- Premiums increase with age and health inflation.
You are sitting outside the operation theatre. One of your parents has just had a heart attack and needs open-heart surgery. The other is diabetic. Both are over 60. Neither has health insurance. One hospitalisation is all it takes to wipe out years of savings and disrupt every plan your family has made.
Can your parents still get insured at this age? Will the premiums be affordable? And will the policy actually pay when it matters? The answers are more complicated than insurers make you think.
Can You Buy Health Insurance For A 60+ Parent?
Until 2024, IRDAI norms meant that most insurers did not offer health insurance to people over the age of 65. Anyone over that age had to undergo compulsory pre-insurance health check-ups, and any pre-existing medical conditions, like diabetes, BP or heart problems, were usually not covered. Insurers either rejected such applicants or charged prohibitive premiums.
But after a 2024 IRDAI directive, insurers are now required to offer health policies to senior citizens regardless of their age or existing medical conditions. Even people aged 80 or 90 can apply for health insurance. The regulator has asked insurance companies to come up with special plans for senior citizens and to try to offer coverage for applicants with all sorts of existing medical conditions.
This does not mean that insurance for people aged 60+ will suddenly be cheaper and easier to get. Insurers worry about the risk associated with providing health cover to older people as they are more likely to need medical treatment. This worry translates to higher premium costs, waiting periods for some conditions, limited coverage and strict conditions after the medical check-ups. Although the rule improves access, some practical difficulties remain.
Before providing insurance to senior citizens, insurers conduct medical tests. This is called underwriting. Based on the underwriting process, the insurers can increase premiums, exclude certain diseases, increase co-pay or reject an application completely. So two people of the same age can receive very different policies. That is why online premium quotes are often only rough estimates, not final prices.
It is generally advised to continue the health insurance provided by the employer or company from which a person retires. Such policies generally have lower premiums and higher acceptance of pre-existing diseases. Buying a fresh retail policy is a tougher task.
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Why Senior Citizen Health Insurance Claims Often Fall Short
The presence of a waiting period clause means that your policy provider will not pay for the treatment of existing diseases for a certain number of years after buying the policy. IRDAI has capped the waiting period for pre-existing diseases at 36 months. After you complete the continuous coverage period of 3 years, those conditions usually get covered. Some insurers offer shorter waiting periods, like 2 years or 6 months, but such plans are usually more expensive.
Almost every senior citizen plan carries a mandatory co-pay of 10 to 40 per cent. Co-pay means that the patient must pay some part of the hospital bill themselves. This is for every hospitalisation, not just once. For example, if the admissible claim is Rs 4 lakh and your policy has a 30 per cent co-pay, the insurer pays Rs 2.8 lakh. Your family arranges the remaining Rs 1.2 lakh. This is common practice because older people are viewed as high-risk customers, although some policies allow a lower co-pay percentage if you pay a higher premium.
The room rent cap is the most confusing and misunderstood clause. The company fixes the maximum amount that it will pay for the hospital room. If you buy a policy cover of Rs. 5 lakh and you receive a hospital bill of Rs. 3 lakh, you would expect it all to be paid by the insurer. But if your policy has a room rent cap of Rs 5,000 a day while the actual room rent is Rs 8,000 a day, the insurer would say that the room is more expensive than allowed and will not only reduce room charges but also many other expenses proportionally. Even if your total bill is Rs. 3 lakh, you will have to pay Rs. 1.2 lakh while the final settlement is Rs 1.8 lakh. This matters especially for elderly patients, for whom private rooms are often medically necessary to reduce infection risk.
Health Insurance Premiums After 60
Older people usually need more medical care, making them high-risk customers. The insurance companies thus charge them higher premiums. After 70–75 years, many insurers place customers in a “high-risk” category, causing sudden jumps in premiums. Health inflation in India is running at around 15 per cent annually, which insurers factor into premium calculations.
The IRDAI has said that insurers cannot hike premiums just because of an individual’s claims history. If you had a surgery last year, your insurer cannot increase your premium prices because of the claim. But insurers can still increase premiums for an entire group or category of customers. This is called a “portfolio-based” increase and has been happening across retail health policies over recent years.
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What To Check Before Buying Health Insurance For Senior Citizens
Insurance companies often advertise high claim settlement ratios in the 95+ per cent range. But this number usually includes both young and old customers. For senior citizens, the number could be much lower. Older applicants are advised to check claim experience from other senior citizens and age-specific claim settlement data, if available.
If your current policy has a high co-pay, a very low room rent cap or poor service in general, you can switch to another insurer during the renewal process as per IRDAI rules. The completed waiting period and no-claim bonus are also transferred.
IRDAI has also said that insurers cannot refuse to renew a policy because the customer has made claims. Even if a senior citizen had an expensive surgery last year, the insurer has to renew the policy. Refusals can take place only in case of fraud, hiding medical information or making false declarations. Also, if the insured amount remains the same, insurers are generally not supposed to demand fresh medical tests every year at renewal.
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