Best HMO for Senior Citizens in the Philippines 2024
“Healthy citizens are the greatest asset a country could have,” per popular Prime Minister Winston Churchill. This is true even for the older members of the society. Senior citizens are vital members of Filipino households, offering wisdom, guidance, and love to a growing family.
With increasing age, there is a higher risk of diseases like hypertension, diabetes, cataracts, and arthritis. This age group is also more prone to body pains, insomnia, and accidents like falls.
Are you trying to find the best health card or HMO for senior citizens within your budget or needs? In this article, we explore different health insurance in the Philippines so you can find one best for you and your family.
Disclaimer: This article is for informative purposes only. The author and Filipiknow.net are not affiliated with the mentioned providers.
Table of Contents
At a Glance: Best HMO for Senior Citizens in the Philippines
1. Best Low-Cost HMO for Senior Citizens
| HMO/Health Insurance | Pros and Cons | Recommended For |
| Maxicare Prima Gold | Pros: Unlimited consults and diagnostic, 24/7 Teleconsultation ER coverage of up to ₱20,000 Dental services Good value for coverage Cons: No inpatient hospitalization benefits Low coverage for ER services Consults and labs are limited to Maxicare PCCs | Patients who want to maximize preventive care benefits through routine consults and labs but want that added security in case of medical emergencies |
| Maxicare EReady Advance Titanium and Maxicare EReady Advance Platinum | Pros: Cheap ₱50,000 coverage on ER treatment With inpatient benefits and life insurance Option to choose a plan with access to 6 major hospitals With free and unlimited consultations with primary care physicians in Maxicare PCCs, 24/7 Teleconsultation Coverage for pre-existing conditions Discounts Cons: Limited inpatient benefits One-time use only Limited to Maxicare-accredited network Consults to Maxicare PCCs No coverage for routine outpatient diagnostics | Patients on a budget who want to be prepared for sudden medical emergencies Patients who want to supplement existing plans with ER and inpatient coverage |
| Medicard RxER | Pros: Cheap APE and Basic Lab screening once a year Unlimited consultations 30% discount on outpatient labs Dental services Outpatient ER coverage Cons: No inpatient hospitalization benefits Some conditions not included in the coverage Consults are limited to MediCard clinics and UROIC | Patients on a budget who want unlimited consults and access to laboratory and ER services |
| PhilCare VidaCare Core and PhilCare VidaCare Premiere | Pros: Unlimited medical and dental consults Unlimited outpatient laboratory and diagnostics Unlimited HeyPhil Digimed consultations Pre-existing conditions consult covered Cons: No inpatient benefits Limited to accredited providers Limited ER services coverage | Patients who want a plan that maximizes routine consultations and laboratory screening |
| Insular Health Care ER Care All-In 100 Adults | Pros: Cheap ₱100,000 coverage for emergency cases due to accidents and viral and bacterial illnesses With outpatient ER and inpatient benefits Coverage for accidents and special modalities Cons: No coverage for outpatient consultation or diagnostic/laboratory procedures One-time use only | Patients who want to supplement existing plan with ER and inpatient coverage Patients on a budget who want to be prepared for sudden medical emergencies |
| MediCard Health Check MediCard Health Plus PhilCare Unli-Consult for 65+ InLife MedConsult for Senior | Pros: Unlimited consultations or teleconsultations Cheap Cons: No ER or inpatient hospitalization benefits | Patients who want free consultations only |
2. Best Health Insurance/HMO for Senior Citizens with Pre-Existing Conditions
| HMO/Health Insurance | Pros and Cons | Recommended For |
| AXA Global Health Access and Allianz-PNB Allianz Well! | Pros: Worldwide access Comprehensive and impressive coverage and benefits Covers ER, inpatient, and preventive care With pre-existing conditions Coverage subject to conditions Cons: Expensive premiums | Patients with pre-existing conditions who want comprehensive benefits |
| Caritas Health Shield Enhanced Core 10 | Pros: With coverage for outpatient consults and labs APE and preventive health benefits Insurance benefits 10-year coverage Cons: Pre-existing conditions not covered in the first year 5-year paying period with an incremental increase in coverage yearly Limited to the accredited provider | Patients with pre-existing conditions who want comprehensive benefits and prefer the offered payment scheme |
