PETALING JAYA: The Federation of Malaysian Consumers Associations (Fomca) has sounded the alarm over surging private health insurance premiums, adding that many elderly Malaysians are being priced out of protection just when they need it most.
Its CEO Dr Saravanan Thambirajah said premiums for policyholders over the age of 60 have surged two to threefold in the past two years, in some cases rising as much as 300%.
“Many retirees who have maintained their policies for decades are now forced to surrender them. Some even sacrifice their own coverage so their children could remain insured.”
He said the trend is deeply worrying, as seniors feel they are being “punished simply for growing older”.
He added that Fomca has seen a growing number of complaints about delayed or rejected claims, excessive red tape and insurers overriding the recommendations of doctors.
“When medical decisions are dictated by administrators instead of doctors, the system has failed.
“Some seniors even find it cheaper and less stressful to pay out-of-pocket than to use their insurance.”
He welcomed the government’s Reset initiative, a multi-agency effort led by the Finance Ministry and Health Ministry to address medical inflation and rising private healthcare costs.
The initiative brings together private hospitals, insurers and consumer advocates to address the root causes of cost escalation and to design a fairer, more transparent healthcare system.
“Medical cost inflation cannot be addressed in isolation. It requires structural reform across both public and private sectors.”
He said under the Reset framework, the government is drafting a long-term plan to reform cost structures, co-payment systems and pricing models, with Finance Minister II Datuk Seri Amir Hamzah Azizan announcing plans for a new insurance-based health product by the end of 2026.
“These reforms are complex and would take time, but they are essential to restore balance and trust in the system.”
He also highlighted the lack of transparency in premium hikes, adding that insurers often blame “rising medical inflation” without providing clear justification.
“Renewal letters are filled with technical jargon but rarely explain why the premium of a senior has doubled or tripled.
“When consumers ask for clarification, they are trapped in endless calls and emails that lead nowhere.”
Saravanan added that the complaint and appeal process for rejected claims remains cumbersome, especially for elderly policyholders who struggle with digital systems.
While the Financial Mediation and Ombudsman Scheme (FMOS) and Bank Negara Malaysia provide official redress channels, accessibility remains limited.
“Fomca call for for a simpler, more senior-friendly complaint mechanism, one with clear timelines, fewer technical barriers and proactive support for elderly claimants.”
The consumer group is also calling for an urgent overhaul of health insurance products to ensure affordability, fairness and transparency, particularly for senior policyholders.
He also said insurers should proactively reach out to seniors who have dropped their policies due to high premiums and offer them reactivation opportunities once reforms take effect.
He emphasised the need for transparent hospital pricing, adding that the Reset initiative must include standardised tariffs and benchmarks to curb arbitrary billing and unnecessary procedures.
“If medical inflation is stabilised, those savings must be passed back to consumers through lower premiums and sustainable benefits.”
Saravanan reminded Malaysians, especially seniors, that they have the right to fair and affordable coverage.
“Health protection should not be a privilege that disappears with age.
“If your premium has skyrocketed or your claim was unfairly rejected, demand transparency and take your complaint to FMOS or Bank Negara.”
He said insurers must remember that their long-term sustainability depends on consumer trust.
“You cannot call it ‘protection’ if people are forced to drop out when they need it most.
“Malaysia’s elderly deserve dignity, not exclusion. The system must protect them, not punish them, for growing old.”
