What to Look for in a Health Insurance Plan If You Are Buying Health Insurance After 50

India's medical inflation rate is currently around 14%, while hospitalization charges in the country surged by 11.35% in the 2023-2024 fiscal year, according to a report by a health insurance company. Such facts underscore the importance of having a comprehensive health insurance plan.

As we age, our healthcare needs become more complex and expensive. Aging raises the risk of conditions like diabetes, high blood pressure, and heart disease, many of which require ongoing treatment and regular checkups.

At the same time, medical expenses are climbing due to rising healthcare inflation, making even routine care a significant financial concern.

For those nearing retirement, the need for protection becomes even more pressing. Employer-provided health coverage often ends when you leave the workforce, taking away a vital safety net just when it's needed most. That's why having an individual health insurance plan isn't just a good idea-it's essential.

Let's examine why health insurance after the age of 50 is crucial. We'll cover key things to consider when choosing a policy in your 50s, 60s, and beyond and offer practical tips to help you make wise, future-ready choices for your health and financial well-being.

Choose a Higher Sum Insured with a Suitable Cover

When buying health insurance at age 50, the first thing to check would be the sum insured. With the increase in medical expenses, procedures such as cardiac surgery, cancer therapy, or orthopedic measures can cost anywhere from ₹10 lakh to ₹25 lakh in India's best hospitals.

Why ₹10–₹25 Lakh Is a Better Benchmark

Although ₹5 lakh coverage may seem adequate on paper, it may not be sufficient when confronted with a medical emergency. It is advisable to take a coverage of at least ₹10 lakh to ₹15 lakh. A few high-end policies are also available, offering coverage of up to ₹25 lakh or even ₹1 crore.

What is Adequate Coverage?

Look for adequate coverage policies that include:

• In-patient hospitalization.

• Daycare procedures.

• Pre- and post-hospitalization costs.

• Home care/ domiciliary care.

• Emergency ambulance fees.

• Organ donor fees.
  

Specific policies now include wellness programs, regular checkups, and teleconsultation coverage, making them ideal for on-the-go health management.

Rajesh Kakkar, Business Head & Principal Officer, Zuari Insurance Brokers Ltd, states that "Insurance companies have started app-based reward programs that promote fitness activities. This allows individuals to reduce their premiums at the time of renewal through participation and earning rewards."

Also Read: Health Insurance for Senior Citizens in India

Check Pre-Existing Disease (PED) Coverage

Most people experience pre-existing conditions like diabetes or hypertension by the time they turn 50.  Therefore, they must factor in the following points when making an informed choice:

1. Understand the Waiting Period

Most plans have a waiting period for pre-existing diseases of 3 to 4 years. During this time, costs arising due to PEDs will not be payable by the insurer. However, most highly rated insurers have begun offering plans with lower PED waiting periods of 2 years, which can significantly enhance early claim eligibility.

By reducing the PED waiting period from 48 months to 36 months (IRDA stipulated), more individuals are likely to opt for health insurance, thereby enhancing insurance penetration in the country," says Siddharth Singhal, Business Head of Health Insurance at Policybazaar.com.

The moratorium period has also been decreased by the Insurance Regulatory and Development Authority of India (IRDA) from 8 years to 5 years. According to the IRDA notification, once a policy has completed a continuous period of 60 months in the books (including portability and migration), it cannot be repudiated. These 60 consecutive months are referred to as the moratorium period.

2. Terms of Coverage

Not all policies are the same when it comes to treating PEDs:

• Some don't cover chronic diseases, such as diabetes, at all.

• Some cover them, but with loading (additional premiums).

• Some have co-payment clauses, which means you pay a fixed percentage of the treatment cost.

• Compare how various policies deal with long-term chronic conditions:

• Is diabetes covered beyond 4 years or 2 years?

• Are annual checkups or medical tests compulsory?

• Is there any permanent exclusion clause?
  

Pro Tip – Contact the experts at AssetPlus to find affordable health insurance after 50 that offers open PPO policies, minimal waiting periods, and transparent disclosures. One should carefully review the policy brochure, and a financial advisor will assist you in making informed choices for the best-in-class plan.

Exercise Caution Regarding Entry Age and Renewal Limits

A common misconception is that health insurance for people in their 50s can be canceled at any time. However, health insurance plans still carry ceiling age entry limitations, mostly between 60 and 65 years of age. After you reach this age threshold, your choices are diminished.

Select Policies with Lifetime Renewability

IRDA assures lifetime renewability for policies bought before the cut-off entry age. So, if you wait until 60+ to purchase health insurance, you end up with higher charges and tighter clauses.

Seek Policies with:

• No age limit for entry.

• Guaranteed lifetime renewal.

• Minimum medical underwriting - Select plans that cover regardless of existing conditions, with proper statements.
  

Pro Tip - Seek advice from AssetPlus health insurance professionals and get the best plan at the right time. Buying health insurance at age 50 or earlier guarantees broader options, reasonable premiums, and uninterrupted health coverage well into your old age. 

Opt for a Low Waiting Period and No Sub-limits

When comparing the best medical insurance for those over 50, opt for policies with no sub-limits and minimal waiting periods.

Understanding Sub-Limits

The insurance companies may impose the following:

• Room rent limits, for instance, are ₹4,000 per day.

• Disease-specific sub-limits, for example, ₹1 lakh for cataract.

• ICU caps and surgery sub-limits.
  

Opt for Plans Without Sub-limits

The right medical policy for people above 50 will have:

• No room rent limit.

• No disease-specific capping.

• Minimum or zero co-payment clause (ideally 0% for 50–60 years).
  

