Cover For Alzheimer’s: Why Traditional Health Insurance Isn’t Enough

Generally, health insurance plans in India provide coverage for hospitalization costs related to alzheimer's disease and dementia, as long as the treatment requires an inpatient facility.

Health Insurance Does Not Cover Long-Term Care 

In advanced markets like the US, there is long-term care (LTC) insurance, which usually cover all or part of the cost of assisted living facilities and in-home care for people with chronic conditions that need constant attention and cannot perform everyday activities on their own.

Unfortunately, there are no long-term care plans available in the Indian market, which currently lacks the technical expertise to develop and underwrite such solutions. These products are unique, as they envisage continued payouts upon the policy being triggered for the entire lifetime of the insured person. This is unlike conventional health insurance, which involves only episodic payments related to a hospitalization.

“However, long-term care such as continuing nursing, assisted living, or memory care homes, custodial-type care is typically excluded from standard health insurance policies. It is important to note that the exclusions directly depend on and vary across insurers,” says Sarita Joshi, head of health and life insurance, Probus.

“While long-term or home-based care is not part of standard coverage, many insurers today offer add-on benefits that include short-term nursing or home care support. Customers should look for these “nursing at home” or “home hospitalization” add-ons when selecting or customising their policy to enhance protection,” says Siddharth Singhal, head of health insurance, Policybazaar. While these will not provide comprehensive long-term protection, they can provide an added layer of services.

Additionally, everyone should glance through the policy document properly because there can sometimes be specific exclusions or sub-limits. Although an acute medical condition is covered, there will be a need for additional coverage to receive continuing support for these conditions. To sum up, traditional health insurance is more hospitalization-oriented.

Consider Additional Riders 

Standard health insurance plans typically cover only inpatient treatment. If there are health issues associated with alzheimer’s or dementia, families can consider critical illness riders that pay lump-sum amounts on diagnosis.

“Otherwise, only a handful of comprehensive and wellness-based plans have extended coverage for other areas of mental and neurological incidents. As progressive conditions like dementia often involve long-term support, it may be helpful to align your base health policy with riders or separate long-term care products to fill the gap between medical-travel costs,” says Joshi.

“Families should prioritize plans with a high sum insured or unlimited restoration benefit, along with a strong hospital network that includes facilities equipped for neurological and geriatric care. These features ensure continued financial protection as such conditions progress and require more frequent or specialised treatment,” says Singhal.

A shorter waiting period for pre-existing conditions and inclusion of home healthcare or domiciliary care are additional advantages. Daily hospital cash, caregiver support, or rehabilitation coverage could ease a family's financial burden as a neurological disease progresses. “Usually, conditions such as Alzheimer’s or dementia involve frequent medical services. In addition, families should examine the insurer's claims service and exclusions, particularly for long-term,” says Joshi.

As mentioned above, traditional health insurance is more hospitalization-oriented. “Many degenerative conditions like dementia or Alzheimer’s do not require hospitalization but more of assisted care. Hence, one cannot obtain financial protection against long-term care requirements from traditional health insurance,” says Hari Radhakrishnan, expert, Insurance Brokers Association of India (IBAI).