Comprehensive Guide to Elderly Medical Insurance Plans: Optimal Configuration of Social and Commerci
As people age, medical expenses become one of the biggest financial burdens for the elderly. How can you choose the most comprehensive and cost-effective healthcare coverage plan for your parents or yourself? This article provides a systematic analysis of the latest policies and products for elderly health insurance plans, covering the combination strategies of basic medical insurance, commercial insurance, and local benefit insurance. It also offers tips for purchasing, claims guidance, and pitfalls to avoid, helping you build a worry-free health protection network for seniors.
1. The Three Pillars of Elderly Medical Insurance
1. Basic Social Medical Insurance (Mandatory)
| Type | Eligible Age | Annual Premium | Reimbursement Rate |
|---|---|---|---|
| Retired Employee Medical Insurance | No Limit | Exempted | 75%-90% |
| Urban and Rural Resident Medical Insurance | No Limit | 380-600 CNY | 50%-70% |
| New Rural Cooperative Medical Scheme (NRCMS) | No Limit | 350-500 CNY | 40%-65% |
Advantages:
✅ Coverage with pre-existing conditions allowed
✅ Lifetime renewal guaranteed
Limitations:
❌ Only covers expenses listed in the medical insurance catalog (e.g., cancer drugs often excluded)
❌ Annual limit typically between 200,000 to 500,000 CNY
2. Commercial Medical Insurance (Strong Supplement)
(1) Cancer Prevention Medical Insurance (Available for patients with hypertension, diabetes)
- Recommended Products: Haoyi Medical Lifetime Cancer Prevention, Ping An Lifetime Cancer Prevention
- Coverage: Cancer hospitalization, special medications, radiotherapy
- Price Reference: About 1500 CNY/year at age 70
(2) Million Medical Insurance (For Healthy Individuals)
- Recommended Products: ZhongAn ZunXiang eSheng (Parents Version), Ping An eSheng Bao
- Health Requirements: No hypertension, cardiovascular or cerebrovascular diseases
- Price Reference: About 2000 CNY/year at age 65
(3) Accident Medical Insurance (Essential)
- Recommended Products: China Life Parents Comprehensive Accident Insurance
- Coverage Highlights: Special coverage for fractures and joint dislocations
- Price Reference: About 80 CNY/year
3. Local Benefit Insurance (Inclusive Option)
| City | Product Name | Special Coverage |
|---|---|---|
| Beijing | Jing Hui Bao | Includes CAR-T therapy (1.2 million CNY) |
| Shanghai | Hu Hui Bao | Reimbursement for overseas special medications (30 types) |
| Guangzhou | Sui Sui Kang | No disease history restrictions (including uremia) |
| Chengdu | Hui Rong Bao | Reimbursement for expenses outside the medical insurance catalog |
Price Range: 80-180 CNY/year
2. Customized Elderly Medical Insurance Plans
1. Plan for Healthy Individuals (No Major Illness)
- Basic Layer: Urban and rural resident medical insurance + local benefit insurance
- Enhanced Layer: Million medical insurance (2 million CNY coverage)
- Emergency Layer: Accident insurance (including hospitalization allowance)
- Annual Total Premium: About 2,500 CNY
2. Plan for Chronic Disease Patients (Hypertension, Diabetes)
- Must-have: Cancer prevention medical insurance (covers most common critical illnesses)
- Supplement: Local benefit insurance (breaks medical catalog restrictions)
- Special: Diabetes complication insurance (e.g., Taikang Sweet Life)
- Annual Total Premium: About 2,000 CNY
3. Plan for the Very Elderly (Over 80 Years Old)
- Core Coverage:
Resident medical insurance (basic reimbursement)
Accident insurance (special fracture coverage)
Long-term care insurance (disability subsidies) - Optional: Some cities offer senior-specific benefit insurance (e.g., Shenzhen)
3. Five Key Tips for Elderly Insurance Purchase
1. Health Disclosure Strategy
- Mandatory Questions:
Hospitalization records (within 2 years)
History of malignant tumors, heart attack, stroke
Current medications (e.g., antihypertensives) - Smart Underwriting Applications:
✅ Thyroid nodules TI-RADS category 2 usually insurable
✅ Hypertension (<160/100 mmHg) insurable by some products
2. Methods to Overcome Age Limits
- Million Medical Insurance: Some products extend maximum insured age to 70 (e.g., Ping An eSheng Bao)
- Cancer Insurance: Up to 80 years old (e.g., Haoyi Medical Lifetime Cancer Prevention)
- Group Insurance Channel: Supplementary medical insurance through children’s employers
3. Premium Optimization
- Family Discount: 10% off for 3 or more insured members
- Annual Payment vs. Monthly: Save 5%-8% by paying annually
- No-Claim Bonus: Premium discounts for 3 consecutive claim-free years
4. Claims Practical Guide
1. Document Preparation Checklist
- General Documents:
Diagnosis certificate (from level-2 or higher hospital)
Original payment invoices (medical insurance settlement bills)
Examination reports (CT, MRI, etc.) - Special Cases:
Prescription and pharmacy invoice for externally purchased drugs
Records for cross-region medical treatment filing
2. Fast Claims Channels
- Online Channel: Ping An Health App (claims under 10,000 CNY processed in 1 day)
- Advance Payment Service: ZhongAn and Ping An support large medical expense advances
3. Dispute Resolution Process
- Internal complaint with insurance company (response within 30 days)
- Complaint to the China Banking and Insurance Regulatory Commission hotline (12378)
- Litigation in court (recommended to hire a lawyer if dispute exceeds 10,000 CNY)
5. Policy Benefits
- Medical Insurance Catalog Expansion: Added 111 new drugs (including new Alzheimer's medications)
- Upgrade of Cross-Province Settlement: Hospitalization costs can be directly settled nationwide
- Long-term Care Insurance Pilot Expansion: Disabled elderly can receive monthly subsidies of 1,500-3,000 CNY
Important Reminder: The centralized enrollment period for resident medical insurance is usually from September to December; if missed, you must wait until the next year!