Caring for Parents From Abroad: Real Costs in India and Philippines

The message usually arrives at a bad hour. A hospital billing desk in Coimbatore wants an advance before an angiogram; a cousin in Iloilo says the caregiver has quit and Lola cannot be left alone tonight. The child is in Calgary or Riyadh, eight or five time zones away, with a card that works abroad and a parent whose phone keeps asking for an OTP nobody can read. Long-distance care is often described as an emotional problem. In practice, much of it is a payments problem: getting the right amount to the right counterparty in India or the Philippines, quickly, without handing a frail parent a pile of cash.

This guide looks at what that care actually costs in the two countries with the largest overseas families, which public schemes now carry part of the load, and how to structure the money so that the 2 a.m. call is a bill to settle rather than a crisis.

Ageing at home, children abroad

India is ageing faster than most people realise. The UNFPA's India Ageing Report found that people aged 60 and over were 10.5% of the population in 2022 and are projected to reach 20.8% by 2050, with the elderly outnumbering children under 15 by around 2046. About one-fifth of older Indians already live alone or only with a spouse, 71% live in rural areas, and nearly a third of older women have never worked and have no income of their own.

Those numbers overlap heavily with migration. Kerala, which received about a fifth of India's remittances in the RBI's last survey, is also one of the oldest states, with women at 60 expecting around 22 more years of life. The pattern is familiar: one child in the Gulf or North America, another in Bengaluru, and parents in the family home who are fine until, suddenly, they are not.

The Philippines has a younger population but an even heavier reliance on overseas earnings. Personal remittances reached a record $39.62 billion in 2025, with cash remittances equal to 7.3% of GDP. The United States supplied 39.7% of cash remittances, followed by Singapore at 7.3% and Saudi Arabia at 6.6%. A large share of that money pays for medicine, maintenance drugs and someone to sit with an elderly parent. Our explainer on OFW remittances covers the corridor itself.

Who pays the hospital: public cover is finally growing

For decades, Indian families paid most health costs out of their own pockets. That is changing, slowly. The government's National Health Accounts show out-of-pocket spending fell to 39.4% of total health expenditure in 2021-22, from 62.6% in 2014-15, while government spending rose to 48% of the total. Even so, almost two rupees in every five spent on health still come straight from households, and for families with a child abroad, that often means a transfer.

The biggest recent change for older parents is the Ayushman Vay Vandana card. Since October 2024, every resident Indian aged 70 and above qualifies for Rs 5 lakh of hospital cover under AB PM-JAY, regardless of income. By 31 December 2025, about 96.7 lakh cards had been issued and 10.3 lakh hospital admissions authorised, worth Rs 2,154.37 crore, across more than 33,000 empanelled hospitals. That works out to roughly Rs 20,900 per admission, which suggests the scheme is mostly paying for routine procedures and short stays rather than long ICU episodes. Enrolment is done online with e-KYC, which a child abroad can often walk a parent through on a video call.

In the Philippines, the shift happened earlier. Under Republic Act 10645, every Filipino aged 60 and over who is not already a PhilHealth member through work is automatically covered, with premiums paid by the national government from sin-tax revenue. Coverage includes room and board, professional fees, medicines, outpatient consultations, the Konsulta primary-care package and dialysis, and zero-balance billing has expanded in government hospitals. Indigent seniors also receive a social pension of P1,000 a month, doubled under RA 11916, reaching more than 4 million people by end-2025 with over a million more on the waitlist.

Public cover now handles the big hospital bill more often than before. What it does not handle is the Tuesday afternoon: the caregiver, the pharmacy run, the electricity bill.

India and the Philippines side by side

Sources: PIB National Health Accounts, Outlook Money, Gulf News, GMA News, Samarth, RBI, BSP via Philstar. Care costs are indicative ranges, not quotes.

Worked example: budgeting care for a parent in a Tier-2 Indian city

Take a 72-year-old widow living alone in Coimbatore, with a son in Calgary. She is mobile but has diabetes and needs help with cooking, bathing and medicines. Here is what a sensible monthly structure looks like, using published ranges.

• Care: Samarth's 2025 survey of home-care pricing puts part-time attendants at Rs 12,000-25,000 a month and basic live-in care at Rs 35,000-50,000, with Tier-2 cities running 15-20% below metros. A live-in attendant in Coimbatore might therefore cost around Rs 28,000-42,500. Budget Rs 35,000.
• Hospital risk: She qualifies for the Vay Vandana card, which covers up to Rs 5 lakh at empanelled hospitals. That does not remove the need for private cover if the family prefers non-empanelled hospitals, but it changes the size of the emergency fund.
• Recurring bills: electricity, water, phone, gas cylinder, property tax and medicines. These are best paid directly by the son, not routed through her account. Systems like Bharat Connect let many of these billers be paid from one interface.
• Emergency buffer: At Rs 20,900 per average Vay Vandana admission, a buffer of Rs 1-1.5 lakh held in an account the son can operate covers deposits, non-covered consumables and transport for several episodes.

