Healthcare costs have risen unprecedentedly in Kenya since the recent past.
This is even more so to the seniors, especially those who have attained retirement age of 60 years, as the traditional individual health covers phase out or become prohibitively expensive as individuals hit 60–65 years.
Insurers have sat down and are now offering medical insurance for seniors.
These health insurance covers for seniors are tailored to their needs as we shall see in later on as we go through the most popular medical insurance covers for seniors.
When I talk of a senior, a senior, in this case, is typically an individual aged 55 to 80+.
In this write-up, I will evaluate the mandatory public framework alongside the top private health insurance options for seniors to find the best balance between cost and comprehensive care.
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Foundation: Public Cover via Social Health Authority (SHA / SHIF)
The national health fund moved from the long-standing NHIF to SHA/SHIF.
This move fundamentally changed how all citizens, particularly senior citizens, access and pay for medical care.
SHA is a mandatory public health cover, and it is no longer a voluntary cover like the old good days.
For senior citizens, the SHA structure organises care across standard facility tiers, levels 1 through 5, aiming to streamline chronic disease management and routine care through specialized funds.
Level 1, 2, and 3
Levels 1, 2, and 3, covers dispensaries, community health workers, and local health workers.
Under these 3 levels, the scope of senior benefits is free basic outpatient care through the primary healthcare fund.
What is covered include routine check-ups, basic diagnostics, and management of common age-related chronic conditions like hypertension and diabetes.
Levels 4 and 5
Levels 4 and 5 facilities include sub-county and county referral hospitals, alongside contracted mid-tier private facilities.
The scope of senior benefits under levels 4 and 5 include inpatient admissions, major/minor surgeries, and specialized services via SHIF.
Other benefits for seniors are capped allocations for oncology (cancer care), renal dialysis, and critical care infrastructure.
While SHA provides the basic public healthcare to senior, the cover is quite limited and it is designed to be so.
For a senior looking for seamless comprehensive and premium healthcare, they will need to turn to private medical insurance covers designed for seniors.
Relying exclusively on SHA introduces some notable limitations. They include:
- Strict referral system where you must start at lower-level facilities (levels 2 and 3) before getting authorization for specialist reviews or level 4 and 5 facilities admissions.
- Only a few select premium Tier I hospitals accept SHA since amounts allocated for certain treatments are by far inadequate, rarely covering the full cost of high-end private rooms or specialized consultants.
- Level 4 and 5 hospitals get congested most of the times. Senior looking for specialized treatments might face long waiting periods.
What to Look for in Senior Cover
Before settling on a particular health insurance for seniors, there are certain things you should focus on.
They include but not limited to the following:
- Maximum joining age and lifetime renewability. Check whether you are eligible and whether you can renew it for life after joining.
- Pre-existing and chronic conditions sub-limits. You should carefully check what amounts are allocated to conditions like hypertension, diabetes, arthritis, and newly diagnosed conditions and cancers.
- Waiting periods. This also of big concern to understand. Certain conditions, especially pre-existing and chronic conditions, might wait for up to 12 months before they are actively covered.
- Co-payment and deductibles. These are monies that you first pay before seeing a doctor or before your medical bill is paid. Certain medical covers for seniors remove these costs, especially the deductibles.
- Medical underwriting requirements. Most medical insurance covers for seniors include mandatory pre-entrance medical examinations before approval.
Now let us focus on the specific flagship senior products from Kenya top insurers.
Head-to-Head Comparison: Best Private Senior Medical Covers in Kenya
Britam Milele Senior Health Plan/Milele Elderly Parent
- Eligibility: Britam Milele Health Plan for the elderly is designed for seniors above the age of 55 years, with no maximum exit age.
- Key Strengths: The plan has 5 categories namely Platinum, Gold, Silver, Bronze, and Essentials. Platinum is the most premium and has no sub-limits (you can use all your cover amount on a single condition). Essential plan is very affordable making Milele Senior Health Plan one of the most affordable medical insurance covers for seniors. The plans come with high inpatient limits between KES 300,000 and KES 10,000,000, shared or unshared. The outpatient cover ranges from KES 30,000 to KES 200,000.
- Cover Scope: The plan offers comprehensive inpatient and outpatient care including dental, optical, psychiatric, rehab, organ transplant, chronic, congenital, and pre-existing conditions. You will also benefit from annual wellness check-ups and home nursing.
