Difference between Mediclaim insurance & Health insurance

April 6, 2021


RHI Agency Team

The health sector is an area where people spend a lot of money. And as people get older, the health deteriorates and a huge amount of money is needed for their treatment and various check-ups.

In America, we have had progress in the number of insured elderly for consecutive years. However, that has broken down since 2015. In beginning in 2017, the number of uninsured nonelderly Americans increased for three straight years, growing by 2.2 million from 26.7 million in 2016 to 28.9 million in 2019, and the uninsured rate increased from 10.0% in 2016 to 10.9% in 2019.

It is a fact that people who are insured have better access to healthcare than people who don’t. Generally, people who are insured have better access to preventive care and services for major health conditions and chronic diseases. And without insurance, you are looking at bank-breaking bills that that can easily destabilize a family’s financial security.

But what should I choose: Mediclaim or Health insurance?

When it comes to health-based insurance, there are two major options – Mediclaim and Health Insurance. The two main types of policies are medical and health insurance. Most people think that both are the same, but we will see that we are very much different.

Mediclaim Insurance

Mediclaim or Mediclaim insurance is a type of policy that gives coverage against one’s hospital expenses only. That is, for the patient to get benefit from mediclaim hospitalization is mandatory. This policy usually offers coverage to a certain limit only and for the treatment of some specific diseases.

Mediclaim insurance usually does not offer the benefit of add-on covers and is not flexible.

Health insurance

Health Insurance is different from mediclaim as it offers coverage that extends to more than just the hospitalization expenses of the insurer. It usually covers a range of medical expenses like annual health check-ups, medicinal expenses, OPD treatment expenses, etc.

The main benefit of health insurance is the availability of a wide range of add-on plans that can be customized according to the needs of different customers.

Benefits of Mediclaim and Health Insurance

  • You will get your medical expenses covered which you are hospitalized. This can be very beneficial for an elderly person who is prone to sickness more often
  • Option for cashless mediclaim policy, wherein the expenses are paid directly by the insurer. This avoids the headache of filling paperwork, especially for old people
  • Option for reimbursement, in which the insurer will reimburse your money

Benefits of Health Insurance

  • Grants a comprehensive coverage
  • Option for add-ons which can be very beneficial for old people who suffer from various serious illnesses
  • Provision to select a specific senior citizen health plan for old people
  • Can opt for a family plan that covers all your family members
  • Cover pre and post-hospitalization costs
  • Will allow you to opt for critical illness cover if needed
  • Option to add extra benefits like maternity benefit, outpatient benefit, etc.

Making an informed choice between Mediclaim or Health Insurance

Both Mediclaim and Health insurance has their own benefits. But the better choice for every individual will be different and will depend on a variety of factors like the financial condition, your age, health issues that you and your family are dealing with, whether you prefer flexibility or not, premium amount you are ready to pay, etc.

Details about some of the benefits

Pre and post hospitalization

A mediclaim policy is strictly limited to the coverage of hospital expenses. It can cover the treatment of certain illnesses for a particular period. Whereas health insurance offers a broad spectrum of health benefits. It includes the medical costs incurred before and after a number of days of hospitalization. These include doctor’s fee, diagnosis charge, etc. These extra costs are not included in any normal mediclaim policies

Ambulance charge

An ambulance can be necessary especially if you are an old person or suffer from any serious illnesses or injuries. A mediclaim does not allow to reimburse ambulance costs. But most of the health insurance plans cover the expense of the ambulance to a certain limit. These expenses will be reimbursed by your selected insurance company

Cost and Benefits

The coverage of mediclaim is usually restricted and hence the cost of the policy is also lower than the Health insurance policy. But health insurance is a bit broader and offers a lot of extra benefits and options. Because of these reasons the premium costs of health insurance are higher, but also pays a higher sum

Number of Claims

A mediclaim allows the insurer to make multiple claims in a year, till the sum assured limit is not reached. This can be very beneficial to old people who get hospitalized often due to various illnesses. But a person who has purchased health insurance can only avail of its benefits once a year.

So both mediclaim and health insurance have their benefits and drawbacks. While opting for health insurance you must spend some time considering all the factors and benefits each plan will offer. Also, health insurance provides benefits to your family as well, hence their needs must also be considered especially when you have old people in your family.

An insurance agent will provide you all the information on the different schemes available and even help you choose between a mediclaim and health insurance. He will also provide you with all the options available to you and help you to reach the best decision.

So if you have not purchased a mediclaim or health insurance, hurry up. Delay must not be made in securing your and your family’s future.

Let us help you choose the right insurance!

We understand that it can be quite tricky to choose between the two and you have to consider various factors to land an option. So let our experts make the process easy for you!

At RH Insurance Agency, we strive to provide our clients with streamlined experience for choosing the insurance that benefits them the most! We provide our clients with insurance assistance to help them make the right purchase decision.


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