Health insurance benefits upgraded: Elderly, near-poor households covered at 100%

As of January 1, 2026, tens of thousands of people from near-poor households and elderly individuals aged 75 and above who receive social pension allowances in Dong Nai province will be entitled to 100% coverage of medical examination and treatment costs within the benefit scope of health insurance participants.

Increasing health insurance benefit levels for near-poor households and the elderly

According to Resolution 261/2025/QH15, dated December 11, 2025, of the National Assembly, which outlines several special mechanisms and policies aimed at creating breakthroughs in the protection, care, and improvement of public health, many new health insurance policies will take effect starting January 1, 2026. Accordingly, the health insurance fund will increase both the rate and level of coverage for health insurance medical examination and treatment costs. At the same time, it will cover the costs of screening, diagnosis, and early treatment for certain diseases, with priority given to specific target groups.

As of January 1, 2026, individuals aged 75 and above will be eligible for 100% health insurance coverage. Photo: Bich Nhan

Specifically, from January 1, 2026, health insurance participants from near-poor households and elderly individuals aged 75 and above who receive social pension allowances will be entitled to 100% coverage of medical examination and treatment costs within the scope of health insurance benefits.

Nguyen Thi Quy, Deputy Director of Dong Nai Social Insurance, stated that the province currently has more than 17,600 near-poor households and over 63,300 people receiving monthly social pension allowances in accordance with the relevant legal regulations. Currently, health insurance participants from near-poor households are entitled to 95% coverage of medical examination and treatment costs within the scope of benefits. In comparison, those receiving monthly social pension allowances under legal provisions are covered at 80%.

To ensure the policy is implemented in practice, Nguyen Thi Quy, Deputy Director of Dong Nai Social Insurance, emphasized that Dong Nai Social Insurance will closely coordinate with the Dong Nai Department of Health and medical facilities across the province to organize implementation and payment to the right beneficiaries, in accordance with regulations, ensuring that social insurance participants fully and promptly enjoy their benefits.

As soon as the policy takes effect, Dong Nai Social Insurance will implement 100% health insurance coverage for near-poor households and individuals aged 75 and above who are receiving social pension allowances in accordance with regulations. This coverage applies across all levels of medical examination and treatment when patients seek care at the appropriate level and are referred in accordance with professional requirements or for specific conditions listed in the official regulations.

“This is a humane, timely, and highly practical policy for vulnerable groups in society. Raising the health insurance benefit to 100% will help near-poor households and the elderly reduce the burden of medical expenses, feel more secure in accessing health care services, and thereby contribute to ensuring social security and improving quality of life for the people,” Quy expressed.

The “problem” of balancing benefits and the sustainability of the health insurance fund

Dong Nai General Hospital is the province’s top-tier medical facility. Almost every day, the hospital receives numerous severe cases involving elderly patients with underlying health conditions, many of whom face financial hardship and have no family support.

Le Thi Phuong Tram, Deputy Director of Dong Nai General Hospital, shared that the hospital operates at a specialized level, handling numerous high-tech procedures, including cardiovascular interventions, oncology treatments, heart surgeries, and joint replacements, which result in very high treatment costs. At the same time, it is not uncommon for elderly patients with multiple chronic illnesses requiring long-term care to be admitted to Dong Nai General Hospital. Medical expenses can become a significant burden, especially for individuals without caregivers or those facing challenging economic circumstances. Therefore, expanding health insurance concessions, particularly by increasing the coverage level to 100% for elderly individuals eligible for social pension allowances, will help patients feel more secure in continuing their treatment, adhere to prescribed regimens, and reduce cases where treatment is abandoned due to financial constraints.

Caring for patients after myocardial infarction intervention at Dong Nai General Hospital. Photo: Bich Nhan

Tram said: “This is not only financial support but also demonstrates the concern of the country for the health of elderly people, contributing to reducing pressure on families and on medical facilities themselves during the treatment process. The hospital will strictly comply with regulations when patients come for medical examination and treatment”.

Related to this issue, Specialist Doctor Level II Le Quang Trung, Deputy Director of the Dong Nai Department of Health, added: This policy directly protects the most vulnerable population groups, contributes to reducing the risk of impoverishment due to illness, encourages people to access medical services earlier and more fully, thereby improving treatment effectiveness and quality of life.

However, alongside its clear benefits, the policy also presents significant challenges for the health system and the health insurance fund. Expanding coverage for patient groups with high demand for medical services, along with payments for expensive drugs and advanced medical techniques, will increase long-term financial pressure on the fund. “We are facing declining birth rates and an aging population. As a result, the number of older adults is rising. Without appropriate control mechanisms, there is a real risk of service overuse, excessive medical indications, or unnecessary referrals to higher-level facilities, all of which would reduce the efficiency of shared resource utilization,” Trung expressed concern.

To ensure the policy is both practical and sustainable, Trung emphasized the need for a combination of measures, such as: establishing strict criteria for prescribing drugs and applying new medical techniques; strengthening the role of grassroots health facilities in managing chronic diseases and caring for the elderly; enhancing supervision and transparency in health insurance payments; and ensuring clear communication so that people fully understand the scope of their benefits. If implemented in a coordinated manner, these changes will not only expand health insurance entitlements but also serve as a long-term social investment, contributing to the stability and improvement of the national health care system.

This breakthrough policy not only helps reduce the burden of medical expenses for vulnerable groups but also raises expectations for improving the effectiveness of health care and ensuring social security in the context of an increasingly aging population.

By Bich Nhan – Translated by Minh Hanh, Minho