Elderly medical insurance critical but underused

Healthcare infrastructure remains heavily concentrated in urban centres, limiting the utility of medical insurance for those who retire in rural areas

BUSINESS FEATURE | ISAAC KHISA | Uganda’s insurance industry is tiptoeing into one of the country’s most neglected frontiers – medical cover for the elderly. The move, long overdue, marks a subtle but significant shift in how the country is beginning to think about ageing, healthcare, and financial security.

In recent years, insurers such as Jubilee, GA Insurance, and ICEA Lion Assurance have begun to roll out policies aimed at shielding senior citizens from the financial shock of illness. The products, ranging from basic outpatient care to comprehensive inpatient and chronic-disease coverage are designed to protect those who have outlived their working years but not their medical needs.

But despite innovation in product design, uptake remains strikingly low. Uganda’s insurance penetration stands at under 1% of the Gross Domestic Product, among the lowest in Sub Saharan Africa.For the elderly, the figure is negligible.

Few elderly people see insurance as a safety net; fewer still can afford the premiums. Five percent of the country’s 45.9 million people (about 2.3 million citizens) are aged 60 or older. However, their ranks are set to swell sharply over the next three decades, according to the Uganda Bureau of Statistic’s National Population and Housing Census 2024.

Life expectancy, now hovering around 68 years, has risen steadily thanks to improved healthcare. But longevity has come with an expensive downside. The elderly are increasingly burdened by non-communicable diseases such as; hypertension, diabetes, and cardiovascular complications that demand long-term, and often costly, medical care.

“Medical insurance costs may appear substantial, but the principle of insurance is about numbers,” says Maurice Amogola, a veteran insurance consultant and former chief executive at Minet Uganda, an international insurance broker.

“The problem is that we only start thinking about risk when it is already at our door. We plan for sickness when it has already arrived.”

Amogola’s observation cuts to the heart of a cultural paradox: in much of Africa, families still regard caring for the elderly as a moral obligation rather than a financial decision.

Insurance, by contrast, is seen as both foreign and transactional; a product rather than a principle. “We have not fully trusted insurance as a social safety tool,” Amogola says. “It is still seen as something for the rich. But those who need it most are retirees and elderly managing very limited incomes.”

Cultural calculus of risk

Resty Nakwanyi, the Assistant Medical Manager at GA Insurance, sees this mistrust play out daily.

“Our people are yet to embrace medical insurance for the elderly,” she says. “They usually want to buy a policy when a loved one is already in the hospital and medical bills are overwhelming. But insurance is meant for protection; you are covered before the crisis arises.”

She adds that many potential clients are discouraged by “waiting periods” built into insurance contracts, which delay coverage until a certain time after purchase. “Once they hear they must wait three to six months before benefits apply, they walk away,” she says.

The misunderstanding reflects both low insurance literacy and the sector’s failure to communicate its long-term value. Many Ugandans associate insurance with bad experiences such as claims disputes, opaque terms, or unresponsive service rather than the concept of shared risk. As a result, even when products exist, trust remains elusive.

Premiums for elderly health cover typically range from Shs 1.7 million (US$460) for a basic annual plan to Shs 7 million (US$ 2,000) for a comprehensive family package, depending on household size and coverage. For a retired teacher or small-scale farmer, these sums can easily exceed annual income.

Arithmetic of ageing

Emmanuel Mwaka, the Chief Executive Officer at ICEA Lion Life Assurance Uganda, believes that the solution to medical insurance for the elderly lies not in discounting premiums but in changing habits.

“Most elderly people have wealth tied up in land or houses, not cash,” he told The Independent in an interview. “That means they struggle to meet regular insurance payments.” To bridge that gap, Mwaka says ICEA Lion has introduced long-term savings and pension-linked insurance products, allowing individuals to accumulate funds during their working years.

“We’re walking people through a journey of financial security,” he said. “When you build savings and later convert them into an annuity, you secure lifetime income. When that is paired with medical insurance, you can access healthcare without drawing directly from your pocket.”

Mwaka says this is one of the few visions of financial continuity, but one constrained by the country’s economic realities. Uganda remains overwhelmingly rural, with roughly 80% of citizens living outside urban centres. Health infrastructure, too, is heavily urbanised. Many rural districts lack quality hospitals or specialists, limiting the usefulness of even the best insurance plan. “The more we expand medical facilities into rural districts, the more practical and affordable medical insurance becomes,” Mwaka argues.

The Ministry of Health estimates that 1.4 million elderly Ugandans require health services annually. But the system is ill-equipped to cope. The country faces a shortage of health workers, estimated at 30–60% below requirement, alongside chronic underfunding.

Only 15% of total health expenditure comes from government; households bear about 41%, much of it out-of-pocket. The result is a health system that too often pushes people into poverty precisely when they need care the most.

