The United Nations Population Fund projects that the share of senior citizens in India will rise to 20.8 per cent of the population by 2050, with nearly one in five Indians expected to be above 60. While it reflects longer life expectancy and a growing recognition of healthy ageing, it also calls for a strategy that fills the gap of affordable, accessible, and comprehensive health insurance for its elderly population.
With rising chronic and lifestyle diseases, the older population of the country faces rising medical costs, complicated claim procedures and limited coverage. India’s recent GST reforms exempt health and life insurance premiums from 18 per cent tax but the real question is whether our insurance ecosystem is equipped to support its elderly population.
A growing population with inadequate coverage
Despite the demographic shift, India’s elderly remain among the least insured. The current health insurance system, designed largely for younger, working-age individuals, struggles to accommodate the medical realities of ageing: multiple comorbidities, longer recovery times, and recurring outpatient care.
Neha Sinha, Dementia Specialist, CEO and Co-founder, Epoch Elder Care said, “Despite the rapid demographic change in the country, health insurance coverage for senior citizens in India is still very inadequate. Seniors often pay overvalued prices for insurance once they hit the age eligibility threshold of 60+ due to the higher risk associated with advanced age. Many plans limit the age for eligibility to join (usually between 65 and 70). This effectively leaves most atrisk individuals without any way to enrol in a plan. Health insurance companies frequently use unfair underwriting methods and implement risk management strategies that disadvantage individual consumers.”
Rajagopal G, Director and Group CEO, Lifebridge Group says that health insurance for the elderly in India remains in its early stages. While there are now more senior-focused products available, most are still hospitalisation-centric, offering limited support for the out-ofhospital care that older adults often require, such as rehabilitation, palliative care, and dementia support.
The impact of this gap is very evident. Many elderly Indians exhaust their life savings or depend on their children to pay for hospitalisation and long-term treatment. And as Vivek Srivastava, Ex-CEO, HCAH, points out, “Overall insurance penetration has not kept pace with need: many older adults rely on out-ofpocket spending for routine, chronic and long-term care, which frequently causes financial distress.”
GST relief: A step forward?
The removal of 18 per cent GST from health, and life insurance premiums recognises healthcare as a necessity not a luxury. It has been widely welcomed.
Sinha says , “The most recent GST reforms, also termed as the ‘GST 2.0’, have rather rained down as drops of relief on most of the population, including the elderly citizens. By easing the tax burden, policies that were once financially out of reach for the middle class are now more accessible. Lower premiums could encourage more families to purchase new policies or renew lapsed ones. This change may significantly improve retention rates among elderly policyholders.”
Sanjiv Bajaj, Joint Chairman and MD, BajajCapital opines that by making health insurance GST-free, India has recognised healthcare as a necessity, not a luxury. This is not just a tax change, it is a social signal that protecting health in old age is a national priority. But experts also agree that this alone won’t bridge the structural gaps.
“While any tax relief is astep in the right direction, the recent GST reforms on insurance premiums are more of a gentle nudge than a gamechanger, especially for senior citizens. As it stands, shaving off a bit of tax won’t move the needle unless the core offering becomes more meaningful”, cautions Rajagopal G.
Srivastava also adds that, “The reforms are necessary and positive, but not sufficient by themselves to guarantee large, immediate increases in elderly coverage. Close monitoring and enforcement (to ensure benefits are passed on) and complementary measures will determine real uptake.”
Globally, many nations provide subsidised or fully funded healthcare for retirees. While India is still building such a system, removing GST on health insurance is a step in the right direction.
Bajaj stresses that this move should be a beginning, not an end. Complementary reforms are needed like specialised senior citizen plans with coverage for OPD visits, homecare, and chronic illness management, tax incentives for families supporting parents’ premiums and predictable pricing models to prevent sudden premium spikes that make policies unaffordable.
