HMOs For Senior Citizens In The Philippines

Navigating medical issues can be challenging as we age, and even more so for seniors with specific conditions. Finding the right hospital, managing high consultation fees, and dealing with additional costs can be overwhelming. Fortunately, there’s a solution that can ease this burden: an HMO.

An HMO (Health Maintenance Organization) offers vital support by providing access to a network of doctors and clinics and covering most, if not all, medical expenses. By paying an annual premium, a member can gain comprehensive coverage and access to accredited healthcare providers, making it easier to manage their health and medical costs effectively.

Whether you’re shopping for a senior family member or for yourself, check out our curated list of the best HMO plans available in the Philippines below to find the ideal option.

ALSO READ: Top 5 HMOs Recommended By Parents For Families

HMO Plans for Senior Citizens in the Philippines

Maxicare PRIMA Gold
The Gold Plan, priced at P16,888, provides comprehensive coverage for all age groups, including seniors, at Maxicare Primary Care Clinics (PCCs). It offers up to P20,000 for emergency care and unlimited access to over 800 lab tests and diagnostics, with no additional fees for consultations or paperwork.

You can have unlimited visits with PCC doctors and receive annual ER coverage of up to P20,000 at Maxicare hospitals nationwide. Moreover, the plan includes one-time dental services through Metro Dental and offers group life insurance with up to P50,000 in Accidental Death, Dismemberment & Disablement (ADD&D) benefits for members aged 15 days to 80 years.

How to Apply:

• Shop for the plan on Maxicare's website. After purchase, register your e-voucher to activate it. Register as soon as possible to avoid expiration or any issues.

How to Activate Your Maxicare PRIMA Gold:

1. Visit the Online Card Registration Page.
2. Input the Reference Number from your purchase receipt email.
3. Fill in the required personal details and click “Submit.”
4. After successful registration, your Maxicare PRIMA Gold eCard will be emailed to you. You will also receive your policy and card number via SMS.

Important Notes:

• You can start using your unlimited consultations and laboratory tests immediately after receiving your eCard.
• Emergency Care benefits will be active 15 days post-registration.
• Your physical membership card will be sent to your address within 15 working days of registration.
• The card is non-transferable after registration.
• Check the FAQ for a list of valid IDs.
• There is a 15-day free-look period for refunds, but refunds are only possible if the card has not been used.

Visit maxicare.com.ph to know more.

PhilCare VidaCare Core
Costing P11,120, VidaCare Core provides a year-long health coverage for individuals aged 60 and above, becoming active seven days after registration. This non-transferable Certificate of Coverage includes unlimited medical consultations with Philcare-accredited physicians, specialists, and dentists nationwide. It also covers unlimited outpatient laboratory and diagnostic procedures at PhilCare clinics and partner HealthFirst Clinics, excluding physical therapy.

Additionally, the plan offers unlimited HeyPhil Digimed consultations. While it covers pre-existing conditions, it does not include consultations for behavioral disorders, developmental or psychiatric conditions, or psychosomatic illnesses, whether congenital or acquired.

Availment Procedure:

• Shop for the plan here.

Consultation Availment:

• For medical consultations, create a self-issued Letter of Authorization (LOA) and personalized membership card at Consultations page. Present LOA, personalized membership, card and 1 valid ID with picture to chosen medical specialist.
• For dental consultations, ensure to call the dentist first for available schedule.

HeyPhil Digimed Consultation Procedure:

• Download the HeyPhil DigiMed application through Play Store (for android phones) or App Store (for IPhones).
• Click 'Need Online Mental Counseling or Medical Consultation? Click Here' found at the bottom part of the app screen.
• Go to 'With Reference No? Click Here' found at the upper part of the app screen.
• Fill out the Patient Profile then click submit.
• Enter your Chief Complaint or the reason why would you like to seek for medical consultation.
• Attach a photo of your most recent doctor’s prescription or laboratory test results if available, otherwise, proceed to read and agree with the terms and conditions in availing a digital consultation.
• Click the Request Consultation to queue your digiconsult request with one of our DigiMed doctors.
• Stand by for your DigiMed Doctor’s call until the submitted chief complaint and copies of prescription and laboratory test results have been assessed. Please be reminded that your DigiMed Doctor calls from an unregistered number in your contact list.
• Engage with a medical tele-conferencing with your DigiMed Doctor.
• Check on the medical assessment and prescription sent to your registered email.

Important Notes:

• The client may review and cancel this health plan within 15 days of receiving the Certificate of Coverage, provided that the plan has not been used. After this period, the membership coverage will be terminated.
• Refunds are subject to PhilCare’s Termination Policy. To request cancellation, email prepaidcs@philcare.com.ph.

Visit philcare.com.ph to know more.

ER Care All-In
ER Care All-In plan provides comprehensive coverage for sudden medical emergencies for both outpatient and inpatient care. This one-time use health plan is available to children aged 1 to 17 and adults aged 18 to 64, covering emergencies due to accidents, viral or bacterial diseases, and specific conditions. Adults can access a benefit plan of P80,000 for P1,350, or a plan of P100,000 for P1,750.

Coverage includes doctor’s fees, emergency room treatment, laboratory and diagnostic procedures, room accommodation for confinement, necessary medications, and surgery-related costs. It also covers the use of operating rooms, recovery rooms, and ICUs as needed, with a P5,000 limit for special treatment modalities. Additional benefits include a P1,000 hospital cash allowance for adults and one year of unlimited telemedicine access for kids. Valid for one year or until used, ER Care All-In can be utilized at over 500 IHC-accredited hospitals in the Philippines.

