If you are planning to purchase a health insurance plan in India, you may be wondering what the maximum age limit for health insurance is. The good news is that there is no fixed blanket age limit for health insurance in the country for buying a medical insurance policy.
This means that individuals of any age can purchase a health insurance policy to cover their medical expenses, without worrying about a medical insurance age limit. That said, it is important to keep in mind that insurance companies may have their own age restrictions or age limits for health insurance plans of certain kinds. For instance, private insurers may enforce a maximum age limit for health insurance that covers critical illnesses. This is because the likelihood of developing such illnesses increases with age.
Furthermore, some health insurance companies may also have an age limit for health insurance in general. This means that they may not offer coverage for individuals over a certain age, since the risk of an insured incident occurring increases significantly as people age. Alternatively, to offset this risk, some health insurance providers may charge higher premiums for older individuals instead of enforcing a maximum age limit for health insurance.
Aside from medical insurance plans offered by private health insurance providers, there are also policies and schemes offered by the Government of India. Some examples of such schemes are the Pradhan Mantri Jan Arogya Yojana (PMJAY) and the Rashtriya Swasthya Bima Yojana (RSBY). If you are eligible for the benefits from such policies, you will have to check the maximum age limit for health insurance coverage under these schemes.
Fortunately, you do not have to worry about a medical insurance age limit in most of the schemes introduced by the government. They typically provide coverage for certain medical expenses for eligible individuals regardless of their age.
Nevertheless, age is an important factor to consider when buying a medical cover, even if there is no age limit for health insurance set by your preferred insurer. This is because with age, your chances of developing health problems go up, and so does your need for more extensive coverage. Consequently, the premium for the policy also varies based on the age of the person who is applying for the cover. More specifically, the premium will be higher for older individuals as compared to younger individuals.
So, when purchasing a medical insurance policy, you need to consider the medical insurance age limit, if any, as well as the effect of age on the premium.
Important Update (Dated May 30, 2024) – Good news for Health Insurance policyholders! According to the Master Circular on Health Insurance Business 29052024 rolled out on May 29, 2024 by IRDAI, insurers are to decide on the request for cashless claims within 1 hour of receiving the request. Also, the final claim is to be granted within 3 hours after the policyholder’s discharge from the hospital. Insurers have been directed by IRDAI to establish necessary systems and procedures for this process by July 31, 2024.
The Master Circular on Health Insurance Business 29052024 circular is available here - https://irdai.gov.in/document-detail?documentId=4942918
What is the Maximum Age Limit for Health Insurance?
As mentioned in the section above, there is no mandatory maximum age limit for health insurance policies per se. That said, the Insurance Regulatory Development Authority of India (IRDAI) has maintained that the medical insurance age limit is 65 years of age. This is why many health insurance providers set the maximum age limit for health insurance at 65 years.
So, one of the options available for older individuals is a comprehensive senior citizen health plan, which may have a conducive age limit for health insurance. These plans are designed to provide coverage for a wide range of medical expenses that are particularly common in older adults. The best part is that the entry age for these plans, which may vary depending on the insurer, typically ranges from 60 to 65 years.
It’s essential to remember that while the entry age limit for health insurance plans like these may be set, there is usually no upper age limit for enjoying the coverage. This means that even if you are over the prescribed medical insurance age limit for purchasing the cover, you can continue to get the benefits of the health cover you possess.
Furthermore, there are also some insurers who may offer plans specifically tailored to the needs of people aged 80 years and more. With such a relaxation in the age limit for health insurance, senior citizens and super senior citizens can also enjoy additional benefits and coverage options.
While these are the possible scenarios, it is important to confirm the actual age limit for health insurance with the insurance provider you intend to purchase a cover from. This is primarily because not all insurers offer medical coverage for older adults. There are still some providers who have a strict maximum age limit for the health insurance policies they offer. So, it is always a good idea to do your research, compare different options and ensure that you are getting the best coverage for your needs and budget.
Drawbacks of Investing in a Medical Insurance Policy After the Age of 50
You now know that the maximum age limit for health insurance varies from one plan to another. So, it may be natural to put off purchasing a medical cover, since you may assume that you can always buy one at a later date. With medical insurance age limits being quite relaxed in policies by some insurers, you may even delay your purchase and decide to get a health insurance plan when you are nearing your 60s.
However, this may not always be the best idea financially. There are several disadvantages to investing in a health insurance policy later in life, after the age of 50 or so, even if you may be within the medical insurance age limit set by your preferred insurer.
Here is a closer look at the top 5 disadvantages of delaying your purchase of a health insurance plan.
