Who Gets Covered? State-Level Inequalities in Health Insurance for Older Adults in Kerala and Bihar

Background: Substantial state-level disparities exist in health insurance coverage among older households in India, influenced by socio-economic, demographic, and policy factors. Objective: To compare the prevalence, composition, and determinants of household health insurance coverage in Kerala and Bihar using LASI Wave-I data (2017–18). Conclusion: Kerala’s inclusive, diversified insurance model contrasts sharply with Bihar’s low, socially stratified coverage. State-specific strategies targeting marginalised caste groups in Bihar and addressing religious and household-size gaps in Kerala are essential for advancing universal health coverage among India’s ageing population.