| Medicard VIP | Pros: Access to 5-star hospitals Patients can choose their physician Executive check-up Services in MediCard Lifestyle Center With ER coverage and inpatient hospitalization benefits Dental services Access to preventive services in MediCard Clinics Cons: Limits for pre-existing conditions, accidents, and dreaded diseases Limited to accredited providers | Patients with pre-existing conditions who want comprehensive benefits but with flexible plan options |
3. Best Health Insurance for Senior Citizens Above 70 Years Old
| HMO/Health Insurance | Pros and Cons | Recommended For |
| Pacific Cross Premier and Kaiser Senior Care | Pros: Specially designed for senior citizens Comprehensive benefits and good maximum coverage per year Cons: No coverage for pre-existing conditions in the first year and subject to the approval of the company Kaiser: Reimbursement type based on coverage. Patients need to pay the initial percentage of bills Higher cost of premiums at age 70 | Patients 70 and up who want comprehensive benefits |
| Paramount Direct Prime Care Plus Cash Plan | Pros: Cash benefits per day of hospitalization ICU, Surgical, and Convalescence Benefits Cheap Cons: Cash benefit only No coverage for outpatient or inpatient health services No coverage for labs or consults | Patients above 70 who want to supplement existing plans with a cash-benefit plan |
4. Best Health Insurance Packages for Senior Citizens
| HMO/Health Insurance | Pros and Cons |
| PhilHealth | Pros: Premiums for senior citizens are free; automatic members may claim PhilHealth benefits Cons: Limitations in inpatient and outpatient coverage; it needs to be supplemented by other health insurance plans |
| SUN Senior Care | Pros: With preventive and critical illness benefits Cons: Need to pay higher premiums to get higher coverage |
| PruLife Care Advance Plus | Pros: With critical illness benefits (early and advanced stage benefits) Cons: Need to pay higher premiums to get higher coverage. No coverage for pre-existing conditions |
Health Insurance vs. HMO for Senior Citizens: What’s the Difference?
HMOs, or health insurance benefits through Health Maintenance Organizations, work by billing your hospital bills to the yearly amount limit set by the HMO. Usually, members can avail themselves of the benefit of the accredited healthcare provider network of the HMO.
This network includes hospitals, clinics, dental services, and doctors. Benefits covered by HMOs usually include outpatient care through consultation and laboratory tests, hospitalization, use of operating rooms and recovery rooms, doctors’ professional fees, and emergency room fees.
The National Health Insurance Act of 1995 defines it as an “entity that provides, offers, or arranges for coverage of designated health services needed by plan members for a fixed prepaid premium.”
An HMO plan can be a yearly comprehensive plan through an individual or a family account or be enjoyed as a company health insurance benefit. The coverage is comprehensive and includes outpatient, inpatient, and ER care.
HMO companies also offer prepaid health cards. These health cards are readily available even on e-commerce sites. Payment is only once, and coverage is usually good for one year. But since these are cheaper, the benefits enjoyed are generally limited.
On the other hand, health insurance plans or policies offered by private life insurance companies (examples include SunLife, AIA Philippines, and PruLife UK) provide financial support if you are hospitalized or diagnosed with a covered illness.
Health insurance offers medical coverage through lump sum if you are diagnosed with a critical illness like cancer, heart attack, or stroke. Some policies also give cash assistance for accidents and daily cash benefits for each day of hospitalization.
Coverage will depend on the type of health insurance and the diseases and treatments it covers.
Critical illness coverage might be something to consider for senior citizens, as accidents or sudden medical emergencies are higher in this age group.
Government Health Insurance for Senior Citizens
The health insurance provided by the national government is PhilHealth or The National Health Insurance Program.
PhilHealth’s mandate is to provide health insurance coverage and ensure affordable, acceptable, available, and accessible healthcare services for all the citizens of the Philippines.
Unemployed senior citizens or senior citizens with no regular income are exempt from paying PhilHealth premium contributions.
Read this article for a more detailed discussion about PhilHealth benefits for senior citizens.