Shift from hospitalisation-centric models to holistic, continuous care
The real challenge is not just affordability, but it’s relevance. Our elderly population needs a plan and products, reflecting the continuum of ageing, ranging from preventive screenings to rehabilitation and palliative care.
Gaurav Dubey, Founder and CEO, Livlong 365 said, “Elderly healthcare requires a shift from hospitalisation-centric models to holistic, continuous care. Product design must evolve to cover OPD consultations, diagnostics, home care, and mental health support— since seniors engage with healthcare far beyond hospital admissions. Disease-specific plans for chronic conditions like diabetes or heart disease, bundled with preventive screenings, can create both affordability and sustainability. Subscription-based health packages—combining insurance with teleconsultations, pharmacy benefits, and wellness services—are another promising model. By blending coverage with day-to-day healthcare needs, insurers can reduce claims volatility while giving seniors predictable, manageable costs. Without such innovation, coverage will remain restricted to wealthier groups, leaving most seniors unprotected.”
Insurers, too, are beginning to experiment. Siddharth Singhal, Business Head – Health Insurance, Policybazaar notes that “To serve the ageing populations, insurers are introducing pricing and design innovations such as modular, personalised insurance covers that let customers tailor benefits and premiums as per their individual needs. The entry age is now extended up to 99 years, with mandatory co-pay requirements (earlier 20 per cent) being removed for greater flexibility. To enhance affordability, monthly EMI options are also available. These innovations are set to become even more granular and attractive, making health insurance more accessible and seniorfriendly.”
Yet, the fundamental shift lies in changing how eldercare risk is assessed. “Imagine insurance that’s as dynamic as the lives seniors lead where premiums are not just agebased, but also reflect proactive health choices. Think modular plans that let seniors pick what they truly need, be it chronic care, telehealth, or assisted living support. If we can link coverage to preventive health data and reward active ageing, we shift from a reactive system to a proactive one. That’s not just innovation, it’s inclusion with intention”, suggests Rajagopal G.
Policy push and public-private partnerships
For real impact, industry innovation combined with policy foresight is important. Experts also agree that government intervention is critical to expand insurance adoption among seniors.
Ashok Kumar, Chief Strategy and Distribution Officer, MediBuddy mentions, “Existing products charge sharply escalating premiums, with restrictive clauses for pre-existing conditions, waiting periods, and caps on chronic care. Ayushman Bharat and state-specific insurance provide some relief, but access is uneven, and benefits rarely meet the needs of long term geriatric or palliative care. The Government of India has an alternative now offered as Vay Vandana Cards. However, the uptake is very limited for many reasons but should improve in the coming years.”
“By contrast, China has near-universal basic coverage through its Urban Employee Basic Medical Insurance (UEBMI) and Urban–Rural Resident Basic Medical Insurance (URRBMI) schemes. However, even this scheme has low reimbursement rates for the elderly, especially in rural areas, leaving gaps in high-cost chronic care. The United States has Medicare, a federally funded scheme covering citizens over 65. It provides relatively broad coverage, but seniors still face high out-of-pocket expenses for drugs, nursing care, and supplemental insurance. The understanding from these countries is that we need both government and private cover, with the former covering the base and the latter the outof-pocket, something similar to German disability benefits.”
Sinha proposes certain measures like, “Requiring all insurers to offer at least one standardised health policy for elderly citizens with no upper age limit, guaranteed issue irrespective of health status. The government can release their own plans for less fortunate individuals and the middle class who cannot pay for premium insurance plans. Provide income-based premium subsidies for private or semi-private insurance, similar to how electricity subsidies are structured.
Rajagopal G envisions that “A national framework for geriatric insurance could lay the groundwork, with built-in incentives to bring private insurers on board. And if we truly want to future-proof eldercare, regulatory support for longterm care insurance and public-private partnerships will be essential. It’s time for policy to catch up with demographic reality and lead with foresight.”
