Government Health Insurance Schemes for Senior Citizens

Why is Health Insurance Important for Senior Citizens in India?

Take a look at some of the reasons why health insurance is essential for senior citizens:

• Rising Medical Costs - The cost of healthcare facilities is increasing at an alarming rate in India. For instance, heart surgery in India can cost anywhere between ₹1 lakh to ₹10 lakh, depending on the type of surgery. Buying a mediclaim insurance policy can help senior citizens pay for costly procedures without exhausting their savings.
• Increased Health Risks - With age, the risk of chronic illnesses, such as diabetes, heart disease, arthritis, etc., increases. Not only are these treatments expensive, but they are also long-term and may require regular medical check-ups. A senior citizen health plan can help to deal with these expensive treatments no matter how long the treatment continues.
• Limited Income Post-Retirement - Senior citizens usually have limited income sources after retirement. Without insurance, managing all medical expenses can become difficult, leading to financial stress.
• Cashless Treatment - All health insurance companies offer cashless hospitalisation facilities to their customers where the hospital bills are paid directly by the insurer. This ensures hassle-free medical care without the need to make an upfront payment.
• Coverage for Critical Illnesses - Senior citizen health insurance plans often provide coverage for critical illnesses like cancer, stroke, and kidney failure, which involves expensive treatments.
• Tax Benefits - Under Section 80D of the Income Tax Act, 1961, premiums paid for senior citizen health insurance are eligible for tax deductions.

List of Government Health Insurance Schemes for Senior Citizens

Here is a quick rundown of various types of government health insurance schemes that offer mediclaim coverage to senior citizens during their golden years:

1. Pradhan Mantri Jan Arogya Yojana (PMJAY)

   Pradhan Mantri Jan Arogya Yojana (PMJAY), commonly known as Ayushman Bharat Yojana, is a health scheme launched by the central government to support economically weaker families in the country. It provides coverage for secondary and tertiary care hospitalisation to over 12 crore vulnerable families in India.

   Highlights:

   • Sum Insured - ₹5 lakh per family annually
   • No restrictions on family size, age, or gender
   • Covers pre-existing diseases from day 1
   • Coverage for 1,929 medical procedures
   • Covers up to 3 days of pre-hospitalisation and 15 days of post-hospitalisation costs

2. Pradhan Mantri Suraksha Bima Yojana (PMSBY)

   Launched on June 1, 2015, the Pradhan Mantri Suraksha Bima Yojana provides financial protection in case of accidental death, total disability, or partial disability. This personal accident insurance policy is available to individuals aged 18 to 70 years who have a savings account in a participating bank or post office.

   Highlights:

   • Coverage of ₹2 lakh in case of accidental death or total disability
   • Coverage of ₹1 lakh for partial disability
   • Annual premium of ₹20 is automatically deducted from the policyholder’s account

3. Central Government Health Scheme (CGHS)

   The Central Government Health Scheme (CGHS) was launched in 1954 to provide comprehensive medical care to central government employees, pensioners, and their dependents.

   Highlights:

   • Treatment is available at CGHS wellness centres, government and empanelled private hospitals
   • Reimbursement of hearing aids and other medical appliances cost
   • Free consultation with specialists at polyclinics and empanelled hospitals
   • Tests like X-rays and lab investigations are provided free of cost

4. Employees' State Insurance Scheme (ESIC)

   The Employees' State Insurance (ESI) scheme is a government-backed health insurance and social security program designed to support employees in the organised sector. It covers permanent factories/businesses with 10 or more employees. In some states, the scheme also covers shops, transport companies, restaurants, and newspapers with 20 or more employees.

   Highlights:

   • Ensures financial protection for workers and their families during medical emergencies.
   • Sickness benefit, maternity insurance, funeral expenses and confinement expenses are also available
   • Compensates for wage loss due to temporary or permanent disablement
   • Family receives a dependent benefit in case of an employee’s death or injury at work

5. Universal Health Insurance Scheme (UHIS)

   Introduced by the Ministry of Health and Family Welfare, the Universal Health Insurance Scheme offers financial protection in case of medical emergencies, accidents or death of the primary breadwinner of the family. It is available to both Below Poverty Line (BPL) & Above Poverty Line (APL) families.

   Highlights:

   • Coverage of up to ₹30,000 for medical expenses
   • Covers hospitalisation expenses without any waiting period
   • Accident death cover of ₹25,000 is available for the head of the family or spouse
   • Disability compensation of up to ₹50 per day for up to 15 days is available

6. West Bengal Health Scheme (WBHS)

   The West Bengal Health Scheme (WBHS) was launched in 2008 to provide better healthcare facilities to state government employees, pensioners, and their dependents. It also covers IAS, IPS, and IFS officers in the state. In 2014, WBHS was renamed "West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme 2014".