Best Health Insurance in the Philippines for Senior Citizens
1. Best Low-Cost HMO for Senior Citizens
For those on a budget, prepaid HMO health cards offer good benefits.
You can get one for outpatient consultation and another for emergency room or inpatient hospitalization coverage. The following are some prepaid health cards with good coverage that you might consider:
a. Maxicare Prima Gold
Pros and Highlights:
- Age Covered: 60 years and above
- Unlimited consultations and diagnostics for those 60 and up in Maxicare Primary Care Clinics and MyHealth Clinics
- Emergency Room coverage of up to ₱20,000 annually in all accredited hospitals nationwide
- Dental Service: Single-use per service at MetroDental
- Preexisting conditions covered and with 24/7 teleconsultation access
- Good value for coverage
Cons and Limitations:
- Exclusions: Inpatient hospitalization benefits
- Limited Emergency Room Service coverage
- Unlimited consultations and diagnostics only available in Maxicare Primary Care Clinics or MyHealth Clinics
- Lab requests honored are only from Maxicare-accredited healthcare providers.
Requirements and Validity:
- Valid for one year from the activation date
- Requirements: One-time payment and online registration.
Price: ₱12,999 for one-year coverage
b. Maxicare EReady Advance Titanium and Maxicare EReady Advance Platinum
Pros and Highlights:
- Age Covered: 15 days to 65 years old
- Up to ₱50,000 coverage on emergency treatment, including conditions requiring confinement in a regular private room
- Maxicare ER Ready Advance Platinum has access to all Maxicare-affiliated hospitals nationwide, including six major hospitals in NCR: Asian Hospital and Medical Center, Cardinal Santos Medical Center, Makati Medical Center, St. Luke’s Medical Center (Quezon City and BGC), and The Medical City
- Maxicare ER Ready Advance Titanium has access to all Maxicare-affiliated hospitals nationwide except the six major hospitals in NCR mentioned above
- Covers any life-threatening or unexpected onset of a condition or illness which requires immediate management within 24 hours, including confinement in a regular private room
- With outpatient ER coverage and inpatient coverage
- With free and unlimited consultations with Internal Medicine, Family Medicine, GP, and Pediatricians in all Maxicare Primary Care Clinics nationwide
- With life insurance for accidental death, dismemberment, and disablement up to ₱50,000
- Preexisting conditions covered and with 24/7 teleconsultation access
- Emergency Medical Assistance with Assist Americas for members traveling more than 150 km from home or in a foreign country for up to 90 days
- Access to Maxicare HealthHubs
- Discounts with Metro Dental, My Health, and Maxicare Lifestyle Partners
- Good value for coverage
- You can use multiple cards per year but only one active card at a time
Cons and Limitations:
- Single-use per card
- Services should be from affiliated physicians and hospitals only
- Excludes injuries, infections, or conditions from certain conditions. Review the specifics in the provided link above
Requirements and Validity:
- Valid for one year from the activation date
- Requirements: One-time payment and online registration
Price:
- ₱4,999 for one-year coverage of Maxicare EReady Advance Titanium
- ₱5,999 for one-year coverage of Maxicare EReady Advance Platinum
c. Medicard RxER
Pros and Highlights:
- Age Covered: 18 years and above
- Annual physical exam with basic laboratory screening in any Medicard freestanding Clinics and Uro Industrial Clinic (UROIC)
- Outpatient consultations in any Medicard freestanding Clinics and Uro Industrial Clinic (UROIC) with General Practitioner, Family Physician, Pediatrician, Internist, or Gynecologist (except Maternity)
- 30% discount on out-patient laboratory, procedures, and skincare clinic
- Dental services: One-time oral prophylaxis and dental consultations, 30% discount on procedures
- Outpatient Emergency Care Coverage
- Good value for coverage
Cons and Limitations:
- Exclusions: Inpatient hospitalization benefits
- Some conditions might not be covered
Requirements and Validity:
- Valid for one year from the activation date
- Requirements: Fill up a form at any freestanding Medicard Clinic or apply here.
