Senior Citizen Health Insurance Q&A: Joydeep Saha | Upbhokta Panchayat
Expert Interview: Challenges and Future of Senior Citizen Health Insurance in India
The NITI Aayog's Senior Care Reforms paper mentions that only 18% of seniors have health insurance, which means the vast majority are completely exposed. An expert discussion on senior healthcare coverage challenges and trends.
Q1. What are the key health insurance challenges faced by senior citizens in India today?
The fundamental challenge is that most seniors reach their most medically vulnerable years without adequate financial protection. And this is not just about affordability. It is about availability, awareness, and product design all falling short at the same time.
Many senior citizens in India still rely on their children or personal savings when a medical expense arrives. The NITI Aayog's 2024 Senior Care Reforms paper mentions that only 18% of seniors have health insurance, which means the vast majority are completely exposed. Beyond that, even those who do have insurance often find that high co-payments, sub-limits, and waiting periods for pre-existing conditions make their policies less useful than they expected. With age comes complexity, multiple conditions at the same time, frequent visits, and ongoing medication, and keeping affordability and risk in mind, the products for senior citizens are designed with such restrictions.
Q2. How has the senior citizen health insurance market evolved over the past few years?
The market has come a long way, and I say that with genuine conviction. There was a time when getting health insurance as a senior was almost impossible. Products were scarce, premiums were prohibitive, and renewals came with conditions that made long-term coverage uncertain.
That has changed. Regulatory direction from IRDAI brought structure to the market, standardising entry age and ensuring renewability so that seniors are not left without options. Products today are more thoughtfully designed, and the government's expansion of Ayushman Bharat PM-JAY in 2024, extending Rs. 5 lakh annual coverage to all citizens aged 70 and above regardless of income, was a significant step forward.
What gives me confidence is not just the policy progress but the shift in attitude. Families are now thinking about senior healthcare protection much earlier, and that cultural change is just as important as any regulation.
Q3. What factors should consumers consider before purchasing a health insurance policy in their retirement years?
The most common mistake people make is treating health insurance as a one-time decision. You buy it, file it away, and assume it is working for you. It rarely stays that way.
At ManipalCigna, this is a pattern we have tracked through our India Health Quotient 2026, a study conducted in partnership with YouGov India, covering a sample of 2,600 respondents across the country. The study looks at how Indians perceive health, make insurance decisions, and adapt to changing healthcare needs across life stages. What it clearly reinforces is that health and health insurance is not static.
Retirement-age health needs are dynamic. What you needed at 60 is very different from what you will need at 70. So, when choosing a plan, start with the basics. Look at the coverage amount and ensure it is realistic given today’s and future medical costs. Understand your co-payment obligations and waiting periods for pre-existing conditions. These factors shape almost every claim experience you will have.
Once those are clear, go a level deeper. Check which hospitals are in the network near your home, understand how the claims process works, and read the exclusions. These are the details that rarely get attention at the time of purchase but matter enormously when you actually need care.
Our study found that only 12% of insured Indians review their policy more than once a year - a gap that can quietly cost you.
Q4. What role can insurers, regulators, and consumers play in improving health insurance access and affordability for senior citizens?
Improving senior health insurance is not something any single stakeholder can do alone. It requires all three to play their part and play it well.
Insurers need to lead on product innovation. Today's senior needs coverage that goes well beyond hospitalisation, including home care, long-term care, and conditions like dementia that can be financially devastating over time. The NITI Aayog's Senior Care Reforms paper has specifically called for this, and it is a direction the industry must take seriously.
The regulator is already working towards strengthening this segment through a sharper focus on differentiated customer service and clear pricing regulations tailored for senior citizens. Additionally, there is an opportunity to further support this cohort by simplifying policy language, making it easier for seniors to understand what they are buying and the recourse available to them.
At the same time, consumers also need to play a more proactive role. As highlighted in the India Health Quotient 2026, 38% of urban Indians neither own insurance nor intend to purchase it. This mindset will only shift when regulators, insurers, and consumers work together consistently to drive awareness, accessibility, and trust.
Q5. What emerging trends do you foresee in the health insurance sector for India's ageing population?
Three things stand out to me as I think about where this sector is heading.
First, the demographic reality. India's elderly population is projected to reach 230 million by 2036. That is not a distant concern. It is happening now, and the insurance sector needs to scale its thinking accordingly.
Second, a generational shift in responsibility. Our India Health Quotient 2026 found that 29% of employees aged 25 to 34 already want their employer's policy to cover their parents. The younger generation is stepping into caregiving roles earlier, and products need to reflect that new dynamic. That being said, with the rise in the awareness of medical costs, people should start planning well in advance rather than waiting to get into that cohort.
Third, technology. With 63% of Indians feeling positive about AI in healthcare according to our India Health Quotient 2026, there is real appetite for tools that predict, monitor, and personalise care. The future of senior health insurance will increasingly be built around staying well, not just recovering from illness.
Q6. What message would you like to share with Indian consumers, especially senior citizens and their families, regarding health insurance preparedness and financial security?
My message is simple: start before you think you need to.
Health insurance works best when it is put in place during a period of stability, not in response to a crisis. By the time a health event forces the conversation, choices are limited and costs are higher. The best time to act is always earlier than feels necessary.
Our India Health Quotient 2026 study found that insured Indians scored significantly higher on overall well-being than those without coverage, and this held true even among people under high stress. That finding stayed with me. It tells you that insurance is not just about the money. It is about the confidence of knowing you are protected.
For families with elderly parents, please make this a planned conversation, not a reactive one. That small shift in approach can make an enormous difference when it matters most.
“ग्राहक को पूरी लागत, प्रक्रिया और हर चरण की स्पष्ट जानकारी मिलनी चाहिए”
होम लोन किसी व्यक्ति के जीवन का सबसे बड़ा और लंबे समय तक चलने वाला वित्तीय फैसला होता है। ऐसे में ग्राहक के लिए केवल कम ब्याज दर ही पर्याप्त नहीं है। लोन की पूरी लागत, प्रोसेसिंग फीस, अन्य शुल्क, दस्तावेज, स्वीकृति की प्रक्रिया, भुगतान, सर्विसिंग और शिकायत निवारण—हर चरण में पारदर्शिता जरूरी है।
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