What are the Best Ways to Reduce a Medical Aid Premium?
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Frequently Asked Questions: 11 Ways to Reduce a Medical Aid Premium
1. How can I lower my medical aid premiums without affecting the benefits?There are several strategies you can consider when looking at reducing your medical aid cost. You can switch to a cheaper hospital-only benefit plan or consider a plan with co-payments on day-to-day costs. Plans using networks of providers are generally cheaper, and some have premiums based upon your income. Please use us for professional advice before you switch!
2. What are the advantages of joining a hospital-only benefit plan and self-funding day-to-day costs?
This is an option to consider if you have low out-of-hospital claims. A hospital plan has lower premiums than a comprehensive plan, but it still covers your area of highest medical cost risk - private hospitalization. Fedhealth’s flexiFED plans are ideal for this.
3. How can I protect myself from high dental treatment costs?
Dental treatment is costly, and most plans offer in-hospital dental treatments. For out-of-hospital routine treatment like check-ups, fillings, root canal, and crowns, a dental insurance plan can help. It is totally separate from a medical aid and pays you on the occurrence of a listed event.
4. What are GAP or top-up insurance plans, and why are they important?
GAP or top-up insurance plans are an important safety net, bridging the difference between medical scheme rates and private providers' charges – which can be up to 5 times the medical aid rate. They cover shortfalls with hospital claim shortfalls and procedure co-payments. If you choose to join a cheaper plan, with lower benefits, a Top Up plan is vital.
5. What are network provider plans?
When a medical aid plan uses network hospitals and providers, they can negotiate cheaper fees. This is passed onto you as a member through lower premiums. Most networks use private providers and if they are close to you, and you are happy to use them, then network plans have value.
6. How can I get help in understanding the benefits of a medical aid and make sure I will always have support when I need it?
We offer you professional help with any aspect of medical aid. At no extra cost!
Simply use/appoint us as your broker, and you have expert guidance and support for your specific medical aid needs.
11 Simple Ways to Slash Your Medical Aid Costs!
Are you, like so many medical scheme members, finding it tough to meet your premium payments?
Maybe you feel you can't afford to keep paying for your plan and need to consider a cheaper medical aid?
Here are some ideas you can consider to make your medical aid premium more affordable.
There are so many schemes and plans option available, so much technical wording and a lot of confusing information available,that you must use an Independent Medical Scheme Broker!
And I can help you AT NO COST!
We all face 4 main financial risks with our medical costs:
- Private hospital care
- Dental treatments, whether in or out of the hospital.
- Everyday expenses like medicines, (which you may be able to self-fund through your own savings plan.)
- Chronic medication costs
To keep premiums affordable, many members are downgrading to lower benefit and cheaper plans.
(Remember, the greater the benefits of a plan, the higher the costs. Read this...)
Most schemes offer members the option to move to a lower plan during the year and many are considering options that:
- have no safety net when savings are used,
- have smaller day-to-day medical savings funds
- have only in-hospital benefits - where they self-fund day-to-day expenses - but keep the same private hospital cover,
- are entry-level plans offering basic hospital and essential day-to-day benefits.
- have income-related premiums.
But, never be without private healthcare hospital cover!
If you are on a tight budget, you may have no option, but to reduce your contribution.
However, please try to consider other areas of cost saving before you consider changing your medical scheme.
Options to reduce your premiums.
- Switch to a cheaper plan ( hospital only plan) and self-fund your out of hospital costs.
- Join a plan with co-payments that reduces your premium.
- Consider fewer dependants, by placing them on their own plans, which you can pay still for.
- Change to a cheaper network plan, where you use specific providers.
- Join an income-based, premium plan.
- Opt out completely and use state healthcare facilities (not recommended!)
Most important of all - get professional advice before doing anything!
Is a hospital only benefit plan with your own day-to-day savings a good idea?
If you can self-pay normal day-to-day medical expenses, such as GP visits, consider an in-hospital benefit only plan. It's cheaper and still covers big medical bills!
You must cover private hospitalisation. for without it you are in trouble having to use state care!
Dental work can be pricey, especially things like wisdom teeth removal.
Consider getting a Dental Insurance Plan, to help with unexpected costs.
By insuring for these two areas of high risk and self-funding the balance of your day-to-day costs, you will have an affordable plan that gives you confidence that unexpected high costs will not bankrupt you!
Why you should consider joining a private hospital plan...
- Guaranteed hospital admission with no co-payments!
- Hospital ward, theatre fees and other providers costs paid.
- ICU and day clinics benefit.
- In-hospital doctors and specialists covered.
- Some procedures in a GP room are paid!
- Cancer, Stroke, Organ transplant cover!
- Chronic illness benefits!
- Emergency help!
Some schemes also offer:
- casualty expenses.
- post-hospital benefits.
- the ability to upgrade to a higher plan if you suffer a defined life-changing event!
You can join a cheaper, lower benefit plan, safe in the knowledge you can upgrade your cover should you need to.
Many happy medical scheme members have only in-hospital benefit plans, as they feel secure in knowing they are protected from unexpected, high medical costs.
Want more information? Go here ...
There is a plan that offers unlimited in-hospital AND certain out-of-hospital dental benefits!Join this plan and you address your 2 greatest medical expense risks - private hospital and dental costs - AND can use any provider you want - all in one plan!
Not only that, but it has had the lowest rate increase of any hospital plan over the last 8-years!
Cover for additional members and children is very affordable, making this plan an excellent option for young families, low-income individuals, retirees, or people in good health who only need private hospital and dental cover and can comfortably pay their day-to-day expenses!!
