Health insurance: Do senior citizens have enough health cover options? Here's what the govt said

The decision to reduce tax rates on life and health insurance premiums was postponed by the GST Council during their 55th meeting on Saturday. Officials stated that additional technical details needed to be addressed, and therefore, the Group of Ministers (GoM) was assigned the task of further discussions.

Bihar Deputy Chief Minister Samrat Chaudhary emphasized the necessity of another GoM meeting to make a final decision on the taxation of group, individual, and senior citizens' insurance policies. 

However, there is a concern about the availability of sufficient health insurance plans for senior citizens, as insurance plays a vital role during old age, especially when there is no one else to rely on.

Senior Citizen Health Insurance provides coverage for medical expenses for individuals aged 60 and above. This insurance plan includes preventive health check-ups and cashless hospitalization at designated network hospitals.

Earlier this week, Pankaj Chaudhary, Minister of State in the Ministry of Finance, spoke about the number of insurance schemes currently available for senior citizens in the private insurance market and their affordability.

While answering a question asked in the Parliament, Chaudhury said: “Insurance sector regulator the Insurance Regulatory and Development Authority of India (IRDAI) has issued IRDAI (Insurance Products) Regulations, 2024 and Master Circular on IRDAI (Insurance Products) Regulations 2024-Health Insurance, containing provisions to ensure that insurers make available products / add-ons / riders to provide wider choice to the policyholders / prospects catering to all ages. These two documents direct that insurers shall allow for customization of products by customer by providing the flexibility to choose products / add-ons / riders as per his/her specific needs."

The affordability issue was addressed by the clarification that Irdai's regulations require premium amounts to be fair, non-discriminatory, and provide value for money. There are multiple schemes available in the market tailored to different age groups and their unique needs. Private insurers offer additional options and riders for specific requirements, giving policyholders and potential buyers a variety of choices to consider.

Recently, the Centre expanded the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) to offer health insurance coverage of up to Rs 5 lakh annually to all individuals aged 70 and above, regardless of their income. The PM-JAY program aims to deliver essential healthcare services to vulnerable populations, with senior citizens now eligible for coverage of up to Rs 5 lakh annually for secondary and tertiary hospital treatments. Additionally, senior citizens who are part of a family already enrolled in PM-JAY will receive an extra top-up of Rs 5 lakh specifically for them. The program provides coverage at more than 29,000 empanelled hospitals.

Senior citizens currently enrolled in government health insurance schemes such as CGHS or ECHS, as well as those covered by private health insurance or the Employees’ State Insurance scheme, can choose to either keep their current coverage or switch to AB PM-JAY for enhanced benefits.

Is Ayushman Bharat PM-JAY enough?

Though the government has expanded the coverage of the Ayushman Bharat-PM-JAY scheme to include individuals aged 70 and above, regardless of their income levels, not all seniors may benefit from this scheme. Those in higher income brackets are more likely to view it as a supplementary option rather than a replacement for private health insurance policies.

PM-JAY does not offer reimbursement for treatment outside of its empanelled hospitals. If your preferred hospital or a facility near your home is not part of the PM-JAY network, you will not be able to receive care there. This limitation may pose a challenge for individuals accustomed to receiving treatment at a specific facility.

Under the AB PM-JAY scheme, hospital admissions are restricted to general wards, while private health insurance frequently offers the choice of private rooms. This can be a crucial factor for elderly patients who value privacy and enhanced comfort during hospital stays.

Patients enrolled in PM-JAY may experience lower priority in hospitals as a result of government-mandated reduced tariffs, which are in line with CGHS rates in Tier-1 cities.

Moreover, delayed payments could compound this problem, prompting hospitals to prioritize individuals with private insurance coverage over PM-JAY beneficiaries.

Due to the high volume of visitors at the empanelled hospitals, older individuals may also face the difficulty of waiting in line for tests and treatment.