Understanding barriers and enablers of health insurance awareness among older adults in India: Insights from LASI, 2017–18, with a focus on migration status

Awareness of health insurance is uneven among older adults in India and remains a critical barrier to enrolment. This study examines the social and structural factors associated with health insurance unawareness among uninsured older adults in India, with particular attention to migration status. Data were drawn from Wave 1 of the Longitudinal Ageing Study in India (LASI, 2017–18). The analysis was restricted to uninsured older adults. Chi-square tests and binary logistic regression models were used to examine associations between migration status, socio-demographic characteristics, and health insurance unawareness. Model 1 shows that non-migrant older adults are 7% more likely to be unaware of health insurance than migrants [UOR: 1.07*, CI: 1.04–1.12]. Higher education reduces this likelihood, with older adults at higher education levels having 78% lower odds of unawareness [UOR: 0.22, CI: 0.20–0.23]. In Model 2, after adjusting for all factors, non-migrants continue to show higher odds of unawareness [AOR: 1.12***, CI: 1.08–1.17]. Urban residents are less likely to be unaware than rural residents [AOR: 0.57, CI: 0.55–0.60], and those living with a spouse also show lower odds compared to individuals living alone [AOR: 0.76***, CI: 0.64–0.90]. ** Migration status, education, and social factors are significantly associated with health insurance unawareness among older adults. Non-migrants, older adults with low education, rural residents, and those living alone or in poorer conditions are more likely to be unaware of health insurance. Promoting insurance literacy can help to increase awareness.