   Highlights:

   • Reimburses indoor treatment in empanelled and non-empanelled hospitals
   • Covers OPD treatment for 18 specified diseases
   • Allows treatment in 11 approved hospitals outside West Bengal
   • Offers cashless health insurance facilities of up to ₹2 crore per indoor treatment

7. Yeshasvini Health Insurance Scheme

   The Yeshasvini Health Insurance Scheme was launched by the Government of Karnataka for members of cooperative societies, self-help groups and farmers. It aims to provide quality healthcare at minimal costs, ensuring better access to medical facilities.

   Highlights:

   • Sum Insured - ₹5 lakh
   • Covers 2,128 medical procedures, including heart diseases and orthopaedics.
   • Beneficiaries can receive treatment in the general ward only
   • OPD consultation is capped at ₹200 for three months at network hospitals

8. Mukhyamantri Amrutum (MA) Yojana

   The Mukhyamantri Amrutum Yojana is a health insurance initiative by the Gujarat State Government that provides quality medicare services to lower-income families and those living below the poverty line. It ensures cashless medical and surgical treatment for catastrophic illnesses related to cardiovascular diseases, neurological diseases, etc.

   Highlights:

   • Sum Insured- ₹5 lakh
   • Premium is wholly paid by the government
   • Covers 698 procedures and major illnesses like heart disease, cancer, kidney and liver diseases, etc.
   • Coverage for knee and hip replacements with a cap of ₹40,000 per joint
   • Kidney, liver, and kidney-pancreas transplants are also covered up to ₹5 lakh
   • ₹300 is provided per hospital visit for treatment

9. Karunya Arogya Suraksha Padhathi (KASP)

   The Karunya Arogya Suraksha Padhathi (KASP) is a government-funded medical insurance scheme in Kerala that provides financial protection for secondary and tertiary medical care to eligible families. This scheme was introduced by merging various government health schemes to ensure better healthcare access for economically vulnerable families.

   Highlights

   • Sum Insured- ₹5 lakh
   • No restriction on family size or the age of beneficiaries
   • Covers pre-existing diseases from day 1
   • Coverage for 1,573 medical procedures
   • Covers 3 days pre-hospitalisation and 15 days post-hospitalisation expenses
   • Benefits of the scheme are portable across the country

10. Telangana State Government - Employees and Journalists Health Scheme

    The Telangana Government introduced the Employees and Journalists Health Scheme to provide medical benefits to its active and retired employees, including pensioners and journalists, and their dependent family members. The scheme offers cashless treatment at empanelled hospitals of Rajiv Aarogyasri Health Care Trust.

    Highlights:

    • No coverage limit for procedures listed under the scheme
    • Offers in-patient treatment for listed therapies for identified diseases
    • Covers medication for 10 days and complications for 30 days post-discharge
    • One-year coverage for follow-up services for specified treatments
    • OPD care for predefined long-term chronic illnesses at in listed hospitals

11. Rashtriya Swasthya Bima Yojana (RSBY)

    The Rashtriya Swasthya Bima Yojana was introduced in 2008 by the Ministry of Labour and Employment for underprivileged individuals working in the unorganised sector. It helps protect the BPL families from financial burdens due to hospitalisation expenses.

    Highlights:

    • Sum Insured- ₹30,000 per family
    • No restriction on the age or number of family members
    • Covers treatments for all PEDs
    • Reimburses actual travel costs, up to ₹100 per visit, with a yearly limit of ₹1,000
    • Payment of ₹30 annually for registration or renewal

12. Bhamashah Swasthya Bima Yojana (BSBY)

    Bhamashah Swasthya Bima Yojana was launched by the Rajasthan State Government in 2015 and was renamed as the Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana in 2021. It provides cashless insurance coverage for both general and critical illnesses to economically weaker families in Rajasthan, including those covered under the National Food Security Act (NFSA) and Socio-Economic Caste Census (SECC) 2011.

    Highlights:

    • Sum Insured- ₹5 lakh, with ₹50,000 for general treatments and ₹4.5 lakh for critical illnesses coverage
    • Covers multiple medical procedures with 1,576 treatment packages
    • No restriction on the age or number of family members
    • Covers in-patient & day care treatments
    • Coverage for 7 days of pre-hospitalisation and 15 days of post-hospitalisation expenses

Difference Between Government Health Insurance and Personal Health Insurance Plans for Senior Citizens

Check out the table below to know how government health plans for elderly people are different from personal senior citizen health insurance plans:

Government vs. Regular Health Plan for Senior Citizens: Which One is Better?

Government health plans are affordable but offer limited benefits, with most schemes offering a maximum coverage of up to ₹10 lakh. This may not be enough for rising medical costs. In contrast, personal senior citizen health plans provide a much higher sum insured options and cover a wider range of expenses, including day care treatment, critical illnesses, and modern treatments.

While government plans are budget-friendly, their coverage may fall short in critical situations. Regular plans have higher premiums but offer extensive protection, making them a better choice for senior citizens seeking comprehensive coverage and peace of mind.