philhealth for senior citizens

A great inevitability of life is that our body tends to be more prone to diseases and health risks as we age.

Various medical institutions tend to emphasize this fact, and it is a main selling point among many health insurance companies. For this reason, senior citizens are encouraged to be more responsible for their health. They are advised to take better care of themselves by performing exercises appropriate to their condition, having regular checkups, and minding what they eat.

Unfortunately, senior citizens are often deterred by exorbitant medical fees and expensive hospital costs, considering that most of them are relying on their pensions and retirement funds. However, this does not always have to be the case—especially in the Philippines. Should there be any need for medical checkups, hospital confinement, and other healthcare needs, seniors can take advantage of their PhilHealth benefits. While most seniors are aware of the standard twenty percent discount in hospitals, there may be benefits that they are uninformed about. So, as a senior citizen of the Philippines who regularly made contributions to PhilHealth while employed, what benefits do you have? And how can you process your claims?

To find out, read below:


a.) Inpatient Benefits

PhilHealth’s inpatient benefits allow a certain amount to be deducted from the total of a senior citizen’s total private hospital bill. Hospital bills typically include hospital charges and the doctor’s fees, and the amount to be deducted (which varies on a case-to-case basis) depends on the patient’s condition or disease.

b.) Outpatient Benefits

Senior citizens are also entitled to outpatient benefits which include hemodialysis sessions, radiotherapy sessions, and outpatient blood transfusions, which senior citizens suffering from cancer or kidney ailments can take advantage of. Apart from all these, senior citizens are also entitled to TB-DOTS Package, which is worth Php4000, Animal Bite Package, worth three thousand pesos, and the cataract extraction package, which is worth Php16,000. Lastly, elderlies may also avail of the primary care benefits 1, otherwise known as the TSeKaP (Tamang Serbisyo para sa Kalusugan ng Pamilya).

c.) TSeKaP (Tamang Serbisyo para sa Kalusugan ng Pamilya) Benefits

TSekaP Benefits is a program that includes preventive befits such as regular BP measurements, smoking cessation counseling, digital rectal examinations, and lifestyle modification counseling. Other diagnostic medical examinations such as urinalysis, chest x-ray, fecalysis, fasting blood sugar, lipid profiling, and sputum microscopy.

d.) No-Balance Billing Policy

Senior citizens confined in accredited public hospitals will be able to avail of the No-Balance Billing Policy (NBBP). This means that senior citizens in public hospitals no longer need to pay anything upon discharge. However, this is subject to some rules and is typically done on a case-to-case basis.

e.) DOTS (Directly Observed Treatment Short-Course)

Senior patients who require first-line drugs or anti-retroviral treatment for any HIV/AIDS-related diseases may avail of the DOTS package. The package includes diagnostic exams, consultation, and prescription medicines provided that seniors visit a PhilHealth-accredited DOTS center in their vicinity.

f.) Z Benefits Package

Senior citizens who are diagnosed with diseases that are medically and economically catastrophic need not worry. While these diseases require senior citizens to undergo long-term and expensive treatments, they can make use of their PhilHealth benefits. With PhilHealth’s assistance, the potential financial blow will not be as exorbitant as it would be without the coverage. Diseases that are covered under the Z package are:

  • Early stages of breast cancer
  • Standard risk for coronary bypass graft surgery
  • Early stage of cervical cancer
  • Prostate cancer with low to intermediate risks
  • Acute lymphocytic/Lymphoblastic Leukemia with standard risks
  • Z morph external lower limb prosthesis: Initial prosthesis from knee down (left, right, or both)
  • Total Hip Prosthesis, cementless
  • Kidney Transplantation for End-Stage Renal Diseases (Low Risk)
  • Partial Hip Prosthesis (bipolar)
  • Implants for Hip Replacement: Total Hip Prosthesis cemented
  • Implants for Fractures around the Hip (Multiple Screw Fixation)
  • Compression Hip Screw Set
  • Femoral Shaft Fractures (Intramedullary Nail with Interlocking Screws)
  • Proximal Femoral Locked Plate
  • Locked Compression Plate (LCP: Broad/Metaphyseal/Distal Femoral)


1.) Lifetime Members

People aged 60 and above or retired senior citizens who paid no less than 120 months of contributions are lifetime members. Also, it is worth noting that lifetime members get a free lifetime coverage premium. This means that there is no longer a minimum payment requirement for them to claim their benefits.

2.) Automatic Members

With the Expanded Senior Act or RA 10645, all senior citizens who are aged sixty and above are considered PhilHealth members automatically—even if they did not pay for monthly contributions. These non-paying senior citizens also get a free lifetime coverage premium like any lifetime member.


As a senior citizen, availing of PhilHealth benefits can be a huge help to defray medical costs and lessen pecuniary burdens—especially in times of prolonged hospitalization. That said, one of the best courses of action to take is to research the various aspects of your medical needs and how government institutions can aid you.