Expert comments on medical insurance system in Armenia 

ArmInfo.  Our government has been working for the past 5-6 years to implement a COMPREHENSIVE health insurance system in the country (which is highly welcome), but since it turned out to be limited in coverage (not only in terms of  coverage but also in terms of reimbursement of service costs), it was  decided to change the title of the bill to "On Universal Health  Insurance" (which is certainly more honest :)): (The author's style  and punctuation have been preserved - ed.).  Haykaz Fanyan, head of  the ACSES analytical center, shared his assessment.

The expert posted a table on his Facebook page showing the systems of  15 EU countries, along with their key performance indicators. In  countries with a similar system, which will be implemented in Armenia  starting January 1, 2026 (Estonia, Lithuania, and Poland, ranked 8th,  12th, and 13th), beneficiary satisfaction is estimated at 63%, 51%,  and 51%, respectively.

However, in the Netherlands, which has a mandatory universal  healthcare system managed by the state and supplemented by private  insurance companies, every resident is required to have basic health  insurance (Zorgverzekeringswet). Long-term care is covered by  separate insurance (Wet langdurige zorg). Here, the citizen  satisfaction rate is estimated at 83%.

"Insurance in the Netherlands is also mandatory, provided through  numerous private insurers, which, in my opinion, is the most optimal  way to limit numerous and varied risks," Fanyan wrote.

Germany tops the ranking (with 85%), with a dual health insurance  system: mandatory public insurance (GKV), which covers approximately  90% of the population, and private insurance (PKV). Mandatory  insurance is financed by wage contributions (shared equally by both  the employee and the employer), while private insurance is  individualized.  Regardless of the type of insurance, every resident  is required to have health insurance.

"It is regrettable that since January 5, 1992, the establishment of a  market economy in Armenia, such a massive step back to a model  characteristic of an administrative-command economy has been taken,  where the state [a quasi-state fund] would determine the price of any  service that is not, by its nature, a natural monopoly," concludes  Haykaz Fanyan, promising to present a policy brief on the topic in  December.

As a reminder, on November 13, the Armenian government adopted a  written resolution "On approving and recognizing as urgent the draft  law "On Universal Health Insurance" and related laws." Thus, the  first stage will begin in January 2026. The system will be  implemented within three years. By 2028, the entire population of  Armenia should become beneficiaries of this system. The state  procurement system will gradually transition to compulsory health  insurance. Until then, those who used the state procurement system  will continue to do so.

In the first stage, the compulsory health insurance system will  include children under 18, individuals aged 65 and older (even if  employed), individuals with disabilities aged 18 to 65, and members  of socially vulnerable families. The state will fully cover the  health insurance coverage for these categories of citizens.  Citizens  with a monthly income of over 200,000 drams will pay for their own  insurance. Overall, the first stage plans to reach 1.6 million  beneficiaries (citizens of the Republic of Armenia who have resided  in the Republic of Armenia for more than 183 days).

Able-bodied citizens who are unemployed and do not belong to special  social groups will not yet receive insurance, but in the future, it  is planned to require them to pay for their own insurance. "In the  future, we intend to establish this procedure, requiring them to pay  contributions even if they are unemployed." "This is consistent with  our policy of stimulating employment," Health Minister Anahit  Avanesyan stated at a cabinet meeting on November 14.

In 2026, the insurance will cover the most in-demand services,  including outpatient services, clinic visits, family doctor visits,  specialist consultations, and laboratory tests (a certain number per  year). The list of services will be expanded and refined, covering  certain surgical procedures, including ophthalmological (cataracts),  cardiovascular, and others. Annual medical examinations will be  mandatory under the system.

Compensation will apply to certain types of medications (based on the  active ingredient, not the manufacturer). If citizens wish to  purchase a more expensive medication, they will be required to pay  extra.  If an ambulance transports a patient to the hospital and they  receive inpatient treatment or surgery, this will also be reimbursed  up to a certain amount (if the compensation is insufficient, the  patient will pay the difference). In the future, coefficients will be  established that will reduce state payments for citizens who abuse  tobacco and alcohol. If, after calling an ambulance and undergoing an  examination, the patient is not referred for hospitalization but  nevertheless decides to undergo treatment, they will be referred to a  clinic for testing. The tests will be covered by insurance, but the  patient will be responsible for paying for hospital treatment.

The system will automatically check people and automatically include  beneficiaries. They will then receive an invitation to become  beneficiaries of the system through the Armed eHealth e-health system  (or through their local doctor).

The base cost of an insurance policy in 2026 will be 129,600 drams  (10,800 drams per month), compared to 164,000 drams a year ago  (naturally, the policy coverage has been reduced compared to the  initial draft).  Part of this amount will be offset by payments to  the Zinapa Military Insurance Fund. These payments, increased in  2021, are now returning to their previous level of 1,000 drams,  regardless of salary.

Specifically, individuals with salaries between 200,000 and 500,000  drams will be able to reduce their monthly Zinapa premium from 5,500  to 1,000 drams. The 4,500 drams saved can be used to pay for health  insurance. Additionally, when filing their income tax return in 2026,  they will be able to receive an additional 6,000 drams per month (as  a tax deduction). For citizens with salaries between 500,000 and 1  million drams, the Zinapa contribution will also be reduced to 1,000  drams (from 7,500), allowing them to redirect 6,500 drams toward  insurance (in 2027, they will be able to receive a 4,000 drams  monthly refund).  Individuals earning over 1 million drams will be  able to file their income tax return in 2027 and receive a 4,000  drams monthly refund. The insurance payment will be made by a tax  agent, meaning it will be deducted from wages in the same way as  income tax, social security contributions, and other taxes.

A state fund will be created to manage the health insurance system.  It will operate under temporary management for three months, after  which a state selection committee will form its board of directors  (which, as stated in the Concept for the Implementation of Compulsory  Medical Insurance, will be chaired by the Minister of Health).

The 2026 budget allocates 127 billion drams for the implementation of  the health insurance system.