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Can A Rs 5 Lakh Health Coverage Take Care Of Senior Citizens’ Needs?

Health insurance has become necessary as medical inflation rises steeply, but how much coverage should you have?

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Versha Jain
December 23, 2023
Health Insurance Mistakes That Every Retiree Should Try To Avoid

Health Insurance Mistakes That Every Retiree Should Try To Avoid

As medical inflation skyrockets, the need for a health insurance policy has become more critical than ever. The cost of a health policy pinches you more when you need it the most. When you reach middle age, retire, or approach retirement, you may be fighting various health issues, but the cost of a health plan at that age can be quite substantial; hence, one should buy a policy when young whether it be 5 lakh health coverage or any other.

So, buying a health plan at a young age makes more sense than when you are old and have higher health risks as the cost will be relatively lower. But if you are a senior citizen and want to buy a health plan, the biggest question is how much coverage you should take and whether the policy adequately covers all the major diseases. Generally, the higher the sum assured, number of critical illnesses covered, and the facilities offered, the higher the cost.

Says Anuj Kesarwani, a certified financial planner, chartered trust and estate planner, and founder of Zenith Finserve: “Medical inflation is rising at the rate of 14 percent in India. It means the cost of treatment is doubling in 5 to 6 years. This is a staggering rate of growth.”

Most advisors recommend coverage of at least Rs 5 lakh, but is this sufficient for someone near retirement or those age 60 and older living off their savings? Says Dr S. Dheeraj Krishnaa, head of wellness and telehealth at Star Health and Allied Insurance, “The onset of morbid diseases is much higher in senior citizens, so they should take a higher sum insured.” Additionally, seniors could also be prone to cardiac-related issues, knee and hip problems, etc.

Also Read: Should Seniors Consider These 5 Government Health Insurance Policies?

Kesarwani says, “A comprehensive policy with Rs. 5 lakh cover with all must-have features and no major downsides is recommended. A policy with less than Rs. 5 lakh coverage generally does not provide a comprehensive cover. Although a Rs 5 lakh cover is insufficient as senior citizens are susceptible to hospitalization owing to their age and the fact that it becomes difficult to increase cover at a later age at a reasonable cost.”

Krishnaa adds that getting a policy in old age becomes difficult due to strict underwriting rules, medical examinations, and other hassles. Even upgrading the sum insured can be challenging. “So it is better to plan 5-10 years and pick the highest sum insured,” he says.

So, what could be sufficient health insurance coverage for senior citizens?

There is no straightforward answer. Some advisors suggest 50 percent of the annual income; however, this rule may not apply to all, as they will have different health issues, income levels, preferences, etc. Nonetheless, before buying a health plan, you may consider the following three points:

Medical Inflation: While purchasing health coverage, it is vital to consider medical inflation. Weather it is a 5 lakh health coverage or not it should be sufficient to cover all major illnesses, from cancer and cataracts to knee replacement surgeries.

Affordability: No matter how good the policy features are, they must also be affordable. Senior citizens must be able to pay the premiums and renew the policy. Otherwise, the whole exercise will go in vain. Medical expenses may vary from one city and hospital to another, so plan for the costs and the coverage accordingly. Lifestyle is also an important consideration. Kesarwani explains that if a person works odd-hour shifts, it may disrupt his sleep, leading to health issues. Likewise, people in metros like Delhi may face pollution-related health issues. Therefore, one must mitigate these issues besides purchasing a health policy.

Age & Health Conditions: You could increase or decrease your insurance coverage depending on your age, health condition, and family medical history. If you already suffer from a specific disease, you may opt for a rider or a top-up plan covering the particular illness.

What Is The Ideal Amount of Cover? 

According to Dr Krishnaa, it depends on the policyholders’ priorities for hospitals. “If they want to go to a tier 1 hospital, the cost would be around Rs 10-15 lakh. So, they should pick Rs 10-15 lakh sum insured at the minimum, majorly senior citizens, as they are at a higher risk.”

Kesarwani suggests, “The minimum base cover for someone in the 50s and beyond should be Rs. 15 to 20 lakh today. This should be reviewed every 4 to 5 years to protect the savings from depletion”. He adds, “Generally, most treatments cost up to Rs. 20 lakh except in exceptional cases. There is no point in taking huge covers as they come at a premium.”

A 5 lakh health coverage can be sufficient for some and insufficient for others. There is no standard insurance coverage for all. Dr Krishnaa says, “If people can’t afford it, they should take a lower cover than no cover at all.”

Neglecting your health will weaken your immunity, which may lead to various health problems. Given the rising medical costs, planning for health exigencies in advance is worth it. So, before buying a health plan, consider the costs, future medical inflation, and your current health condition. Buy a comprehensive plan at an early age that can last after retirement.

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