5 Things You Should Know About Elderly Health Insurance

A recent survey showed that 1 in 4 of Hong Kong’s 1.12 million elders (those 65 or over) suffers from one or more chronic health conditions. The survey also showed that 38.5% of elders had consulted a doctor during the 30 days before the survey data was collected.

Although Hong Kong’s public healthcare sector provides excellent care to the population, wait times can be long, especially for specialist care. In Kowloon West, for example, the wait time for a stable case to see a specialist eye doctor can be as long as 180 weeks! Thankfully, the city’s private healthcare system provides a great alternative to long wait times. The private healthcare system is quicker, more convenient, less crowded… but also more expensive.

That’s why it’s essential to have a good medical insurance plan to protect you from financial surprises during your retirement years. But what are some things you should know about health insurance for the elderly and retired people?

1. Be aware of age limits

When it comes to health insurance, there are two age limits to look at:

• Age limit for applying
• Age limit for coverage of specific diseases and conditions

Age limit for applying

Generally, the maximum age for applying for insurance is between 60 and 75 years – the specific age limit depends on the insurance company and product. Health insurance plans are guaranteed renewable for life, meaning you can renew your policy year after year, no matter how your health condition changes while the policy is in force.

VHIS Certified Plans have a maximum entry age of 80 years, with guaranteed renewal up to the age of 100 years. For instance, April’s MyHealth plan accepts applications from those not older than 65 years (for fully underwritten and CPME policies) or 45 years (for moratorium policies). And Cigna’s HealthFirst Elite plan accepts applications from those not over 70 years old. Both of these medical insurance plans are guaranteed lifetime renewable.*

*Note: This information was accurate as of the time of writing in October 2024. No responsibility is accepted for any inaccuracies, errors, or omissions.

Age limit for coverage of specific diseases and conditions

Moreover, be sure to carefully read over your policy’s terms to see if coverage for a specific disease might cease when you reach a certain age. For example, some health insurance policies might not cover Alzheimer’s disease or dementia after you reach the age of 65.

2. Get familiar with policy exclusions

You may also wish to read carefully over your policy’s terms to familiarize yourself with your policy’s exclusions. Exclusions are items in your policy that your health insurance won’t cover. You don’t want to run into an incident where you undergo an expensive treatment that isn’t covered by insurance.

Common exclusions include:

• Pre-existing conditions
• Non-emergency dental care (unless your policy includes a dental benefit)
• The cost of eye examinations and prescription glasses and contact lenses (unless your policy includes an optical benefit)
• The cost of durable medical equipment or appliances for home use, such as wheelchairs, dialysis equipment, hearing aids, walking aids, airway pressure machines and masks, portable oxygen and oxygen therapy devices, and special braces
• Surgical procedures that are not deemed medically necessary, such as LASIK surgery and cosmetic surgery
• Expenses incurred from experimental or unproven medical treatments

Note that each policy is different from the next, so check the terms of your policy carefully to get a clear idea of what’s covered (and what’s not). If in doubt, chat with your insurance broker or advisor.

3. Pay attention to any moratoriums in your policy

A moratorium or waiting period is a set length of time during which your insurance provider will not cover specific risks (for example pre-existing conditions) when you first take out your insurance policy. Moratoriums differ in length, depending on the item, from 6 months to 4 years.

During a moratorium, you can’t claim for related expenses. Common items with moratoriums include pre-existing conditions like diabetes and hypertension, as well as major dental treatment, hernia, joint replacement, and cataracts.

4. Premiums increase with age, but you can change your deductible

Premiums are based on age, so the older you are, the more you’ll have to pay. That’s because there’s a higher chance you’ll need medical care and file insurance claims. For this reason (and because of medical inflation), you can expect to pay more in premiums each year you renew your policy.

One way to adjust your premiums is by adjusting your deductible, which is the amount you pay out of pocket for healthcare before your health insurance kicks in to cover the remaining amount up to the benefit limit. A higher deductible means lower premiums; a lower (or no) deductible means higher premiums.

It’s best to consult with your insurance broker or advisor about adjusting your deductible; they can provide guidance and help you make an informed decision.

When you might want to raise your deductible

If you don’t seek medical care that often – particularly if you are young and healthy – you can consider raising your deductible to save on your premiums. But keep in mind that if you need substantial medical treatment, then you will need to have cash ready to pay out of pocket to cover your deductible.

When you might want to lower or remove your deductible

If you’re older and might need to seek care for a chronic health condition, you can consider lowering or removing your deductible. Although you’ll have to pay more in premiums, there are two benefits: first, you won’t need to pay as much upfront before your insurer starts paying for your treatment; second, this might make budget planning easier, because your healthcare expenses will be more predictable (since any unforeseen out-of-pocket medical expenses will not be so large). This is a good way to prevent unplanned medical expenses from eating into your retirement savings.

Some health insurance plans allow you to lower or remove your deductible without a new underwriting when you reach 50, 55, 60, 70, 75, or 85. Again, it's best to check your policy terms and speak with your broker or advisor for guidance.

5. Buy health insurance when you’re young and healthy

The optimal time to buy health insurance is when you’re young and healthy, before you discover any medical conditions. This is the best way to secure long-term insurance coverage with the peace of mind that your policy will cover any health conditions you develop as you get older.