Price: ₱1,998 for one-year coverage
d. PhilCare VidaCare Core and PhilCare VidaCare Premiere
Pros and Highlights:
- Age Covered: 60 years and above
- One-year unlimited medical and dental consultation to all accredited physicians nationwide
- One-year unlimited outpatient laboratory and diagnostics available to PhilCare clinics. Physical therapy is not included
- One year of unlimited HeyPhil Digimed consultations
- An additional benefit for VidaCare Premiere Only: Single-use benefit of up to ₱20,000 for outpatient viral and bacterial illness and treatment of injuries from accidents except for stroke in accredited hospitals
- Consults for pre-existing conditions covered except for behavioral, development, psychiatric, and psychosomatic illness
- Good value for coverage
Cons and Limitations:
- Exclusions: Inpatient hospitalization benefits
- Unlimited consultations and discounts only in accredited PhilCare providers and clinics. Use of VidaCare Premium benefit only in accredited hospitals
- Limited ER coverage
Requirements and Validity:
- Valid for one year from activation date; card activated seven days from registration
- Requirements: One-time payment and online registration here
Price:
- ₱13,270 for one-year coverage of VidaCare Premiere
- ₱11,120 for one-year coverage of VidaCare Core
e. Insular Health Care ER Care All-In 100 Adults
Pros and Highlights:
- Age Covered: 18 years old to 64 years old
- ₱100,000 coverage for emergency cases due to accidents and viral and bacterial illness, and specific conditions
- With both outpatient and inpatient emergency care, including ER care, room, and board for admission, diagnostic procedures, surgical fees if needed, and ICU diagnostic procedures as medically necessary
- Coverage for accidents like stroke, fractures, animal bites, burns, etc.
- With coverage for a wide range of infectious diseases and acute cases
- With ₱5,000 coverage for special modalities like laparoscopic procedures, MRI, CT scan, pain management, and other medically necessary modalities
- Good value for coverage
Cons and Limitations:
- Exclusions: No outpatient consultations and diagnostic/laboratory procedures
- It may exclude specific conditions and procedures.
- One-time use only. Multiple cards can be used yearly, but one active card at a time.
Requirements and Validity:
- Valid for one year from activation date; card activated ten days from registration
- Requirements: One-time payment and online registration here
Price: ₱1,750 for one-year coverage
f. Special Mentions
- MediCard Health Check – One-time APE, unlimited outpatient consults at MediCard Clinics with a 20% discount in the outpatient laboratory (₱500)
- MediCard Health Plus – One-time APE, unlimited outpatient consults at MediCard Clinics with 20% discount in the outpatient laboratory, dental services (₱1,100)
- PhilCare Unli-Consult for 65+ – One-year unlimited consultation services from PhilCare accredited doctors and dentists for 66 years old and above (₱5,000)
- InLife MedConsult Senior – Four face-to-face medical consultations with all Insular Health Care-accredited doctors, one-year unlimited telemedicine access, one-year unlimited dental consultations with accredited providers, and dental services for seniors 65 years old and above (₱3,500)
2. Best Health Insurance/HMO for Senior Citizens with Pre-Existing Conditions
A pre-existing condition is an illness or injury you already had before the plan or policy coverage. Examples include hypertension, diabetes mellitus, and asthma, among a few.
When choosing a plan for a senior citizen with a pre-existing condition, you must consider the coverage and the conditions set by the HMO company.
Pre-existing conditions coverage varies from company to company. Make sure to ask about specifics of coverage with your policy provider, including whether or not pre-existing illness will be covered in the first year and the conditions for coverage.
Ideally, one with pre-existing conditions will benefit significantly from a comprehensive health plan with outpatient consultations for preventive care and coverage for hospitalization and emergencies in case of complications from pre-existing conditions.