Poverty, tradition, and the price of survival

Uganda also remains among the world’s poorest nations. Roughly 7.3 million Ugandans—nearly one in six citizens—live below the absolute poverty line, defined as earning less than US$1 per day, per person, according to the Uganda National Household Survey 2023/24, and poverty is most acute in rural areas, where subsistence farming dominates. Here, most elderly citizens reside—on small plots, with little cash income, and limited access to medical services.

For the old, poverty is not abstract but physical. The cost of a blood test, the price of a boda-boda ride to a clinic, and the humiliation of being turned away for lack of payment are real. Many struggle to afford even the most basic medicine.

Numerous studies point to a host of obstacles beyond poverty itself: long distances to health centres, few caregivers, and sometimes, the indifference or even abuse of overstretched health workers.

“Medical insurance for the elderly should not be viewed as a luxury,” says Mwaka. “It’s a necessity; a foundation for dignity and stability in old age. When we invest in protecting our seniors, we strengthen the very communities that raised us.”

But investment requires trust and coordination. The government’s proposed National Health Insurance Bill, first drafted more than a decade ago, has stalled repeatedly in parliament. Without it, Uganda remains one of the few East African nations without a national health insurance framework.

Regional and global lens

Elsewhere in Africa, progress has been uneven but encouraging in the provision of medical insurance for the elderly population.  Currently, South Africa appears to offer the most advanced model, combining public and private systems that provide both universal and specialist coverage.

Kenya has a national health insurance scheme known as Social Health Authority, besides private schemes such as Britam’s Afya Tele micro-insurance, which have shown that affordability and flexibility can draw in lower-income groups, including the elderly.

Ghana, too, offers lessons. Its National Health Insurance Scheme (NHIS), launched in 2003, provides free cover for citizens aged 70 and above—a policy that has dramatically increased healthcare access for seniors, even if service quality remains patchy. These examples suggest that universal systems and private insurers can co-exist effectively when policy frameworks are coherent and public trust is nurtured.

Outside Africa, the models are even more instructive. Japan’s Long-Term Care Insurance (LTCI) system, introduced in 2000, funds subsidized care services for citizens aged 65 and above, financed jointly by taxes and premiums. In the United States, Medicare covers hospital and medical costs for elderly, supplemented by private insurance to fill coverage gaps. Both systems rely on scale, regulation, and a culture of contribution that Uganda has yet to cultivate.

Emmanuel Ainebyoona, spokesperson for Uganda’s Ministry of Health, says the government remains committed to creating a sustainable health-financing model, even if progress has been slow.

“As our population ages, the need for sustainable financing has never been greater,” he says. “Medical insurance provides families with a safety net and ensures older persons receive care when they need it most.”

He insists that the ministry continues to push for the passage of the long-delayed revised National Health Insurance Bill, arguing that it will anchor both private and public efforts under a unified framework. The bill proposes that all Ugandan adults contribute Shs 15,000 (approximately US$4.20) annually, with the government covering the cost for those classified as poor.

But even with a legal framework, execution might  be uphill. Uganda’s tax base is narrow, and fiscal space is constrained. Expanding elderly health coverage will depend on innovative financing, perhaps through public-private partnerships, mobile-based micro-insurance and community-based pooling schemes.

Technology and trust

Industry experts say digital innovation offers a rare bright spot. They say that with mobile penetration now above 70%, insurers are experimenting with digital platforms that allow customers to pay premiums, access policy details, and make claims via mobile phones.  Such tools, they argue, could bring insurance within reach of rural households long excluded from formal financial systems.

Still, awareness remains a formidable barrier as a good percentage of Ugandans do not understand how insurance works. “People need to start saving for medical insurance at a young age,” Amogola argues. “If you begin at 30, by 50 you can have sufficient funds to cover healthcare costs in retirement.”

He advocates for flexible, lifelong policies that can be passed to beneficiaries, ensuring value even if the policyholder dies early.  “Insurance should be embraced, not feared,” he says.

Uganda’s demographic profile remains youthful, with over 70% of its people under 30, but the greying of the population is underway in the next three decades. As life expectancy rises and fertility declines, the ratio of health workers to retirees will also narrow. Without preparation, the country risks a double crisis: overburdened families and an overwhelmed health system.

The latest UN World Population Prospective warns that the number of adults aged 65 years or older in Sub Saharan Africa will rise from 41 million in 2025 to 103 million in 2050. In Uganda, that would mean over six million elderly citizens, many without formal pensions, savings, or insurance.

The implications, industry experts say, go beyond healthcare. An ageing population, if neglected, can drag on productivity, deepen intergenerational inequality, and strain public resources.  But if managed wisely through preventive healthcare, financial inclusion, and targeted insurance, the elderly can remain active participants in economic and social life.