A new study published in The Lancet Regional Health – Southeast Asia and Science Director Elsevier (July/August 2025) involving 10 years of data from nearly 40,000 patients from multiple health care centers, including Hyderabad, has indicated that a large proportion of India’s elderly population undergoing cataract surgery lacks adequate health insurance. What this indicates is that there are critical insurance gaps in health insurance for the elderly.
Limited Awareness And Poorly Designed Plans Leave Seniors Vulnerable
One of the major gaps that can be noted is that elderly patients often lack any form of health insurance, or those who do have some sort of insurance coverage tend to have insufficient coverage to cover the continuously rising medical costs, and hence, they are not adequately covered or have limited insurance coverage. Even after the growing need for health insurance in older age groups, uptake typically declines, which can be attributed to various socio-economic factors.
Due to a lack of coverage or insurance altogether, elderly patients often don’t receive the quality medical care they need, which can result in poor healthcare outcomes. “For elderly individuals, the lack of insurance or inadequate coverage might result in the unavailability of the best medical care. Many elderly individuals, especially in rural areas, are unaware of available insurance schemes or face barriers in accessing them. Consequently, limited awareness also becomes a barrier to accessing quality healthcare services,” says Bhaskar Nerurkar, head- health administration team, Bajaj Allianz General Insurance.
1 July 2025
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The health insurance plans for the elderly are not properly designed for their specific needs. “Even if someone starts taking insurance early and keeps renewing, the premiums inevitably will rise quite high when the person crosses 60 years. At the age of 75 years plus, the premium cost may not even justify the insurance cover being bought. One may be better off dispensing with insurance and absorbing the medical expenses oneself,” says Hari Radhakrishnan, expert, Insurance Brokers Association of India (IBAI). Some health insurance plans may be economical, but they may have restrictions such as co-payments or limits capping which will increase out-of-pocket expenses for the elderly. The choice for senior citizens is therefore limited.
Beyond Hospitalisation: Why OPD, Mental Health, And Home Care Must Be Covered
Another important aspect is Outpatient Department coverage. At this age, elderly people also struggle with diseases that may not require hospitalisation but routine check-ups, sometimes diagnosis, which also cost a lot nowadays. OPD helps the elderly in managing chronic conditions. There is also a gap or lack of long-term management of conditions like diabetes, arthritis, etc, which requires constant attention. Additionally, mental health issues such as dementia, Alzheimer's, etc, are also rarely covered, which need to be addressed.
Some insurance policies do not cover home-based care services, such as nursing or physiotherapy, in their base policies, which is particularly important for the elderly.
Ayushman Bharat And The Way Forward
However, to address these gaps, schemes like Ayushman Bharat are a good attempt to provide financial protection to the elderly and offer broader coverage to various conditions and surgeries that the elderly typically require. It is one of the great options for the elderly to protect their finances in case of a medical emergency.
“Additionally, it is also important that if one can afford it, it is essential to have health insurance coverage with a sufficient sum insured to be able to get quality health care services and the latest medical procedures if needed,” says Nerukar. Awareness campaigns can be another attempt to bridge the gap through correct information, focusing on the elderly and their caregivers to explain benefits and the enrollment process.
It is also crucial to make insurance registration more accessible, particularly for individuals with limited mobility or digital literacy. Ensure equal access to high-quality treatment options for elderly women, who often face systemic healthcare disadvantages.
Currently, insurers are passing on medical inflation to policyholders by frequently re-pricing the product for elderly democratic. Further, there are limitations to what an insurance company that runs on a commercial basis can do to make products comprehensive but economical for the elderly. “Hence, there is a need to have public-private participation schemes where the government can do some amount of viability gap funding between actuarial pricing and market requirement,” says Radhakrishnan.