Total run-rate: roughly Rs 35,000 for care plus Rs 8,000-12,000 for bills and medicines, or about Rs 5.2-5.6 lakh a year, with a one-off buffer of Rs 1-1.5 lakh. Moved as a single monthly transfer, that is a manageable number. Moved as panic transfers each time something breaks, it costs more in fees, worse exchange rates and stress.

If the son still files Indian returns under the old tax regime, health insurance premiums paid for senior-citizen parents can qualify for a deduction under Section 80D, within a combined ceiling of up to Rs 75,000 or Rs 1 lakh depending on ages, provided the premium is paid by any mode other than cash. The deduction is not available under the new regime. Tax treatment for NRIs depends on individual circumstances, so check with a qualified adviser; our guide to tax on money sent to India covers the basics.

The Philippine version

Now take a 68-year-old father in Quezon City with a daughter working in Riyadh. He is automatically covered by PhilHealth. The household's main cost is a live-in kasambahay, whose legal minimum in Metro Manila rose to P7,800 a month from 7 February 2026, up from P7,000. Twelve months at the minimum is P93,600 a year before food, lodging and benefits, and anyone with caregiving skills will expect more. If he receives an SSS pension, it gets a 10% increase each September through 2027, which helps cover maintenance medicines.

Pay the counterparty, not the parent

The most useful shift in long-distance care is structural. Instead of sending a lump sum to a parent and hoping it is spent well, pay the people and institutions directly wherever possible.

1. Caregivers: pay by bank transfer or UPI on a fixed date, with a written agreement. Cash handed over by a frail parent invites disputes and, sometimes, exploitation.
2. Utilities and subscriptions: pay billers directly. Our guide to bill payments for NRIs walks through the options.
3. Hospitals: register the parent's insurance or Vay Vandana card with the nearest large empanelled hospital in advance, so admission can be cashless. Ask the hospital which international payment methods its billing desk accepts before you need it.
4. Insurance: pay premiums from your own account and keep receipts, both for continuity and for any tax claim.
5. Emergency money: keep a defined buffer in an account you can access remotely, with a trusted local relative or friend who can act on the ground.

Paying directly also protects parents from the fastest-growing threat to their savings: scams. Older people who receive regular transfers are prime targets for fake bank calls, KYC-update links and impersonation. See our guide to money transfer scams before setting anything up.

The paperwork that saves a week

Every family that has handled a hospital stay remotely says the same thing: the money was not the hard part, the authority was. Banks will not talk to a child about a parent's account without a mandate. Hospitals want a local signatory. Insurers want original documents. A few hours spent now, while parents are well, removes most of that friction.

• A registered power of attorney or bank mandate for at least one account.
• Copies of ID, insurance cards, Vay Vandana or PhilHealth details, prescriptions and recent test results, stored where the child and a local contact can reach them.
• Nominee and joint-holder details updated on bank accounts and deposits.
• A named local person, with a written list of who to call and what they can approve.

None of this is legal advice, and rules on powers of attorney and joint accounts differ between India and the Philippines, so a local lawyer is worth an hour of fees.

What to watch next

• Through September 2027: the Philippines' SSS pension increases continue, with retirement pensions rising 10% each September. The September 2026 step-up reached about 3.8 million pensioners; the final one is due in September 2027.
• 2026-27 Philippine Congress: the Universal Social Pension Bill, which would extend at least P1,000 a month to all seniors, has cleared a House panel but still needs House plenary and Senate approval.
• Ongoing: Vay Vandana enrolment and claims data from the National Health Authority. Watch whether average claim values rise as older beneficiaries use the cover for larger procedures.
• December 2026: the World Bank's next migration and remittances brief, which will show whether health and care spending is pushing remittances to India and the Philippines to new highs.
• February 2027: India's Union Budget, the usual venue for changes to health-scheme funding and senior-citizen tax provisions.

Our view: public cover in both countries has improved enough that the catastrophic hospital bill is less likely than it was a decade ago. The real cost of caring from abroad is now the steady, unglamorous stream of wages, medicines and household bills, and the families who handle it best are the ones who treat it like a small payroll rather than a series of emergencies. For more on how remittances are actually spent, see what remittances pay for.

About this researchMuffinPay InsightsIndependent analysis of stablecoins, CBDCs, cross-border payments and digital public infrastructure. Every figure is linked to its source. Read our editorial standards →