Higher Cost of Insurance
The older you are when you purchase your health insurance cover, the higher the premium will be. This is true even if the insurer does not have any stringent age limit for health insurance plans they offer. Additionally, most health insurance companies in India set the age limit for health insurance purchase at 65. By this age, policyholders are considered high-risk candidates and are therefore required to pay higher premiums. So, the bottom line is that the risk of developing health issues increases with age, and this is reflected in health insurance premiums.
Limited Health Insurance Benefits
Typically, health insurance plans come with specific inclusions and exclusions. The drawback in purchasing a health insurance plan after the age of 50, even if you are within the age limit for health insurance, is that the benefits offered to older policyholders are more limited. Health insurers may have more exclusions in place. You can, of course, extend the coverage and enhance the benefits with add-on riders. However, this also comes at a steep additional cost for older policyholders.
A Longer Waiting Period
Health insurance plans come with a waiting period during which you cannot raise a claim for any ailments. For younger policyholders, the waiting period is generally shorter, since they are less prone to health issues. But when you are older, particularly at or above the age of 50, health insurers are stricter with their waiting period clauses. You may be able to purchase a cover if you qualify for the policy and are within the maximum age limit for health insurance set by the insurance provider, but the waiting period in health insurance will be longer.
Lower Coverage
Medical insurance policies do not offer unlimited coverage. The coverage is capped based on the policies and terms set by the insurance provider. Generally, the maximum amount of coverage is determined based on the results of the medical checkup that policyholders undergo at the time of purchase. When you are above the age of 50, you may have some health issues that could not only drive the premiums up, but may also lower the coverage you are eligible for.
This is why it is not enough to merely factor in the maximum age limit for health insurance before making a purchase. You also need to plan the investment and buy a health cover when you are younger and healthier.
Exclusion of Pre-Existing Illnesses
A pre-existing illness is a medical condition or illness that an individual had before they applied for or enrolled in an insurance policy. These conditions can range from minor to serious and can include anything from high blood pressure and diabetes to cancer and heart disease. Insurance companies often consider pre-existing conditions when determining eligibility for coverage and setting premium rates.
The older you are, the more likely it is that you may have some pre-existing condition like hypertension or arthritis. If a medical checkup reveals such conditions, or if you are already receiving treatment for the same, your health insurance policy may exclude coverage for those illnesses.
To avoid suffering from the disadvantages outlined above, it is advisable to look beyond merely the maximum age limit for health insurance, and to actually plan your medical insurance purchase in a more prudent manner. By choosing to obtain coverage when you are younger, you can get the advantage of lower premiums, better coverage, more benefits and a shorter waiting period.
Myths About Health Insurance Policy for Senior Citizen
Many senior citizens refrain from applying for a health insurance cover even if they are within the medical insurance age limits because of the myths surrounding this financial product. However, such misconceptions and misinformation about health insurance policies for senior citizens can prove to be disadvantageous in the long run.
If you are older and are approaching the age of 60, you too may be apprehensive about whether or not you are within the age limit for health insurance. You may also have many other misconceptions about this type of coverage. Let’s take a look at some common myths about health insurance for senior citizens and decode the truth behind them.
Myth 1: There is Zero Coverage for Pre-Existing Illnesses
If you qualify for the age limit for health insurance but have a pre-existing illness, you may be worried about not getting coverage for the same. While some insurers may not cover such conditions, there are others who will, although at a higher premium. So, it is not true that there is no coverage for pre-existing conditions whatsoever.
Myth 2: No Health Insurance Requirement for Healthy Senior Citizens
It is natural to assume that if you are healthy, you may not require a health insurance cover at all. So, even if you are below the maximum age limit for health insurance, you may postpone or entirely put off buying this kind of cover. However, the truth is that a medical emergency could occur at any time. So, it is always advisable to be prepared in advance.
Myth 3: A Group Cover is Enough
As a senior citizen, you may be secure in the belief that the health insurance policy offered by your children’s employer may extend to your medical needs too. While this may be partially true in some cases, a group cover is not a substitute for an individual health insurance plan. So, if you are within the age limit for health insurance and still qualify for a cover, it’s best to purchase a policy that is tailored to your needs.
Points Consider While Buying a Health Insurance Plan
Before you buy a health insurance plan, the medical insurance age limit is one aspect to check. In addition to that, there are also other things to consider, as outlined below.
Your Coverage Requirements:
Determine what kind of coverage you require and what you can afford.
The Network of Hospitals and Doctors Included:
Find out if the plan includes the hospitals and doctors you prefer.
The Waiting Period:
Some plans have waiting periods for certain treatments or pre-existing conditions.
The Claim Settlement Process:
Find out if the plan has a quick and easy claim settlement process.
The Coverage Limits:
Confirm if the plan has any caps on room rent, treatment costs or overall sum insured.
The Exclusions:
Be aware of any exclusions in the plan such as pre-existing conditions or treatments not covered.
