“Health insurance becomes more inaccessible precisely when you need it the most,” explains José Luis Fernández Santillana, president of the Spanish Confederation of Organizations for the Elderly (Ceoma), regarding the high prices that companies apply to people over 65 years old. These prices almost triple those paid by 40-year-old users, with an additional cost of about 100 euros per month, bringing the monthly payment for these insured individuals to around 180 euros."
Health insurance has become essential for many people due to “the decline in the quality of public healthcare, especially since the pandemic,” acknowledges Rubén Sánchez, general secretary of the consumer organization Facua. According to data from the insurance employer's organization, Unespa, in Spain there are 12.4 million people with private health insurance, which represents 25.8% of the population. Of these, 1.8 million have taken out their policy since 2020. This is despite the fact that during this period, the average premium in the sector has increased by 50%.
“In public healthcare, long waits for diagnostic tests and results are common, whereas in private insurance everything can be resolved within a couple of weeks,” Fernández Santillana recalls. That is why, he explains, “elderly people end up paying the increase in premiums, even at the expense of reducing their leisure expenses or other items.”
Insurers argue that the increase in premiums based on age is due to technical criteria, similar to those applied in car or home insurance: customers who have a higher risk pay more. According to Rubén Sánchez, “since everyone is covered by public health care, insurance companies are not obliged to provide universal service, and if they consider a person to be high-risk, they can charge whatever price they want or even refuse to insure them.” In fact, many companies do not accept clients over 65 or 70 years old, and some not only raise premiums for those who are older but may also unilaterally decide not to renew their policy if they have incurred significant expenses. This fact represented 5% of the claims received by the General Insurance Directorate in 2022.
Many insurance companies do not accept older clients or they drop them if they generate too much expenses
Laureano Molins, head of the Thoracic Surgery Department at Hospital Clínic and Teknon Medical Center in Barcelona, stated that he often encounters patients who are distressed because they fear losing coverage from their private insurance and not being able to access the doctor who has treated them during their illness. “If a person has been paying premiums for 40 years and generating profits for the company, it is incredible that they can be kicked out or subjected to abusive premium increases so that they do not renew their policy,” he says. In his view, companies “which are large groups with huge profits and assets” should commit to not raising premiums for those over 65 more than they do for other clients, or only by the rate of inflation.
The senior citizens associations are asking the Government to be sensitive and to recover the tax deduction for them
Indeed, however, some insurers have tried to grow using a business strategy offering a single premium without age discrimination, but they have had to give up: they attracted older customers, who spend more and cause losses to the company, while they did not attract young people because they found cheaper premiums in other companies with variable rates based on age.
Difficulties in accessing health insurance are set to increase in 2025: companies have announced premium increases of between 10 and 15% to their customers, the highest in the last decade. A spokesperson for the IDIS Foundation, an institution that brings together insurers and private healthcare companies, pointed out that the rise is a response to “the increasing health costs in an environment where we have an increasingly aging population and continuous advances in innovation and medical technology” which raise the cost of treatments. Thus, he explains, private hospitals and insurance companies have to adjust their fees “to continue guaranteeing broad coverage and quality services.” IDIS notes that the insurance usage rate has also increased, so that “in many cases, it is not used as supplementary coverage to public healthcare, but almost as a substitute.”
Better prices with fewer coverage
The high prices of health insurance, with an average premium of around 80 euros per month, have led companies to seek ways to make it more affordable, but at the cost of reducing coverage or requiring the policyholder to make a copayment for each medical procedure. Many insurers have therefore launched low-cost insurance plans that cover visits to a general practitioner and specialists, but not surgical interventions or hospitalizations. This option appeals to many young people who seek advice from dermatologists, gynecologists, psychologists, nutritionists, or physiotherapists. Another option is insurance plans with copayments, where the policyholder must pay between 10 and 20 euros for a medical appointment, and around 50 euros per day of hospitalization. However, the coverage is comprehensive, and many mutual insurance companies guarantee a maximum annual copayment limit, which can be as low as 300 euros.
Hospital groups are also facing an increase in personnel costs: a shortage of doctors and nurses forces them to pay more to retain them. Furthermore, the establishment of large hospital groups, which reduces competition in some provinces, has led to price increases that in turn put pressure on insurers' accounts.
Therefore, although insurance companies generated €11.238 billion last year – 6.6% more than in 2022 – the cost of healthcare services provided to their clients consumed 95.64% of this amount, leaving them with very slim profit margins in the end.
Can policyholders oppose price increases? The spokesperson for Facua points out that insurance policies are annual and renewable, so the company can apply whatever increase it wants and only needs to give notice two months in advance. In fact, older clients have little choice but to accept, as Dr. Molins reminds us, since they will hardly find another insurance provider: many companies do not accept older clients, and those that do often exclude pre-existing conditions from their coverage.
Companies claim that health costs have skyrocketed: they represent 95.6% of their premium income
Fernández Santillana demands the government to show “more sensitivity” towards the economic effort that elderly people make to pay for their insurance, and the relief it provides for the public healthcare system when they do not use its services. That's why the president of Ceoma demands that at least for this group, the tax deduction in the IRPF that was eliminated in 1998 be reinstated.