Consider the following plans if you or your loved one has pre-existing conditions:
a. AXA Global Health Access
Pros and Highlights:
- Age Covered: 15 days old to 70 years old for application but renewable up to age 99
- Annual benefit limit of ₱50,000,000 to ₱175,000,000, depending on the plan selected
- Worldwide coverage; suitable for those with frequent travels
- With Executive/Annual Check-ups
- Extensive network; may choose preferred doctor and hospital with teleconsultation access
- International Medical Assistance
- With pre-existing condition coverage (subject to conditions) and covers pandemics
- With inpatient, outpatient, and emergency coverage; critical illness coverage; surgical coverage; coverage for special procedures like chemotherapy and radiotherapy; and coverage for alternative medicine practices and medical transport
- With daily hospital cash benefit when hospitalized
- Some plans may include vitamins coverage, good preventive healthcare benefit, and benefit for recovery and rehabilitation
- Broad coverage of benefits can be combined with existing HMOs for more excellent coverage
- Cashless transactions
Cons and Limitations:
- Impressive coverage but high cost of premiums
Requirements and Validity: The plan is renewable and good for one year. To know the list of requirements and how to apply, get in touch with an AXA Advisor.
Price: Around ₱168,499 for a 60-year-old with worldwide health benefits coverage of ₱100,000,000 per year. You can get a sample quote from the link given above.
b. Allianz-PNB Allianz Well!
Pros and Highlights:
- Age Covered: Owner – at least 18 years old; Insured – 0 to 70 years old for enrollment but renewable until age 99
- Annual benefit limit of ₱100,000,000
- Worldwide coverage; good for those with frequent travels
- Covers major illnesses like cancer treatment, dialysis, and organ transplant
- Covers in-patient, day-care, and outpatient specialized treatments, including pregnancy complications, psychiatric care rehabilitation services, and nursing care at home.
- With emergency benefits and coverage for emergency treatment and medical transport
- With Medical Evacuation and Repatriation Services
- Teleconsultation access
- Additional: Wellness and active lifestyle-related expenses
- Cashless transactions
Cons and Limitations:
- Impressive coverage but high cost of premiums
Requirements and Validity: The plan is renewable and good for one year. Sign up for an inquiry session.
Price: Around ₱218,600 to ₱385,200 with worldwide health benefits coverage of ₱100,000,000 per year. You may put in the deductible or amount you pay before the plan is implemented.
c. Caritas Health Shield Enhanced Core 10
Pros and Highlights:
- Age Covered: 7 years old to less than 70 years old
- Coverage is ten years
- With medical expense benefits: Special diagnostics, hospitalization, ER care, and Medical Expense Benefit Outpatient Services
- Members have an annual physical exam, preventive health care, dental care, membership privileges, outpatient services
- With insurance benefits: Credit life, term life, accidental death, waiver of the installment due to disability
Cons and Limitations:
- Coverage is in two phases: a 5-year paying period and a 5-year bonus period. During the paying period, health coverage increases annually. You enjoy lower benefits in the first five years but will get full coverage in the bonus five years
- Pre-existing conditions are not covered in the first year
Requirements and Validity: The plan is good for ten years. Sign up for an inquiry session.
Price: Premium/Contract price depends on the age at enrollment. Request a quote here1.
d. Medicard VIP
Pros and Highlights:
- Age Covered: Up to 65 years old
- With Global Healthcare Assistance
- With access to 5-star hospitals and the privilege of choosing your doctor
- With coverage for preexisting conditions
- With executive check-ups at any Medicard freestanding clinic
- With privileges to use MediCard Lifestyle Center and Conference Rooms.
- May avail of free services in LifeStyle Center
- Free consultations with primary care providers at MediCard clinics with a discount on outpatient diagnostics depending on the plan
- With Emergency Care Coverage and coverage for out-patient medicines
- Dental services
Cons and Limitations:
- Limits for pre-existing conditions coverage depending on the plan
- Limits for dreaded diseases and accidents depending on the plan
- Services should come from Medicard accredited provider
- Some conditions are not covered. Specifics are available here
Requirements and Validity: The plan is renewable yearly. An online application can be made here.
Price: Annual Premium for 61-65 years old ranges from ₱32,993 – ₱104,432
3. Best Health Insurance for Senior Citizens above 70 years old
Most HMOs and health insurances limit age enrollment to 60 to 65. Therefore, finding good coverage for senior citizens over 70 years old could be difficult.