Assess Waiting Periods

Other than PED waiting periods, look for:

• Initial waiting period - Typically 30 days

• Waiting periods for specific diseases (e.g., hernia, joint replacement, piles, etc.) - Typically 1–2 years
  

Explore Critical Illness Add-ons

With growing age, the risk of critical illnesses such as cancer, stroke, and heart disease goes up manifold.

Globally, people over 65 years account for half of all cancer cases, while in India, the proportion is one-third. ICMR predicts a 12% increase in cancer cases in India by 2025, which has increased by 10% in four years. This means critical illness coverage has become a must, especially while opting for private health insurance over 50.

What Is a Critical Illness Rider?

A critical illness rider is an optional insurance policy that requires an additional premium payment, providing a lump sum amount when a specific condition is diagnosed. It can be utilized for:

• Replacement income (if you are not able to work).

• Traveling for specialty treatment.

• Home care.

• Making lifestyle changes or hiring caregivers.
  

Covered Diseases:

• Cancer.

• Heart attack.

• Stroke.

• Kidney failure.

• Coronary artery bypass surgery.

• Organ transplant.
  

Few insurers now cover 20–40 or more critical illnesses, depending on the policy.

Why It Matters After 50

• Critical illness consultation charges could range from ₹15–25 lakh, depending on the severity and length of stay. Classic health insurance might not cover all these charges.

• Adding a critical illness rider to your health insurance at 50 ensures financial security during medical crises. It is a wise addition when investing in low-cost private health insurance after the age of 50.
  

Cashless Network and Claim Settlement Ratio

Cashless hospitalization and seamless claim settlement are now crucial when selecting health insurance after the age of 50.

Check the Insurer's Hospital Network

Select insurers that offer a comprehensive cashless network, particularly in your city or at your preferred hospitals. This allows:

• No payment needed at the time of admission.

• Quick treatment in emergency cases.

• Instant claim settlement by the insurer.

• Leading insurers now have cashless tie-ups with 10,000+ hospitals across the country.
  

Evaluate Claim Settlement Ratio

The CSR displays the paid versus filed claims for a given year. IRDAI suggests searching for insurers with the following:

• 95% or higher claim settlement ratio.

• Under the 7-day average claim processing time.
  

More Tips

• Check user reviews for the quality of service.

• Check the 24/7 helpline or mobile app support for assistance.

• Choose insurers with in-house claim teams.
  

Bonus Tip - In your 50s, unforeseen medical needs may suddenly arise. Your insurance company's support system should be available when you need it, making it one of the most critical factors in health insurance after 50. 

Premium vs. Benefits: Opt for Value, Not Low Price

A common mistake among buyers seeking affordable health insurance after age 50 is selecting the lowest premium option available. However, such policies often come with:

• Restrictive clauses.

• Limited network coverage.

• Unfavorable claim conditions.
  

Rather than chasing the cheapest plan, evaluate:

• Coverage-to-premium ratio?

• Sub-limits, disease-specific caps, or co-payments.

• Value-added services.
  

Example: Policy A could cost ₹15,000 a year and offer ₹5 lakh coverage with co-payments, while Policy B could cost ₹21,000 but come with ₹15 lakh coverage, no sub-limits, and free diagnostics. It is better to choose plan B as it offers better value for money.

Prioritize Flexibility and Features

Choose top-of-the-range policies that offer:

• No-claim bonuses that keep on enhancing your sum insured every year.

• Restoration benefits for over one claim per year.

• Discounts for wellness rewards, fitness tracking, and healthy habits.

When selecting health insurance for individuals in their 50s, prioritize the overall benefit package over the base price. This approach provides peace of mind on finances and health in the long term.

Add Family Members Strategically

If you are considering insuring yourself and your spouse (over 50) or aging parents, you must choose between individual plans or family floater plans.

Floater Plans vs. Individual Coverage

• In a floater plan, every family member is covered by a single sum insured, making it ideal for couples with fewer medical complications.

• Individual policies are the best option for seniors over 50 with existing health conditions. A single claim cannot exhaust the collective cover.
  

Coverage for Parents or Dependents

• For elderly parents (60 and above), consider individual senior citizen policies that target their age group, even if it means a higher premium.

• Additionally, check if the company offers tax relief under Section 80D for premiums paid for parents who are over 60 years old.
  

Conclusion

Turning 50 is a significant achievement; however, having health insurance in one's 50s is a crucial security imperative. The sooner you buy, the greater your access to full coverage, reduced premiums, and short waiting periods.

Don't be wooed by cheap premiums with hidden exclusions. Instead, opt for value-based, benefit-loaded, and future-ready plans that cover your health, along with your financial needs. Discover expert-assisted, customized health insurance policies on AssetPlus. An insurance counselor can help determine your medical needs, budget, and existing risks, ensuring your policy aligns with your life after 50. Contact Assetplus with your financial expert for proper insurance guidance.

FAQs

Can I purchase health insurance after 50 if I already have diabetes or high blood pressure?

Yes, most insurers provide coverage for pre-existing illnesses, but with a waiting period of 2–4 years. Always opt for plans with fewer PEDs and clear terms and conditions.

What is the optimal sum insured for an age of 50 years?

A cover of ₹10–25 lakh is wise for those above 50 years of age, considering increasing medical expenses and lifestyle diseases.

Do I purchase a family floater or an individual policy when I am above 50?

For individuals over 50, individual policies may be more suitable due to higher medical risks. For young dependents, a floater works well.

Is it too late to purchase health insurance when I am 55 or 60 years old?

No. Though options reduce with age, the majority of insurers provide coverage up to 65 years with lifetime renewals. The sooner you buy, the better.

Are critical illness riders worth adding?

Yes. They provide a cash payout upon diagnosis of major illnesses, covering out-of-hospital charges and expenses during recovery.