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Calculation of Senior Citizen Health Insurance Premium

Your health insurance premium will be determined based on numerous variables and specific situations. Knowing the variables that will affect the cost of your premiums will empower you to make the most of your insurance plan.

  • 17 Apr 2023
  • 5 min read

Health insurance is becoming increasingly important in India, with rising medical costs. Every health insurance policy carries a premium, which you need to pay to avail of the benefits of the healthcare plan. And this premium is determined by various factors. The amount one needs to shell out is a major concern, particularly if you are considering a senior citizen insurance premium.

The amount of the premium you must pay for this coverage is a crucial factor to consider, as it can act as a financial safety net in the event of unanticipated medical problems. Your health insurance premium will be determined based on numerous variables and specific situations. Knowing the variables that will affect the cost of your premiums will empower you to make the most of your insurance plan.

Factors Affecting Senior Citizen Health Insurance Premium

Your health insurance premium will depend on the type of healthcare plan you choose. A family floater plan, for instance, is usually less expensive than an individual health insurance policy. But remember that the age of the oldest family member will determine the cost of the premium for a family floater plan.

The scope of coverage and sum insured will also impact your health insurance premium. A lesser sum insured can lead to the lowest premium health insurance for senior citizens, while a higher premium will ensure a greater sum insured. Your insurance will only pay you up to the amounts insured in reimbursement for medical costs. However, you will be responsible for covering additional expenses if your total medical bills exceed the amount specified as the sum insured in your healthcare policy.

Some significant factors that affect a senior citizen’s health insurance premium include pre-existing diseases or health issues, add-on covers, co-payment, habits and lifestyle, and family medical history. Moreover, if you live in an area where there is a high level of pollution or severe climactic conditions, you might have to pay a high premium. Environmental issues play a crucial role in determining the premium of healthcare policies, as senior citizens are prone to health issues arising from living in such regions.

Age of the Insurer

A comprehensive health insurance policy for people aged over 60 years is a must-have as it provides financial security as well as peace of mind. Age is one of the most significant factors that affect senior citizens’ health insurance premiums. The reasons behind this are listed below:

  • As we age, the risks for increased hospitalisations, hereditary illnesses, and the need for medical supervision increase.
  • As it gets harder to anticipate risk factors and medical expenditures as people age, some insurance companies do not reimburse pre- and post-hospitalisation expenses.
  • Several health insurance plans include the option of lifetime renewals, but some insurers only permit renewal until age 80.

Investing in a healthcare plan for your senior citizen parents or yourself will go a long way in safeguarding your finances and providing coverage in a medical emergency. Remember to choose a plan that offers lifetime renewability and not just the lowest premium health insurance for senior citizens. Look for a plan that covers pre-existing diseases, adequate pre- and post-hospitalisation expenditures, a minimal waiting period after which one can avail of coverage for pre-existing disorders, add-ons, top-ups, family floater policies and benefits, and other discounts. Also, opt for a plan that provides adequate coverage for critical illnesses, as with age, there can be a higher risk of senior citizens being diagnosed with such ailments.

Pre-Existing Illness

Let’s look at how pre-existing diseases affect the premiums for health insurance plans, particularly for senior citizens.

  • If a person has a history of medical conditions which affect his/her health in the long run, he/she is more likely to spend more money on consulting doctors and specialists, hospital care and other healthcare services.
  • You cannot avail of any benefits until you complete the waiting period for pre-existing conditions as stated in your policy documentation.
  • The amount of your premium will increase depending on the severity of the pre-existing health condition, as evaluated by a professional.
  • If your close family members have a medical history of a pre-existing condition like heart disease, diabetes, hypertension, etc., you are more likely to have a risk of acquiring it at a later stage in life.

When you search for a healthcare plan, look for one that provides coverage for a maximum number of pre-existing diseases. Check the waiting period and select one with the least time so that you can easily complete it. Sometimes insurers waive the waiting period for an additional fee. Consider this option if you are aged over 60 or purchasing a policy for your senior citizen parents. You can calculate the premium with a senior citizen health insurance premium calculator and get an idea of the plan’s cost.

Medical Test Results

Medical tests enable the insurance company to learn as much as possible about an individual's health. The insurer may tailor a term policy just for you, down to the details like the length of coverage you need, the cost of premiums, and other perks. The findings of the examinations that your insurance provider requests will decide the inclusions and exclusions of your healthcare plan, especially if you're applying for senior citizens' health insurance. The factors listed below may change based on the outcomes of a medical exam for a health insurance policy:

  • The insurance company’s main objective is determining the premium you'll have to pay for your healthcare plan. Based on an applicant's perceived level of risk, the insurer will provide a quote for the plan's premium. Your premium will be minimal if you are in excellent health. If you have any pre-existing problems revealed in the test results, the insurer will consider you a greater risk, and you might need to pay a higher premium. But it will reduce the chances of your claim being denied or rejected.
  • If your medical tests come out reasonably healthy, you may be eligible for a larger sum assured.

Many people think that skipping the tests or not disclosing any pre-existing medical condition will let them get a healthcare policy for a lower premium. It is sensible to opt for a policy requiring medical tests so that the insurer can customise the right plan for you. It is better to pay a slightly higher senior citizen insurance premium than be denied a claim in times of need.

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Co-Payment Option

The part of the sum insured you'll be obliged to pay for your medical insurance is a co-payment. In other words, you and your insurer share the expense of your healthcare. Health insurance coverage for those aged over 60 or senior citizens includes a compulsory co-pay clause due to the exorbitantly greater medical care costs faced by the elderly compared to younger individuals.

  • Some insurers let you choose the size of your co-payment. Opting for a co-payment reduces the amount you pay as a premium for your healthcare policy. It's important to remember that a larger co-pay will result in a lower overall premium, but you will still be responsible for paying a higher amount for claims.
  • The insurer will pay the majority of the claim, but the insured will be responsible for paying a certain amount. Co-insurance varies in proportion based on the kind of medical care received.
  • Typically, a co-pay clause mandated the policyholder to pay 50 per cent of the cost for a claim due to a pre-existing condition and 25 per cent for hospitalisation.

Although opting for co-payment is optional for people aged less than 60, it is mandatory for senior citizens. Anyone can find the co-payment value with the help of a senior citizen health insurance calculator.

Why It Is Important To Buy Health Insurance for Seniors

It has become crucial for every person to purchase suitable health insurance coverage for their loved ones, especially for parents who are senior citizens. Even if you have an employer-sponsored group health insurance plan that covers your parents, a separate health insurance policy customised to meet the needs of senior citizens is a sensible investment. The premium for senior citizen health insurance can offer your parents the appropriate coverage.

Senior citizens are more vulnerable to various diseases and hereditary medical conditions with age and may even require hospitalisation and domiciliary care. A majority of insurers provide annual health check-ups at no cost to the policyholder. This could help diagnose any ailment that a senior citizen may have developed in its early stages and help the person seek timely medical intervention. As healthcare policies for senior citizens are customised, keeping their needs in focus, they provide adequate coverage. Spending a little more on a senior citizen’s health insurance premium could provide add-ons that could help the person in cases of chronic diseases or critical illnesses.

When one obtains health insurance, particularly for senior citizens, he/she may relax knowing that in the event of a medical emergency, most of the financial commitments will be taken care of by the insurer.

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