‘Healthy, young’ but medical insurance premiums rise 25 percent in a year
‘젊고 건강한데’… 1년 만에 건강보험료 25% 급등
뉴질랜드 의료 시스템에 적응해오던 캐나다 출신 이민자 잭(Zac·가명)은 최근 건강보험료 인상 통보를 받고 적지 않은 충격을 받았다. 그는 본인의 보험사와 분쟁 중이어서 실명을 밝히길 원치 않았다.
잭은 뉴질랜드 최대 민간 건강보험사인 서던크로스(Southern Cross)의 울트라케어(Ultracare) 플랜과 추가 항암 치료 보장 옵션에 가입해 있다. 그는 “특별한 질환도 없는 건강한 젊은 성인인데, 보험료가 1년 만에 25%나 올랐다”고 말했다.
그는 뉴질랜드 이주 후 가장 놀랐던 부분 중 하나가 일반의(GP) 진료 한 번에 60달러 이상을 지불해야 하는 것이 ‘당연한’ 구조였다는 점이라고 했다. 이러한 공공 의료 체계의 한계와 진단 지연 우려 때문에 민간 보험에 가입했다고 설명했다.
하지만 그는 급격한 보험료 인상에 대해 사실상 대응할 방법이 없다는 점이 가장 큰 좌절이라고 말했다. “보험약관상 보장되는 항목임에도 청구가 거절된 사례도 있었다”며, “보험료 인상을 제한할 수 있는 감시 기관이나 정부 규제가 사실상 없다”고 지적했다.
건강보험료, 1년 새 최대 50% 인상 사례도
최근 몇 주 동안 RNZ에는 잭과 같은 민간 건강보험료 인상 사례에 대한 제보가 다수 접수된 것으로 나타났다.
컨설팅 업체 챗츠우드(Chatswood Consulting)의 러셀 허친슨은 “현재 대부분의 건강보험사들이 비슷한 수준으로 보험료를 인상하고 있다”며 “일부는 올해 최대 50%까지 오른 사례도 있다”고 말했다.
뉴질랜드 통계청(Stats NZ)에 따르면 소비자물가지수(CPI) 기준 건강보험료는 올해 9월 기준 전년 대비 약 20% 상승했다.
5년간 상승률은 62%, 10년간 114%, 15년간 200%를 웃도는 수준이다.
소비자 단체 Consumer NZ의 보험 담당 레베카 스타일스는 보험료 상승으로 인해 많은 가입자들이 부담을 느끼고 있다고 전했다. 특히 젊은 층의 해지가 늘면서 공공 의료 시스템 부담도 커질 수 있다는 우려를 제기했다.
의료비 상승·고령화·공공병원 지연이 보험료 인상 요인
서던크로스는 최근 연례보고서에서 고객들의 보험 사용량이 과거보다 크게 증가했으며, 이는 공공 의료 시스템의 수술 대기 지연 등의 문제와 맞물려 있다고 밝혔다.
서던크로스 최고고객책임자(CCO) 리건 새비지는 의료비 상승(메디컬 인플레이션)이 보험료 인상의 주요 요인이라고 설명했다.
“의료 산업은 신기술 도입, 사모자본 유입 등으로 갈수록 고비용·고기술 산업이 되고 있다.”
또한 가입자가 고령층으로 갈수록 질병 발병률과 의료 이용이 늘어나며 보험료는 자연스럽게 상승한다고 했다.
그는 보험 가입자가 “오랫동안 보험금을 청구하지 않았는데, 막상 필요해진 시점에 보험료가 오르는 것이 불합리하다”고 느끼는 경우가 많다고 인정했다. 그러나 “보험은 전체 위험 풀(risk pool)을 기준으로 가격을 산정하기 때문에, 젊고 건강할 때 저렴하지 않다면 애초에 가입자가 유입되지 않는다”고 설명했다.
60세 이후 보험료 급등… 월 800~1400달러 부담도
재무 상담사 팀 페어브라더는 보통 건강보험료는 40~50대부터 만성질환과 선택수술 증가로 가파르게 상승하기 시작한다고 말했다.
특히 60세 이후에는 관절 수술, 심장 시술, 암 치료 등 비용이 높은 의료 서비스 이용 빈도가 증가하면서 보험료가 급격히 오르는 경향이 있다.
현재 70세 가입자의 보험료는 월 800~1400달러 수준에 달할 수 있다고 설명했다.
서던크로스는 장기 가입자라면 수십 년간 납부한 보험료만큼 결국 혜택을 돌려받을 가능성이 높다고 주장했다. 보험 유지가 어려운 가입자는 공제액(Excess) 조정이나 보장 범위 축소 등 플랜 재조정을 통해 보험료 부담을 줄일 수 있다고 조언했다.
건강보험 가입자 135만 명… 보장 유지 방안 논의 필요
금융서비스협회(Financial Services Council)에 따르면 뉴질랜드에서 민간 건강보험에 가입한 사람은 135만 명이며, 2024년 3월부터 2025년 사이 가입률은 3.3% 증가했다.