According to Kumar, “For India, policy levers could include targeted subsidies or tax deductions for families covering senior dependents. The health savings accounts (HSA) and excess of loss covers can be a great design for those who will enter the senior citizen category in the next decade or so. The Government can bring the interest income from HSA non taxable as long as it is used for healthcare benefits, which can range from preventive, primary to tertiary care. Encouraging long-term care insurance (LTCI), a segment largely absent in India but mainstream in the developed countries, can develop a new range of care offering institutions, especially those who need long-term care and a lot of hospitalisation can be avoided by focusing on appropriate daily/weekly care.”
Technology as an enabler
Technology could help bridge the gap between inclusion and sustainability. From AI-driven underwriting to telemedicine and wearable data, tech is already transforming elderly healthcare coverage. Dubey agrees that technology is a powerful enabler for elderly healthcare.
“Teleconsultation has already reduced dependence on hospital visits, offering affordable access to doctors from home. Wearables and remote monitoring devices allow early detection of complications in chronic conditions, cutting down emergency admissions. AI can streamline claims processing, reducing delays and frustrations often faced by seniors. Digital health records and predictive analytics also help insurers design more accurate, personalised premiums. For seniors, features like medication reminders, vernacular interfaces, and home diagnostic tie-ups further improve accessibility. However, usability is key—interfaces must remain simple, and offline-plus-online models should coexist. If implemented inclusively, technology can reduce costs, improve efficiency, and make elderly insurance not just a product, but a holistic care solution”, he added.
‘Care at home’, as a concept should evolve. Especially for the elderly, primary care should be delivered at home to increase the frequency of primary care through which tertiary and secondary care can be limited. This also requires long-term products with a long-term premium guarantee, at least five years. The impending regulatory reforms which will allow composite licences will bring long-term platforms with long-term premium guarantees and savings for HSA.”, opines Kumar.
Talking about the role of insurtech, Singhal adds, “Insurtech is playing a crucial role in transforming the insurance landscape, driving both efficiency and accessibility for the elderly customers. Through digital platforms, they are making the policy purchase simpler and more intuitive. For streamlining faster and seamless claims insurtechs are innovating claims automation, and indulging in smarter underwriting to meet the needs of elderly customers.”
Collaboration and continuity of care
Collaboration between the government, insurance players and healthcare providers will pave the next decade of elderly insurance.
Rajagopal G highlights that, “Imagine a powerful partnership that sets clear standards for out-of-hospital eldercare, defining both care protocols and cost structures.”
Srivastava’s recommendation include, “Public-private chronic care pilots that combine subsidised premiums with provider networks for long term care (e.g., domiciliary nursing, physiotherapy, memory clinic) and state level geriatric insurance + service packages (subsidy + network of accredited providers).” He suggests that these should be piloted in high-aging states/cities.
“Such collaborations can combine the reach and social objectives of government with insurer capital and provider capabilities”, he added.
Dubey adds that “NGOs and senior living communities can act as distribution partners, reaching underserved populations.”
Building a culture of care
The consensus across experts is clear — elderly healthcare insurance must evolve from a product to a purpose. “Insurance needs to evolve beyond just hospital stays to truly reflect the journey of ageing.
It should embrace the full spectrum, chronic disease management, home-based care, rehabilitation, dementia support, and compassionate end-of-life services”, says Rajagopal G.
Kumar stresses, “The future for senior citizen care lies in ecosystems rather than isolated products. Hybrid models where Ayushman Bharat covers catastrophic risks while private insurance offers top-up plans for chronic and outpatient care will be the gateway to affordable care.”
Way forward
India’s journey toward inclusive elderly healthcare is just beginning. As Bajaj notes, “Senior citizens have dedicated their working years to building families and the economy. In retirement, they deserve not just respect but reliable healthcare security.” For India’s ageing population, insurance must no longer be a privilege — it must be a promise.” GST reliefs are a start, but systemic innovation in policy, design, and partnerships is key to sustainable elderly health insurance coverage.
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