95% ICR: 61% |
| HDFC ERGO Optima Secure | PED WP: 3 years SI WP: 2 years |
Pre & post hospitalisation cover: 60 & 180 days Restoration: 100% of base SI, once a year (add-on to make it unlimited) Renewal Bonus: 50% pa, up to 100% |
Network Hospitals: 11,500k + CSR: 98% ICR: 85% |
| Care Supreme | PED WP: 4 years (add-ons can reduce it) SI WP: 2 years |
Pre & post hospitalisation cover: 60 & 180 days Restoration: Up to Base SI, unlimited times Renewal Bonus: 50% pa, up to 100% (add-on can increase it to 100% pa, up to 500%) |
Network Hospitals: 16k+ CSR: 90% ICR: 58% |
Government Plans Vs. Private Senior Citizen Health Insurance Plans
While government plans are affordable, they may not always offer the best coverage needed for you or your parents. Let’s take a look at some of the important differences between the two:
| Features | Private Health Insurance Plans | Government Health Insurance Plans for Senior Citizens |
|---|---|---|
| Coverage | The sum insured can go to ₹5 crore & beyond. | The sum insured is low and often capped. |
| Policy Type(s) | Individual health insurance Family floater health insurance Corporate or Bank based health insurance |
Family floater health insurance, Group health insurance, or, at times, individual health insurance. |
| Eligibility | Available for all sections of society, irrespective of their age (Most policies let you purchase up to 99 years old. | Available for the financially challenged and elderly section of society. |
| Pre-existing Ailments | Covered after a preset waiting period (varies, based on the plan availed some offer to reduce this on extra premium payment) | Usually covered from Day 1 |
| Room Rent Restrictions | No room rent restrictions for most of the plans offered by the best health insurance providers in India | Private hospital rooms are not usually offered. |
| Premium payment | Paid by the policyholder | Paid by the State or the Central Government in a pre-defined ratio. |
| Daycare Treatment Coverage | ✅(based on your plan) | ✅ |
| Domiciliary Coverage | ✅(based on your plan) | ✅ |
| Maternity Benefits | ✅(based on your plan) | ✅(sometimes only for a single girl child) |
| No-Claim Bonus | ✅(the % varies based on the availed plan) | ❌ |
| Tax Benefits | ✅Under Section 80D | ❌ |
| Free health checkups | ✅(Yes, based on the policy) | ❌ |
| Medical consumable coverage | Can be covered with Health Insurance Add-Ons | ✅ |
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Conclusion
Health insurance is essential for senior citizens to mitigate rising medical expenses. While private health insurance plans may be a better fit for those seeking higher coverage limits and faster claim settlements, government plans remain an affordable and practical option for lower-income groups.
For those who can afford higher premiums, private health insurance provides more comprehensive benefits. However, for economically disadvantaged individuals, government schemes such as Ayushman Bharat, ESIC Pensioners’ Scheme, etc, provide the necessary financial support.