협회는 직장 제공 건강보험에 대한 복리후생세(FBT) 폐지가 보험 접근성과 부담 완화에 도움이 될 수 있다고 제안했다.
‘Healthy, young’ but medical insurance premiums rise 25 percent in a year
Canadian migrant Zac says there has been a lot to get used to in the New Zealand healthcare system – but one thing he is struggling with is the increase in health insurance premiums.
Zac, who does not want to be named because of a dispute with his insurer, was shocked to be told that his Southern Cross premiums had increased 25 percent in a year. “I am a healthy young adult with no health conditions.”
He is on the country’s largest health insurer’s Ultracare plan, with an additional chemotherapy cover.
“The fear of having a terminal diagnosis or disease being missed or extremely delayed by New Zealand’s alleged universal healthcare system is what prompted me to take out private health insurance as soon as I was eligible. I’ve been a member of Southern Cross for over three years.”
He said he almost “fell off his chair” when he moved here and found it was normal to have to pay $60 or more to see a GP.
But he said he was frustrated at having no recourse for rising premiums. He had had claims declined that should have been covered by his plan, he said.
“There really is no watchdog and government authority that can impose and mandate insurance companies to cap their premium hikes.”
Zac is one of a number of people who have contacted RNZ about their health insurance premiums in recent weeks.
Russell Hutchinson, of Chatswood Consulting, said every health insurance was increasing premiums by a similar amount to what Zac has experienced. “Some of the increases have been 50 percent this year.”
Stats NZ data shows that health insurance premiums, as measured in the CPI, were up almost 20 percent year-on-year in September.
They are up 62 percent over five years, 114 percent over 10 years and more than 200 percent over 15 years.
Consumer NZ’s insurance specialist Rebecca Styles said people regularly got in touch with her organisation, expressing concerns about their premiums rising, and wondering how to keep their cover.
“As more people cancel – particularly younger people – it’s likely this puts more pressure on the public health system, and yes, it also means insurers are earning less and/or the risk profile of those insured goes up, which means they may increase premiums for those still insured to make up for the shortfall.”
Southern Cross noted in its latest annual report that it was experiencing a high volume of claims as customers used their health insurance “more than ever before”.
“This coincided with ongoing challenges within the public health system, including the accessibility of elective surgery.”
Southern Cross chief customer officer Regan Savage said there were several factors that drove premium increases.
He said medical inflation was one part of it, and this would usually increase at a faster pace than general consumer inflation. “The medical industry is, as you’d be aware, fueled by new technology and private equity capital and all sorts of things, which means that it becomes an increasingly expensive and very high tech business, which pushes up the cost.”
People would also pay higher premiums as they got older and their risk of claiming increased.
That increased by a small amount every year, he said.
“And then when we get to an older age band, then we rate that whole group of people together. I don’t want to go into the exact age cutoff we use because that’s getting into the realm of commercial sensitivity. But generally it goes up a little bit for every year that we age and we rate everyone in that age that year. And then it gets to a certain point in older years where we stop moving every year and we just rate everyone above that age in one group.”
He said one question he heard often was from people who had not claimed for years.
“[They say] ‘now I am claiming, but you’re putting the price up right when I need it the most’.
“And I think what’s really important to explain to people is that an insurance book is an entire risk pool. And if we don’t price it cheaper at the younger end, when people are less likely to need it, then they won’t come into the market and the insurers won’t have the customers and the customers won’t have the insurance when they do get older and need it.”
Tim Fairbrother, a financial adviser at Rival Wealth, said health insurance premiums would usually begin to rise in someone’s 40s and 50s as chronic conditions and elective procedures become more common.
“From age 60 onward, premiums increase sharply because of higher claim volumes and the cost of treatments like joint replacements, cardiac procedures, and cancer care.
“Costs for a typical 70-year-old at present range from $800 to $1400 per month depending on the type of product and excess that are applied, which also needs to be taken in the context that this person shouldn’t need any income protection or life insurance.”
People who took out cover young would have protection for conditions they developed through their lives, Savage said.
“We want them to be able to hold on to that cover for as long as possible. And that’s where looking at your plan and looking at your excess comes into the mix.
“It is true that you pay more as you get older, but if it had never been an affordable, reasonable product for you when you were young and relatively healthier, you probably never would have taken it out in the first place. So we believe that the age weighting is a more equitable way of managing the pricing.”
He said people who were struggling with premiums could talk to their insurer or adviser about what changes could be made.
“We have a range of products that people can consider where you can have a full comprehensive suite of benefits that includes all your surgical, but also things like vision and dental.
“Or you can dial it back to a much more surgically focused plan and potentially that might have co-pay on it. So you would pay a percentage of all of your bills … or an excess.”
He said he had seen more people adding excesses to their policies, which could reduce their premiums.
Savage said most people who had been with Southern Cross a long time would end up claiming what they had paid in premiums over a couple of decades.
The Financial Services Council said 1.35 million New Zealanders have health insurance, and cover increased 3.3 percent between March 2024 and 2025.
It said removing fringe benefit tax for employers who offered it to staff would help improve affordability.