About one in four among the pioneer generation is not covered under MediShield, and the proportion is higher among the older pioneers.
Among those not insured by the national health insurance scheme, some were not covered as they had never worked before. Others may have opted out, the Health Ministry (MOH) said in reply to queries from The Sunday Times yesterday.
This group of seniors is likely to be at risk of having to pay for larger hospital bills, and many were unable to sign on or get back on Medi- Shield because they could not afford the premiums or had pre-existing conditions.
This will soon change after the benefits of the Pioneer Generation Package kick in.
Not only will all pioneers be placed on the new MediShield Life scheme, those aged 80 and above this year will also be covered free of charge for the rest of their lives.
In his Budget speech on Friday, Deputy Prime Minister and Finance Minister Tharman Shanmugaratnam pledged to fully cover the premiums for this group of older pioneers through Medisave top-ups and MediShield Life subsidies.
The pioneer generation is defined as those aged 65 and above this year, and who became citizens before 1987.
About 25 per cent of the 450,000 pioneers are aged 80 and older, said the Ministry of Finance (MOF). This is the group that will have their MediShield Life premiums fully taken care of - even those not covered by MediShield today.
A pioneer aged 70 today and on MediShield will pay about half of his current premiums after the premium subsidies and Medisave top-ups kick in. Those not on Medi- Shield now will be brought onto MediShield Life and will also pay less than current MediShield premiums.
Madam Lee Ah Yoke, 86, is one of those who will benefit from the new measures.
The retired hawker does not have MediShield. She was hospitalised earlier this year for dizzy spells and depended on her grandson's Medisave as her three children either do not have Medisave or have had their Medisave depleted.
Tanjong Pagar GRC MP Lily Neo said the Government's promise to foot the bill for the premiums of pioneers like Madam Lee will give many of these seniors - especially those with existing illnesses - peace of mind.
Dr Neo and fellow MP Chia Shi-Lu also felt that the MediShield Life component of the Pioneer Generation Package will help to control health-care costs and keep financing sustainable.
Dr Chia, who sits on the Government Parliamentary Committee for Health, said the GPC had previously raised its concerns to MOH over the vulnerable elderly not covered by MediShield.
Some may currently qualify for Medifund, the Government's endowment fund for the very poor, but this might not be sustainable in the long term, said Dr Chia.
Risk-pooling by extending insurance to everyone is less costly and "the correct use of our funds", added Dr Neo.
Dr Mary Ann Tsao, chairman of the Tsao Foundation, welcomed the move to cover the very old for life, but noted how MediShield Life will be implemented is important.
Among the questions yet to be answered are what conditions will be covered by the scheme and how much the deductible and co-payment amounts will be, she said.
Another group of concern is the elderly without Central Provident Fund (CPF) accounts or who have depleted their Medisave savings.
This group would be among the poorest and "highest-need" as they do not have enough for a CPF account or may not have children to top it up for them, she said, adding that the community and non-profit sector could work with the Government to reach out to them.
An MOF spokesman said that the "vast majority" of pioneers would automatically get the annual Medisave top-ups, which range from $200 to $800 depending on their age this year.
This is because they were either CPF members or had CPF accounts automatically created when they signed up for previous government transfer schemes such as the GST voucher.
Taken together with the annual GST voucher for Medisave, the oldest pioneer would get as much as $1,250 in Medisave top-ups a year.
MOF also highlighted the other Pioneer Generation Package measures which will give substantial subsidies on outpatient treatment at specialist outpatient clinics, polyclinics and private GPs.
This would result in the pioneers having to tap less into their cash or Medisave savings, said the spokesman.