India’s Health Insurance System Is Quietly Abandoning Its Elders

Try getting private health insurance for a 70-year-old with diabetes. Or worse, try using it. What you’ll find is not just a flawed system, but a rigged one.

In India today, senior citizens are not just underserved by health insurers, they are being actively priced out, legally excluded, and quietly pushed out of the risk pool.

A toxic premium spiral

Take a 65-year-old urban Indian. For a ₹5 lakh cover, the average yearly premium is now ₹45,000–₹60,000. Add 18% GST, and you’re at ₹53,000–₹71,000, without add-ons. At 75, premiums cross ₹1 lakh. This isn’t risk-based pricing; it’s extortion wrapped in actuarial math.

With life expectancy rising, insurers know they’ll lose money on this group. So they raise premiums until people drop out voluntarily. It’s not ageism, it’s business. But that business model is crushing elderly Indians.

The illusion of inclusion

IRDAI mandates insurers to offer policies to people up to age 65. Some even extend entry to 70 or more. But here’s the catch:

• Waiting periods for pre-existing diseases stretch up to 4 years.
• Coverage for major procedures (like joint replacements or heart surgeries) is either excluded, capped ridiculously, or labeled “non-admissible” during early years.
• Renewal is “guaranteed,” but that doesn’t stop policy cancellation for “non-disclosure” of trivial ailments.

The worst part? The elderly often don’t know what they’re not covered for, until they file a claim.

Denial by design

Private insurers use a consistent playbook:

1. Delay hospital cashless approvals, forcing families to pay upfront.
2. Send multiple queries during treatment to avoid quick approvals.
3. Deny at discharge, often citing “pre-existing” conditions even if already disclosed.
4. Label claims as fraudulent based on vague “doctor’s opinion” without second review.

One insurer denied an ILR implant for an 80-year-old woman, claiming syncope wasn’t life-threatening. The cost: ₹4.2 lakh. The reason: “Not justified.”

Government schemes: cosmetic and patchy

Ayushman Bharat is designed for the poor, but it barely touches middle-class elders. State schemes like Mukhyamantri Ayushman Arogya Yojana, formerly known as Chiranjeevi Yojana (Rajasthan) or Karunya (Kerala) are too limited in scope or too bureaucratic. These are band-aids, not coverage.

And no central plan covers the middle 300 million Indians, retired teachers, small shop owners, homemakers, widows, people who don’t qualify as “poor” on paper but can’t afford ₹1.2 lakh yearly premiums either.

GST on health insurance: morally bankrupt

Slapping 18% GST on senior citizen health premiums is not just tone-deaf, it’s inhumane. Health care isn’t a luxury. A diabetic or a cancer survivor paying tax on survival should offend every lawmaker in Parliament.

The government says this revenue supports public health spending. But where’s the evidence? Out-of-pocket medical spending still kills more families financially than any other cause.

The brutal truth: seniors are not wanted

Private health insurers don’t want senior citizens unless forced. And regulators don’t force them enough. Worse, the elderly don’t have the time or legal muscle to fight denied claims or misleading policy language. So they exit. Silently. Alone.

This is the equivalent of a fire insurance policy that refuses to cover houses with wiring more than 15 years old.

What can be done

• Remove GST from all senior citizen health plans immediately.
• Standardize policies: A single, nationwide template with clear coverage and exclusions.
• Create a universal senior health cover, like a “Medicare Lite” for Indians over 60, subsidized for low-income groups, with partial premium support for middle class.
• Ban denial of claims due to minor pre-disclosure technicalities, especially for policies held over 3 years.
• Bring in a patient advocate system inside IRDAI or ombudsman bodies.

In a country that prides itself on honoring its elders, we’ve made it impossible for them to age with dignity. We’ve sold them policies that don’t work, taxed them for having medical needs, and abandoned them when they get sick.

If this is not fixed soon, millions will go without treatment not because it’s unavailable, but because it’s unaffordable, denied, or just never approved in time.

No society can call itself civil if it lets its old die in fear of hospitals.