Overcrowding in hospitals, a lack of funding, and problems with accessibility, especially with the elderly and those with long-term conditions, have long afflicted India’s healthcare system. Even though health insurance has made significant progress in supporting people in managing their increasing medical costs, there is still a significant vacuum in one area, coverage for home healthcare.

Changing Family Structures, Rising Need

Many seniors now find themselves living alone or with minimal support, as life expectancy grows and families shift away from joint setups. India faces a unique situation, while the number of seniors is expected to touch 194 million by 2031, over 60% of households are already nuclear. In this setup, rushing to a hospital for every treatment is not always practical, and often not needed. Yet, most insurance policies still make hospitalisation a must for claims. This mismatch between what people need and what their insurance allows ends up burdening both caregivers and those who are unwell.

What Home Healthcare Really Offers

Home healthcare, often referred to as domiciliary care, involves receiving medical treatment in the comfort of one’s home. This includes nursing support, doctor consultations, medications, diagnostic tests, and even post-surgery rehabilitation. It is particularly useful for bedridden patients, have mobility issues or live far from medical facilities.

Gaps in Coverage and Clarity Make Home Care Hard to Access

While some health insurance plans in India now offer a provision for domiciliary treatment, it is still not common knowledge. And even when such a cover exists, it’s surrounded by a maze of conditions, exceptions, and vague clauses. For instance, simple home-based physiotherapy sessions for minor pain might not be covered. But if the same therapy is prescribed as post-operative care following surgery, it might qualify as part of post-hospitalisation benefits.

This fragmented approach has left many families paying out of pocket for home-based care. Only around 10% of health insurance policies at the moment cover home care services, according to an IRDAI report, and this happens only in particular scenarios like fever management or physical therapy prescribed by a doctor. In the meantime, over 70 per cent of India’s senior citizens are affected by long-term illnesses, including diabetes, heart disease, or high blood pressure. Frequent hospital stays are financially and physically taxing for them.

During the COVID-19 pandemic, when hospital beds were scarce, many patients had no choice but to receive care at home. This period made insurers and healthcare providers acknowledge that recovery outside a hospital is not only viable but sometimes preferable. However, once the urgency passed, attention to home care in insurance coverage faded again.

One key reason for slow adoption is a lack of awareness. People often buy insurance without reading the fine print. Terms like ‘domiciliary cover’ or ‘home care rider’ may not even come up during purchase discussions. Many assume that any medically necessary treatment will be reimbursed, only to find out later that home care was never included. On the other hand, some avoid home care altogether out of fear that their claims will be rejected.

There is also a trust issue. Families may worry about the quality of care delivered at home. But the ecosystem has evolved. Several professional home healthcare providers today offer certified staff, portable medical equipment, and real-time monitoring that rivals inpatient facilities. With proper guidelines in place, insurers can work with these providers to ensure quality control and better outcomes.

The structure of coverage also needs to evolve. At present, home healthcare benefits are offered in bits and pieces, pre- and post-hospitalisation cover, domiciliary treatment, and OPD services, all with their own limitations. A more holistic offering, designed around patient needs rather than hospital stays, would help.

There are real savings to be made, too. Hospital bills include heavy costs for room rent, administrative charges, and other non-medical expenses. Home care eliminates these, reducing the cost of treatment by 10–30% in many cases. That is good news not just for patients, but for insurance providers looking to manage claims more efficiently.

Also Read: Why MedTech’s Future Depends on Reskilling India’s Doctors – Now More Than Ever

What Needs to Happen Next

To make this work, some fundamentals need to be in place. Any treatment at home should be backed by a doctor’s recommendation. Insurance companies must clearly define what is covered, what is not, and under what conditions. And awareness campaigns should be run not only for policyholders but also for healthcare providers, many of whom still default to recommending hospitalisation, even when home care would do.

The health insurance sector is overdue for reforms that reflect how people heal. Hospitalisation should no longer be the gold standard for insurance claims. It is time policies adapt to include the home as a legitimate setting for recovery, especially when medical science, patient comfort, and financial prudence all support it.

Views expressed by: Vishal Lathwal, CEO, Apollo Home Healthcare, Apollo Hospitals

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