Here are a few that you can consider if you or your parent/grandparents are 70 and above:
a. Pacific Cross Premier
Pros and Highlights:
- Age Covered: 65 years old and above until age 100
- Specially designed for senior citizens
- Maximum coverage ranges from ₱500,000 – ₱1,500,000 per year
- Basic hospital benefits include room and board, diagnostic tests, medicines, blood and components, anesthesia, and surgical appliances. It also partially covers physician visits and specialist fees, with coverage for private-duty nurses
- Critical care benefits
- Surgical benefits
- ER benefits with transport coverage
- Worldwide emergency assistance services
- Annual physical examination
- Others: Coverage for auto-immune diseases, elective surgery, companion allowance
- Good coverage and benefits
Cons and Limitations:
- Pre-existing coverage is subject to the approval of the company and will be subject to the company’s underwriting guidelines
- The high price of premiums starting at age 70
- Certain conditions are permanently not covered
Requirements and Validity: The plan is renewable yearly. You must submit an application form and pay the initial premium. Inquiries can be made here.
Price: Annual Premium at 70 years old ranges from ₱37,726 to ₱103,246 depending on plan and coverage. This increases yearly until age 100.
b. Kaiser Senior Care
Pros and Highlights:
- Age Covered: 61 years old and above until age 100
- Specially designed for senior citizens
- A comprehensive range of benefits with a maximum limit of ₱250,000 – ₱1,000,000
- The patient may choose a doctor and hospital
- Basic hospital benefits; covers room and board, miscellaneous hospital expenses, and physician’s visit
- Critical care benefits
- Surgical benefits
- With emergency care benefits and coverage for medical transport. It also comes with private-duty nurse coverage if deemed medically necessary
Cons and limitations:
- Reimbursement type based on coverage
- No coverage for pre-existing conditions in 1st year and subject to underwriting or health declaration
- Dreaded diseases or conditions will only be covered after 24 months of membership
- Hospitalization outside the Philippines is not covered
- Certain conditions or procedures are excluded
Requirements and Validity: The plan is renewable yearly. You must submit an application form to any of their offices or through their advisors and pay the initial premium.
Price: Annual Premium at 70 years old ranges from ₱23,000 to ₱62,000 and increases yearly.
Special Mention: Paramount Direct Prime Care Plus Cash Plan
Pros and Highlights:
- Age Covered: 50 years old to 75 years old for enrollment; covers until 80 years old
- Provides daily cash benefit or assistance for each day spent in hospital confinement, with additional daily ICU benefit if admitted in ICU, Surgical Cash Benefit, and Convalescence Benefit
- Affordable and with flexible coverage plans and amounts; you may choose from Plan 500, 1000, 2000, 3000, and 4000 depending on your budget and needs
- Free application; no pre-assessment or interview required
- No policy cancellations
- It may be supplemented to existing HMO and health insurance policy
Cons and Limitations:
- Does not cover pre-existing conditions
- Cash benefit assistance only. It does not cover outpatient or inpatient health services and no coverage for consultations.
Requirements and Validity: Online application is made here. A copy of the policy will be sent to you after review. After review, you may pay your initial premium. Coverage begins after payment of the first premium.
Price: Cheapest monthly premiums range from ₱213 to ₱1,705
4. Best Health Insurance Packages for Senior Citizens
a. PhilHealth
PhilHealth covers all senior citizens who can claim PhilHealth benefits. Aside from its coverage, most HMOs require PhilHealth membership before making you a member.
PhilHealth benefits are maximized first before the benefits of other health insurance plans. Under PhilHealth, there is coverage in outpatient and inpatient services and a “no balance billing” policy if hospitalized in government hospitals.
Read our comprehensive guide for more information about PhilHealth for seniors.
