Many Kenyan retirees are one serious illness away from financial ruin. Rising medical costs, inadequate insurance cover and uncertainty surrounding the Social Health Authority (SHA) breadth of cove and availability of services have left the country’s ageing population dangerously exposed. There is a frightening truth that many Kenyans in formal employment discover only after leaving work – the moment you retire is often the moment you lose access to affordable healthcare.
For decades, employer-sponsored medical insurance shields workers from the true cost of treatment. Consultations, medication, medical tests, specialist care and hospital admissions are largely absorbed by corporate insurance schemes. Healthcare may appear manageable because the employer carries much of the financial burden.
Then retirement arrives. The medical card is withdrawn at precisely the stage of life when healthcare needs may be increasing. The retiree must now pay for treatment personally or purchase private medical insurance at a time when regular income has fallen – and when premiums are at their highest.
This is the contradiction at the heart of retirement in Kenya – the older you become, the more healthcare you may need, yet the less affordable it becomes. According to the Retirement Benefits Authority’s 2024 pensioners’ survey, 77 per cent of retirees were financing their medical care through out-of-pocket payments. For most of those interviewed, health and medical care were among their greatest concerns. This should alarm us. It means that many retirees are paying hospital bills directly from pensions, savings or family support, often without any meaningful protection against a major medical emergency.
For many, this reality arrives with shocking speed. A person who spent thirty or fourty years in stable employment suddenly discovers that managing one serious illness can consume most, if not all, of their retirement income. Savings accumulated over decades can disappear during a single hospital admission. This is the contradiction at the heart of retirement in Kenya – the older you become, the more healthcare you may need, yet the less affordable it becomes. According to the Retirement Benefits Authority’s 2024 pensioners’ survey, 77 per cent of retirees were financing their medical care through out-of-pocket payments. For most of those interviewed, health and medical care were among their greatest concerns. This should alarm us. It means that many retirees are paying hospital bills directly from pensions, savings or family support, often without any meaningful protection against a major medical emergency.
The emotional impact of this change is equally profound. While retirement is supposed to offer a measure of security after years of work and contribution to society – many retirees live with a quiet but persistent fear: what will happen if I become seriously ill? This fear is not irrational. Across Kenya, many retirees are one diagnosis away from financial crisis. Public health financing reforms were expected to offer greater protection, but the transition to SHA has created uncertainty for many Kenyans. Although universal health coverage remains an essential national goal, retirees cannot yet be confident that the current system will protect them adequately when they face major or prolonged illness.
Consequently, those who can afford it turn to private medical insurance. Here, however, they encounter another harsh reality. Medical insurance for people over sixty is available, but often at a steep price. The application process can involve extensive medical assessments, including blood tests, cardiac examinations and chest X-rays – medical tests for which even the applicants are at a loss why every test is necessary or how the results will affect their cover.
Even after passing through the demanding medical tests process, retirees may discover that the protection offered is far from comprehensive. Premiums are high and can rise sharply each year. Pre-existing conditions may be excluded or subjected to waiting periods. Certain treatments are capped, outpatient benefits may be limited, and some policies become increasingly restrictive as the policyholder grows older.
The irony is impossible to ignore. At precisely the point when health risks increase, insurance becomes more expensive, more restrictive and more difficult to obtain. This leaves many retirees dangerously underinsured or completely uninsured. When serious illness strikes, the consequences extend far beyond the individual. Families organise emergency WhatsApp fundraisers. Adult children become caregivers and financiers overnight. Property and investments are sold, while savings meant to support an entire retirement are exhausted in hospital corridors.
A health emergency does not simply affect the retiree. It can destabilise an entire family. Yet despite the scale of this crisis, Kenya still approaches retirement without a sufficiently holistic conversation about ageing. Much of the national discussion focuses on pensions and income – and rightly so – but retirement security cannot be measured by income alone. It must also include access to affordable healthcare, long-term care and support for older people who can no longer live independently.
Kenya urgently needs a national health protection framework specifically designed for older people. Retirees should not enter old age completely exposed to commercial insurance forces. The government should explore subsidised medical schemes for senior citizens, tax-supported elderly healthcare funds and public-private insurance partnerships offering affordable, age-appropriate and comprehensive cover.
Such programmes must be transparent and easy to access. They should protect retirees against catastrophic medical costs, cover common age-related health needs and avoid unfairly excluding people simply because they already have a medical condition. Growing older should not become a penalty in the healthcare system.
Employers can also play a greater role in preparing workers for the medical realities of retirement. Many employees leave the workplace having received some pension guidance but little preparation for what healthcare will cost once employer-sponsored cover ends. Retirement preparation programmes should therefore include practical guidance on medical insurance, long-term care, health savings and the likely cost of treatment in later life. Employers should also be encouraged to offer phased post-retirement medical support, negotiated group insurance or schemes that allow workers to retain some form of cover after leaving employment.
Most importantly, preventive healthcare must become a central pillar of retirement planning. It remains largely absent from Kenya’s retirement conversations. There is no doubt that individuals have a responsibility to adopt healthier lifestyles and protect their health span – the years they live in reasonably good health. But personal responsibility alone is not enough. Kenya needs a stronger national culture of prevention across all ages, promoting regular screening, good nutrition, physical activity, mental wellbeing and the prevention and early management of lifestyle-related conditions long before retirement begins.
Preventive healthcare is not only good for individuals; it is also good public policy. Kenya must begin preparing seriously for the realities of an ageing population. More people are living longer, spending more years in retirement and requiring sustained medical and social support. Yet our healthcare and retirement systems have not adapted fast enough.
The uncomfortable truth is that Kenya is ageing faster than its institutions are preparing. Unless we act now, millions of hardworking Kenyans will discover too late that the greatest risk in retirement is not simply whether they saved enough money. It is whether they can afford treatment when illness strikes.
That is the silent healthcare crisis facing Kenya’s retirees -and it is a conversation the country can no longer afford to postpone.
Dr. Kaendi Munguti is a certified retirement and transition coach and is the Founder and CEO of Reinvent RetireMINT