Prioritising cashless insurance coverage for transition care of seniors

India’s healthcare ecosystem has steadily expanded access to cashless insurance coverage for hospitalisation and acute care. However, one crucial element continues to be overlooked—transition care -- the specialised short-term, step-down care support that helps patients, especially seniors, recover after discharge from the hospital.

“Transition care is the bridge between hospital and home. For older patients who’ve undergone intensive surgeries or suffered major health setbacks like strokes, it can make all the difference in preventing complications, reducing readmissions, and ensuring recovery,” says Ishaan Khanna, CEO of Antara Assisted Care Services.

Why Transition Care Matters

Structured transition care can reduce 30-day hospital readmission rates by 25 per cent to 35 per cent, according to global studies. A 2022 NITI Aayog report also flagged its importance in preventing avoidable hospitalisation and improving outcomes for India’s elderly. Yet, despite its proven benefits, transition care remains largely invisible in policy frameworks and insurance coverage. For families, this means shouldering out-of-pocket costs at a time of emotional and financial vulnerability.

Khanna explains, “Families often walk out of hospitals with discharge notes, and instructions, but not a lot of clarity on what may come next in terms of what the recovery journey would look like or the support that may be needed. Transition care fills this gap. But, without insurance support, access remains limited.”

Antara’s Pioneering Step

Recognising this gap, Antara Assisted Care Services recently introduced cashless insurance coverage for transition care through Third-Party Administrators (TPAs). TPAs act as intermediaries between insurers, providers, and patients, enabling direct settlement of bills without the burden of upfront payments.

“TPA-enabled transition care for seniors is about empowerment and dignity,” says Khanna. “By partnering with TPAs, we’ve ensured families can focus on recovery rather than navigating reimbursement paperwork or arranging deposits in moments of crisis.”

“The absence of TPA-supported cashless insurance for transition care forces multiple families to bring their patients home before time, which results in their need for part-time physiotherapy and informal care even though doctors have explained the benefits of structured care right after hospital discharge. The condition creates a delay in recovery time which affects movement abilities and generates additional health problems and emotional detachment,” he adds.

Health Care at Home (HCAH) is another prominent provider of home healthcare services in India, offering a range of medical and rehabilitation services aimed at delivering quality care outside traditional hospital settings. HCAH collaborates with various insurance companies to facilitate cashless hospitalization and claims processing for patients availing their services.

Optimising India’s Strained Healthcare System

The move comes at a critical time. India’s bed-to-population ratio is just 1.3 beds per 1,000 people, well below the WHO recommendation of 3. Transition care frees up valuable hospital beds by allowing timely discharge of stable patients, while still offering them round-the-clock medical oversight in a lower-intensity setting.

“On average, structured transition care reduces hospital length of stay by three to five days,” Khanna notes. “That’s not just a saving for families—it’s a systemic efficiency that eases pressure on ICUs and wards already stretched thin.”

The Cost And Emotional Imperative

Out-of-pocket spending still makes up nearly 50 per cent of total health expenditure in India. For seniors—one in four of whom are financially dependent on family—cashless insurance for transition care provides a vital safety net.

But beyond numbers, there’s an emotional dimension. Khanna gives the example of a family whose father had suffered a stroke. They were emotionally exhausted and overwhelmed by bills, unsure of how to arrange funds for continued care. When they discovered that the treatment was cashless through their insurer, the relief was immediate. They could admit him without delay or financial scrambling, and that assurance of timely, dignified care provided peace of mind that went far beyond financial savings.

What Needs To Change

For transition care to become mainstream, three things are vital:

* Integration into TPA networks – Accredited transition care providers must be included in cashless panels with defined care protocols

* Dedicated insurance riders – Much like maternity or daycare add-ons, insurers should design standalone transition care products, particularly for seniors

* Policy support – Regulators like IRDAI must incentivise post-acute care inclusion in insurance schemes, public and private

“Transition care is not a luxury, it is a medical necessity,” stresses Khanna. “We need insurers, policymakers, and providers to come together and recognise that.”

A Demographic Imperative

The urgency is underscored by India’s ageing curve. By 2050, 347 million Indians—21 per cent of the population—will be over 60. With that, the incidence of multi-morbidity, hospitalisations, and long recoveries will only rise.

“As we prepare for an ageing India, we must also prepare our systems to support them through recovery,” Khanna says. “Cashless insurance for transition care is not just about better healthcare. It’s about compassion, continuity, and giving individuals and families the confidence that care will not be determined by affordability alone.”