The following packages are recommended for senior citizens who want to add critical illness and life insurance benefits to existing health plans:
b. SUN Senior Care
- Access to Sun Life’s Wellness Program, which offers preventive care services, health perks, and special privileges
- Diagnosis, Treatment, and Rehabilitation Cash Benefit if diagnosed with any of the 17 covered advanced-age critical illnesses
- Special benefits for specifically covered surgeries or conditions
- Life insurance protection
- 3, 5, or 10-year payment periods
- Living benefits through dividends
- The price depends on your age and the coverage you want; the older the policyholder, the higher the cost of premiums
c. PruLife Care Advance Plus
- Eligible applicants 18 years old to 65 years old
- Coverage is one year and renewable til age 70
- Coverage for 36 critical illnesses with early-stage critical illness benefits and advanced critical illness benefit
- A lump sum of ₱250,000 minimal sum assured
- No coverage for pre-existing conditions
- The 90-day waiting period after policy effectivity date
- The price depends on age and coverage
How To Choose the Best Health Insurance Plan or HMO for Senior Citizens
Whether you are deciding for yourself or your parents/grandparents, remember the following when choosing an HMO for senior citizens:
1. Medical Needs
Think about the most important things you need for your plan. No one plan will be able to give you everything. You are going to have to prioritize based on your current medical needs.
Do you want free consultations? Is the plan more for big medical emergencies? Do you want something comprehensive or just something to complement an existing health insurance plan?
Senior citizens usually have preexisting conditions. Will the plan cover it? If they will, will they cover the plan’s first year, or is there a waiting period?
Ideally, go for a plan covering preventive care like routine consultations and emergency hospitalizations.
2. Eligibility
A typical health insurance plan or HMO for senior citizens only covers until a certain age. Check if you fit the age requirement.
3. Cost
Some more comprehensive HMOs might be too pricey if you are on a budget. With HMOs, you pay premiums yearly, the amount of which increases with age.
For senior citizens that get HMOs, some of the premiums might already start at a pretty steep amount if you are enrolling in your 50s or 60s. With health insurance plans, the cost might still depend on age, but the policy cost remains the same until the age limit.
Some companies may allow the integration of senior citizens as dependents in your family or company plan, which may also be something to ask your provider.
For some, the benefits they can get from the plan may outweigh the cost of the premiums. For those on a budget, you may want to mix or supplement different plans to get the coverage you want at a lower price.
Some prepaid HMOs have lower costs, and some companies offer premiums at a lower price.
4. Your Location and Accredited Healthcare Providers
Some HMO companies may charge higher premiums because of a more extensive accredited healthcare network provider.
Regarding accessibility, will the plan give you the hospitals and doctors you want? Check the plan’s coverage and network of providers.
For health insurance plans, are their offices accessible if you plan to file claims or reimbursements?
5. Reviews and Feedback
Some companies might offer pretty good benefits on paper, but lo and behold, they have complicated reimbursement or claiming processes or aren’t suitable for your current needs.
Good research can give you a pretty good idea if processes are smooth, customer service is receptive, and services have a good turnaround time. Feedback from users is usually available on different websites, blogs, and social media platforms.
Reviewing the policy thoroughly and practicing due diligence before availing is a must, regardless of good reviews.
If your budget can allow it, some recommend getting a suitable HMO with comprehensive outpatient and inpatient benefits and supplementing this with health insurance with critical illness benefits and PhilHealth.
This gives you good financial security and maximizes preventive and curative aspects. Health is an investment, after all.
Benefits of Health Insurance for Senior Citizens
If a senior’s health is not managed well through regular check-ups and preventive care, there is a risk of medical emergencies like stroke and heart attacks. This could lead to significant financial stress for the family if unprepared.
Through proper care and good health-seeking behavior, senior citizens can remain productive, comfortable, and happy with good quality of life.
Getting health insurance also gives you a sense of security during medical emergencies.
Some benefits covered by health insurance may include
- Outpatient Care – includes routine consultations, annual physical examinations, laboratory, and diagnostic examinations, and imaging examinations
- Inpatient Care – includes hospitalizations (coverage for one room per day depending on the plan), medications, doctor’s professional fees, and procedures done while admitted, like transfusions. Some health insurances also give daily cash benefits depending on plan and illness.
- Coverage of Surgery and Procedures – may cover the cost of surgical professional fees, use of operating and recovery rooms, and medications. Some may cover outpatient surgical procedures.
- Special Procedures like chemotherapy, radiotherapy, or physical/occupational therapy
- Mental Health Consultations/Support
- Emergency Care – ER fees and procedures like pain management, laboratories, animal bite management, and trauma management
- Coverage or Cash Benefit for Sudden Accidents or Disability
- Critical Illness Benefit
- Financial Support for the bereaved family in case of sudden death or disability
Keep in mind that benefits will depend on the coverage of the plan you have chosen. Some plans offer comprehensive benefits, while some may cover only outpatient services.