How to Apply:

• After purchasing on iCare's website, register your prepaid health plan here. You must complete the registration within 90 days from the purchase date; otherwise, your serial code will no longer be valid for registration.

Important Note:

• The health plan is giftable/transferable as long as it’s not yet registered. Take note that after submitting the recipient's information, an email will be sent to him/her notify them that you registered them under an IHC health plan. They must confirm that they allow the registration to receive the health voucher.

Visit Insular Health Care to know more.

Medicard VIP
The VIP plan offers extensive global emergency services and coverage for individuals up to 65 years old. Key features include 24/7 access to multilingual staff and Western-trained physicians for consultations and referrals, as well as assistance with hospital admission, emergency medical evacuation, and supervised repatriation. The plan also provides global healthcare assistance, access to 5-star hospitals, the ability to choose preferred doctors, coverage for preexisting conditions, executive check-ups at Medicard clinics, and privileges at the MediCard Lifestyle Center, including free consultations and discounts on outpatient diagnostics.

However, the plan has limitations, such as coverage caps for preexisting conditions and certain diseases, and requires that services be provided by Medicard-accredited providers. Some conditions are not covered, and specifics are available upon request. The plan is renewable annually, with premiums for ages 61-65 ranging from P32,993 to P104,432.

How to Apply:

• You can purchase the plan on MediCard's website. 

Important Notes:

• Non-Philhealth members (e.g. parents below 60 and unemployed, etc.) shall pay the Philhealth portion of their total hospital bills during confinement.
• Executive check-ups are for principal member plus one (1) dependent only (provided that dependent enrolled is 18 years old and above)
• Medical evaluation for enrollees age 41 and above is waived.
• Medical, surgical, hospital and professional services expense NOT EXPLICITLY COVERED under this Agreement must be settled by the member upon discharge from the hospital. If MediCard will advance the payment, member shall pay MediCard the advanced amount within seven (7) days from receipt of the statement of account with an administration fee of 15%. If settlement is not made within seven (7) days, a penalty of 2% per month of the amount owing will be imposed until the debt is satisfied. MediCard has the option to suspend the ID card of the member(s) involved until full settlement is made.

Visit Medicard to know more.

CARITAS Health Shield Ehanced Core 10
This plan offers 10 years of robust coverage for individuals aged 7 to 70, with flexible payment options, such as spot cash, annual, semi-annual, quarterly, or monthly installments over a 5-year period. The coverage will increase annually at a fixed rate, and after completing the initial 5 years, you'll enjoy an extra 5 years of bonus protection.

Included in this plan are a range of medical benefits such as special diagnostic procedures, hospitalization, outpatient services, and emergency care. Membership perks also feature annual physical exams, preventive health care, and dental services. Plus, it provides essential insurance benefits including credit life, term life, accidental death coverage, and a waiver of installments in the event of disability.

How to Apply:

To apply for a health plan, prepare the following:

• Completed Membership Application Form (MAF) with payment attached. Note that payments will not be accepted without the MAF.
• Government-Issued ID. Provide an original or photocopy of a valid ID that includes your name, date of birth, and signature. Accepted IDs are:
  - Passport
  - Postal ID
  - SSS card/GSIS e-card
  - Commission on Elections (Comelec) Voter’s ID
  - Professional Regulation Commission (PRC) ID
  - Driver’s License
  - Senior Citizen’s Card
  - Unified Multi-purpose Card
• 2x2 colored picture with a white background.

Important Notes:

Please note, payment of the membership fee does not guarantee approval of the health plan application. All applications are subject to the applicable laws of the Insurance Commission (IC), Anti-Money Laundering Act (AMLA), Bangko Sentral ng Pilipinas (BSP), and Medical Underwriting. Upon approval, the Health Care Agreement and membership card will be sent to your preferred address. You will receive a notification letter if your application is disapproved.

Payments can be made through various channels. For a complete list of payment options, click here.

Visit Caritas Health Shield to know more.

How to Choose the Best HMO for Senior Citizens

Consider the following factors to find the most suitable plan:

Assess Medical Needs
Determine the primary health needs and priorities. Consider whether you need comprehensive coverage for routine consultations, emergency hospitalizations, or specific conditions. Check if the plan covers preexisting conditions and whether there's a waiting period. Ideally, choose a plan that offers preventive care and emergency services.

Check Eligibility
Confirm that the HMO plan fits the age requirements for senior citizens. Some plans have age limits, so ensure the plan is suitable for the age of the person you’re enrolling.

Evaluate Costs
Compare premiums, which vary based on age and coverage. Comprehensive plans are relatively costly, so balance your budget with the benefits offered. Look into whether the plan can be integrated with family or company plans for potential savings. Consider lower-cost prepaid HMOs or plans that fit your budget while meeting essential needs.

Consider Location and Network
Review the HMO’s network of accredited healthcare providers and hospitals. Ensure that the plan covers the locations and healthcare providers you prefer. Also, check the accessibility of their offices for filing claims or reimbursements.

Research
Investigate the HMO’s reputation by reading reviews and feedback from current users. Look for information on the ease of claims processes, customer service quality, and overall satisfaction. While good reviews are helpful, thoroughly review the policy details and ensure it meets your needs.

For a balanced approach, consider combining an HMO with other health insurance options and PhilHealth to maximize coverage and financial security. Investing in comprehensive health coverage is a wise decision for maintaining good health and managing medical costs effectively.

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