- Requirements: Entry age is between 55 and 80 years and if enrolled, it is for life. You must also be subjected to a medical test, but you will be exempted if from another medical scheme (proof is needed)
CIC Seniors Mediplan
- Eligibility: The joining age is between 60 and 80 years, and you renew for life once enrolled.
- Key Strengths: The inpatient limit is between KES 300,000 to KES 5,000,000 per family. The outpatient limit is between KES 50,000 to KES 200,000.
- Cover Scope: The plan offers inpatient and outpatient cover, including dental and optical limits. Conditions covered include pre-existing, chronic, and psychiatric.
- Requirements: Besides other minor requirements, you will be subjected to medical examination borne by you. Medical examination is waived from another scheme, but must provide proof.
AAR Seniors Caare Medical Cover
- Eligibility: The joining age is between 65 to 85 years. Once enrolled, renewal is for life.
- Key Strengths: The inpatient cover ranges from KES 500,000 to KES 10,000,000.
- Cover Scope: The plan offers inpatient and outpatient covers, including pre-existing, chronic and congenital conditions. The cover also includes newly diagnosed cancers, psychiatric treatment, dental and optical coverage.
- Requirements: Medical examination is required.
Jubilee J-Senior Health Cover
- Eligibility: The joining age is between 65 and 79 years.
- Key Strengths: The inpatient cover ranges between KES 500,000 to KES 10,000,000. The outpatient limit is between KES 100,000 to KES 200,000.
- Cover Scope: The plan offers inpatient and outpatient covers including dental, optical, annual check-ups, home nursing, chronic, congenital, pre-existing conditions, mental wellness and psychiatric care.
- Requirements: You will be subjected to medical examination, unless you are already covered under a private medical scheme. Proof is needed.
GA Insurance Hadhi Health Plan
- Eligibility: The joining age is 60 years and above
- Key Strengths: The inpatient limit ranges from KES 1,000,000 to KES 5,000,000.
- Cover Scope: Hadhi Health Plan covers newly diagnosed conditions, psychiatric, pre-existing, and chronic conditions.
- Requirements: Medical examination is required, if not currently covered under any private medical insurance scheme.
Comparative Summary Table For The Best Medical Insurance Covers For Seniors in Kenya
| Product/Insurer | Milele Senior (Britam) | Seniors Mediplan (CIC) | Seniors Caare (AAR) | J-Senior (Jubilee) | Hadhi Health Plan (GA Insurance) |
|---|---|---|---|---|---|
| Entry Age | 55 to 80 years | 60 to 80 years | 65 to 85 years | 65 to 79 years | 60 years and above |
| Inpatient Limit | KES (300,000 to 10,000,000) shared or unshared | KES (5300,000 to KES 5,000,00) | KES (500,000 to KES 10,000,000) | KES (500,000 to KES 10,000,000) | KES (1,000,000 to KES 5,000,000) |
| Chronic/Pre-existing | Covered | Covered | Covered | Covered | Covered |
| Unique Feature | Affordable plans-Very comprehensive-High inpatient limit-Renewal for life once enrolled | -Renewal for life once enrolled | -High Inpatient limit-Renewal for life once enrolled | -High inpatient limit | -Moderate inpatient limit |
How to Apply and Dos and Don’ts
- Be honest in disclosure. To avoid risk of cover cancellation or claim rejection, always disclose pre-existing conditions during enrollment/underwriting stage.
- Source well-documented medical history from your current primary physician before applying. This might help you skip another medical examination.
- Just know in advance that senior premiums rise sharply as the policyholder crosses age brackets. It is a reality, be prepared for it.
You are now in a position to make sound comparisons.
If you want a very comprehensive cover, yet very affordable in some plans, Britam Milele Senior Health Plan is a great choice.
It has a wide eligibility age range from 55 years up to 80 years and once you enroll, you renew for life.
Again, Britam’s most premium plan, Platinum category, removes sub-limits and you can exhaust all your cover in one condition.
CIC Mediplan also has a wide eligibility age from 60 to 80 years and is comprehensive as well.
Jubilee J-senior has a good inpatient limit of up to KES 10,000,000, but age eligibility is very high and narrow starting at 65 years to 79 years. Similarly so is AAR Senior Caare.
GA Hadhi also has a reasonable entry age of 60 years. If you do not mind the moderate inpatient limit of up to KES 5,000,000, it is a good cover. However, it is limited in scope as compared to Britam’s, CIC, and Jubilee senior plans
