The Hidden Gaps in Health Insurance: What You Need to Know Now

As healthcare costs soar and insurance premiums climb, experts and policymakers are urging citizens not to rely solely on insurance for their medical security. While recent regulatory changes—like the IRDAI’s 2025 guidelines—have made health insurance more inclusive, covering severe pre-existing conditions and offering cashless treatment at any hospital, significant gaps remain in achieving true healthcare for all.

 

Key Highlights:

 

Insurance Alone is Not Sufficient: Even with increased coverage, more than 80% of disabled individuals in India continue to be uninsured for health, either being rejected owing to pre-existing conditions or insurers' unawareness. The groups that are highly vulnerable, like women with particular disabilities, also remain under-coverage.

 

Increasing Premiums and Medical Inflation: As premiums increase dramatically due to higher procedure rates and wider coverage, private insurance affordability comes under fire from many. Increasingly, some are opting to self-insure—saving individual healthcare money—but this method is without the risk-pooling advantage of conventional insurance and potentially leaves individuals vulnerable to catastrophic costs.

 

Public Health Efforts Count: Government schemes such as Ayushman Bharat and the National Health Mission have augmented access, particularly to maternal and child health, and increased digital healthcare. They are essential for the people who get left behind by private insurance.

 

New Regulation for Cashless Treatment: Policyholders can now avail cashless hospitalization from any registered hospital, not limited to network centers, increasing accessibility to emergency care.

 

Holistic Planning Required: Experts suggest a combination of insurance, individual savings, and public health scheme awareness to provide total healthcare protection.

 

Real healthcare for all involves an all-around strategy—insurance is only part of the solution.

 

Source: Economic Times, New Indian Express, PIB, Stewart Group