Medicare Senior policy is meant for people aged 60 and above. But it's a letdown considering you'll have to foot 30% of the bill in the event you have to replace your joints or get an angiography or deal with some other select procedure. So if you have joint or cardiac problems, you could look at other similar policies designed for Seniors.
What's good here?
Pre & post hospitalization expenses covered
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
Full coverage even if you are forced to hospitalize at home
The insurer will bear the costs even if you are hospitalized at home due to a condition or the hospital running out of beds. In insurance lingo, they call this a policy with domiciliary cover.
What's bad here?
You will have to pay a portion of the bill
The policy will cover only 85% of the bill in case you opt for a shared room. And 70% in case you opt for anything fancier than a shared room. The rest is on you. They call this mandatory co-payment.
You can only pick a shared room
Tough luck if you are thinking about opting for a single private room. Because the policy only lets you stay in a shared room. If you still want to pick a better room, then be ready to pay a lot more when the final bill shows up. More details here
Has disease wise sub-limits
Your insurance cover won’t be fully available in case you are treated for Angiography, Joint Replacement, Hernia and a few other diseases. Meaning the insurance company has a cap on the total amount they’ll pay out if you are treated for these specific illnesses.
Long waiting period for pre-existing diseases
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems only after 4 long years. It could be much shorter you know? Like 2 years perhaps!
Day Care treatments covered up to a certain limit
If you’re hospitalized for less than 24 hours in lieu of a minor procedure, then the insurer will cover 85% of these costs. Think dialysis, chemotherapy or minor surgeries.
What's lacking here?
No Restoration Benefit
Some policies will tell you - Even after you claim part of the cover on one occasion, you will have the full cover restored, if you are hospitalized another time during the same year. So if you have a family cover and multiple members of the family are hospitalized in the same year, this feature will come in handy. Unfortunately, this policy offers no such benefit.
No Bonus for being healthy and not claiming insurance
Some policies offer you extra cover if you go an entire year without claiming your insurance. This policy, however, offers no such benefit.
Your insurer doesn’t provide free health check-ups
If you want to get a full-body checkup just to make sure you’re in fine working condition, be ready to pay for it yourself.
No Cover for Alternative Medicine
Think of getting Ayurvedic, Homeopathic or other alternative treatment to cure an illness. Tough Luck!!! Your insurer won’t cover this expense.
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