HMO benefits, in particular, can be easily availed through an accredited doctor or hospital, and consumption depends on the maximum benefit illness per year included in your plan.
Tips and Warnings
- When discussing the policy with the provider, make sure to ask questions specific to the case of the one who will be insured. Prepare a list of what you need from the plan and ask if it will be covered. If covered, ask if there are specific conditions to avail of the benefit.
- Go through the policy with the provider and discuss each section. Do not sign or pay until every clause and all the benefits and processes are clear to you.
- Declare all pre-existing conditions or illnesses. Forgetting or omitting these conditions could be a reason for the non-approval of your claims.
- Familiarize yourself with the HMO providers’ e-health services like teleconsultations. This may save you travel time for minor complaints.
- Clarify payment schemes with your provider. Most HMOs offer a flexible payment option with annual, semi-annual, or quarterly options.
- Check the healthcare provider of the HMO company before getting their plan. It is good to note if your current doctors or some nearby hospitals or clinics are accredited.
- Invest in a plan to give the senior patient unlimited consultations and preventive care benefits as much as possible. This age group usually has chronic or multiple medical conditions and sometimes requires consults with more than one specialist.
- Some companies may offer VULs or Variable Universal Life Insurance. It is a type of life insurance that you pay annually that is a mix of life insurance, investment, and savings. A VUL is unsuitable for senior citizens as the fund value of VULs is expected to increase in the long term. Senior citizens aged 60 and above will no longer be able to grow the fund or benefit from it in the long term. Also, VULs are not the best option if you want a comprehensive healthcare benefits plan, as it is not the selling point or highlight of most VULs.
Frequently Asked Questions
1. Can I get two health insurance policies at the same time?
Yes. To maximize your coverage, you can get HMOs and health insurance plans to supplement each other with PhilHealth.
2. Will Philhealth cover all medical expenses? How about HMOs/Health Insurance?
PhilHealth implements a “no balance billing” policy in government hospitals. But most of the time, the health insurance plan will not cover all medical expenses. Some medications and procedures might still be charged hence the need to strategize and plan well when you get health plans.
3. Are vaccinations included in a health insurance plan or HMO for senior citizens?
Not all HMOs provide vaccinations in their plans. Some might include routine vaccinations as part of their preventive healthcare programs or packages. But don’t expect that all HMOs will be covering for it.
Rabies vaccinations are covered under animal bite management in the covered ER services of some plans.
Clarify this with your provider if this is important to you.
4. Are maintenance medications included in a health insurance plan or HMO for senior citizens?
No, most HMO plans or health insurance do not cover maintenance medications. However, you may supplement your health insurance plans with a cash benefit plan to use as an emergency fund for medications.
Barangay Health Centers also give out free maintenance medications for diseases like hypertension.
5. Can senior citizens above 75 years old get HMO?
Only a few offer it, but as discussed in the section about HMOs that are best for those aged 70 and above, there are plans with comprehensive benefits for those aged 70 to 100.
6. What do I do if there are difficulties in processing claims for the benefits of my plan?
The best way is to contact your assigned advisor first for assistance and clarification. Some HMOs also have 24/7 hotlines and help desks in malls and hospitals. Most of them are also reachable online through their websites or social media.
7. Are accidental deaths covered by a health insurance plan or HMO for senior citizens?
Some health insurance policies include life insurance benefits covering sudden death or disability. Clarify this with your provider if this is something you want in your plan
References
- Contact Us. Retrieved 18 June 2022, from https://caritashealthshield.com.ph/contact_us
Written by Camille Lamera, MD
in Government Services, Health and Fitness, Juander How, PhilHealth
Last Updated
Camille Lamera, MD
Camille Lamera is a medical doctor with clinical and government work experience. She has always been passionate about health education and public service, having worked in two government offices and as a part-time educator in Preventive and Community Medicine. She is currently working as a doctor in public health while also doing freelance academic and scientific writing.
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