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

Posted on: Jun 10, 2025 | 3 mins | Written by: HDFC ERGO Team

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

Crossing the age of 50 brings experience and wisdom, but also increased healthcare needs. Medical costs are on the rise, and having a robust health insurance policy can make all the difference. If you're considering health insurance after 50, your requirements differ from those in their 20s or 30s.

So, what should you look for in a plan after 50? Let’s break it down.

1. Choose Plans with Higher Sum Insured

As you age, the chances of needing frequent medical attention increase. Therefore, opt for policies with a higher sum insured. A sum insured of ₹10-15 lakh is advisable.

Why it matters:

• Medical inflation is growing at a rate of 14% annually.

• Treatments like heart surgery, joint replacement and cancer care can cost lakhs.

2. Check Coverage for Pre-existing Conditions

People above 50 often have pre-existing conditions such as diabetes, hypertension, or arthritis. Look for policies that:

• Cover these diseases

• Have shorter waiting periods

3. Opt for Comprehensive Hospitalisation Benefits

At this stage of life, you may face planned or emergency hospital stays. Your policy should ideally cover:

• Pre-and-post-hospitalisation (30 and 60 days minimum)

• ICU charges

• Daycare procedures (such as cataract surgery or chemotherapy)

• The policy should have cashless hospital networks. Ensure that you are aware of the network hospitals and services provided under the plan.

4. Consider Policies That Include Domiciliary Care

Domiciliary care refers to treatment at home. As people age, such options may become important. Select plans that provide decent coverage for domiciliary treatment.

5. Look for Critical Illness Add-ons or Coverage

Critical illnesses become a more pressing concern post-50. You should:

• Check if the base policy covers critical illnesses

• Consider buying an add-on for conditions like cancer, stroke, or heart attack

Some plans provide lump-sum payouts on diagnosis of a critical illness, helping manage treatment and othe costs efficiently.

6. Evaluate Co-payment Clauses

Many insurers include a co-payment clause. This means you may have to pay a portion of the claim amount. Opt for policies with:

• No co-pay clause, or

• Lower co-pay percentage

This ensures you're not burdened with out-of-pocket expenses when undergoing treatment.

7. Understand the Sub-limits and Caps

Some health insurance policies include sub-limits on room rent, surgery, or ICU charges. These can limit your benefits during hospitalisation. Ideally, choose plans with:

• No sub-limits

• Higher room rent eligibility (private single room or higher)

Sub-limits might appear as cost-saving measures, but could prove costly during emergencies.

8. Look Into Preventive Health Check-Up Benefits

Many insurers provide free annual health check-ups. These are especially helpful for those over 50 to detect early signs of diseases. Verify:

• Frequency of check-ups

• Range of tests covered

• Eligibility criteria

9. Examine the Claim Settlement Ratio and Process

Make sure the insurer has a high Claim Settlement Ratio (CSR). A CSR above 90% indicates reliability.

Additionally:

• Check about the cashless claim process

• Look for 24/7 assistance

• Ensure claim documents are easy to access and submit

10. Benefits of Daycare Procedures and OPD Cover

Check if the plan covers daycare procedures (like dialysis or cataract surgery). Also, outpatient department (OPD) coverage is essential, as you may visit specialists more often after 50.

Conclusion

Getting health insurance policies after 50 requires more than just comparing premiums. You must consider long-term benefits, medical needs, and support services. By choosing wisely, you can ensure both financial protection and peace of mind.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

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