That's good news! Check it as you will not be disappointed!
Self-Paying Day-to-Day Costs
When joining a hospital-only plan, you are responsible for covering your day-to-day medical expenses.However, I can virtually guarantee you that - if you save that premium difference - you will (over time) have more than the all the savings of a comprehensive plan!
It is your money to spend as you wish - no restrictions, as you control your savings, get interest and have access to the funds when you need them!
You can’t use money in a medical aid savings fund as you wish! You can’t spend it on a holiday, or for your retirement.
In fact, you can only get any balance back 6-months after you leave the scheme!
Surely you could do better investing your own savings? Of course you can!
Self-funding out of hospital costs, is really the same as a medical aid savings fund. The only difference is that a medical scheme will give you credit for the year - up front in your savings -whilst your own savings take time to grow.
BUT, at least this money is yours and you can do what you want with it!
Why not create a savings plan in a bank account, or use your home bond as an access account!
I personally, added extra to my home access bond! In this way, I lowered the capital loan of my bond, saving a huge amount of interest, which far outweighs any return I get with a medical scheme savings account! And I have access to a large savings fund, should I need it!
The "saved" amount can also fund a vital GAP COVER and top-up PLAN.
Now, you will have unlimited private hospital cover, paying up to 500% of the medical scheme rates, with essential dentistry benefits and no network providers! Unbeatable benefits and cost!
Hospital cover with day-to-day savings.
If you are concerned about covering your day-to-day medical expenses yourself, look at plans that come with day-to-day benefits, funded by a dedicated savings fund.Imagine having a safety net for those unexpected medical costs outside the hospital
A savings fund is precisely that—a cushion to soften the blow of high out-of-hospital medical bills when your wallet feels a bit stretched.
With this fund at your disposal, you can swiftly access medical treatments and medications, facilitating a quicker path to recovery.
The savings account is your personal financial reserve, built from your contributions. The Medical Schemes Act, allows up to 25% of your risk premium to be saved into this fund.
An important point to note: once you accumulate credit in your savings balance, you can't withdraw the cash directly.
It remains accessible only upon terminating your membership, provided you don't enrol in another plan offering savings options.
If you can minimise the amount of the savings fund you feel you need - you could drop your contribution by that savings portion of your total premium! And schemes do offer plans with different savings contributions to meet your wants.
Fedhealth allocates you an amount of savings and ONLY when you spend it do you start paying it back over 12 months or less - interest free!Careful savings management and your premium can be significantly lower than other schemes!
flexiFED plans give you more control, flexibility and choice over your medical plan than any other medical aid plan! And they cost less!
They offer in private hospital cover, chronic condition benefits and a unique method of using savings for your day-to-day costs.
Now, for the first time ever, FlexiFED allows you to begin paying for day-to-day benefits only when you use them - not before!
Here’s how you save… normally medical aid members are charged for day-to-day savings from the start, regardless of whether you have used your savings or not! It is like a compulsory loan being repaid as part of your monthly premium!
But, with Fedhealth your contribution will be lower until you use your savings, as it is only then that you begin to pay those used monies back - interest-free.
Yes, the longer you delay using the savings account - the longer you will experience lower premiums!
How the savings work ...
There are plans that offer a safety net benefit, should you have high out of hospital costs and spent your savings.
The plan will pay certain further out of hospital costs for that year.
However, these plans are very expensive and you need to carefully investigate your situation to see if you really need that threshold benefit.
Most members only reach their threshold benefits late in the year, so they do not use the benefit fully - yet have paid for it! It may well be that the cost of a threshold benefit is higher than the actual expenses you pay and it would be cheaper to pay those costs (after your savings are used) yourself?
Hospital cover with limited day-to-day benefits
You may not need high savings for out of hospital benefits, but still want the safety of having some day-to-day cover should unexpected costs arise?Or you may be young and/or healthy and only need a small fund for unexpected expenses?
The flexiFED plans (discussed above) are ideal for this type of medical aid plan!
This plan will cover your hospital and chronic needs and is suitable for people who are in good overall health, but do incur occasional medical expenses out of hospital.
Schemes also bundle maternity benefits into these plans, making them an affordable option for young mothers-to-be.
Or, how about a plan that offers unlimited network private hospital cover, guaranteed full cover for network in-hospital specialists, chronic medicine, unlimited network GP consultations, a list of defined acute medicines, a dental check and an eye test – all with a small co-payment when you need to use them?
And it offers specific sports-related injury benefits!
You only co-pay for certain out of hospital costs when you need them, not as part of a monthly contribution, therefore avoiding having to pay high premiums for savings that you don't really need!
Gap or top-up insurance.
Private healthcare providers can charge up to 500% of medical scheme rates.Medical aids add procedure co-payments as well.
These are significant concerns for medical aid members.
Protect yourself against these potential threats, by joining Cura's GAP or top-up insurance plan.
OR Zest GAP or top-up insurance plan.
This separate insurance will cover most in-hospital claim shortfalls and any co-payments. It is a vital safety net, ensuring you have adequate benefits for medical treatments without bearing the full burden of unexpected costs.
Protect yourself from soaring medical expenses by bridging the gap between medical scheme rates and the charges imposed by private providers.
Specialised Dental treatments can be extremely expensive!The costs of braces, root canal, implants and so on, can run into thousands of rand. Most treatments are done out of hospital, so are funded from your savings. That can result in less money available for other medical needs and family limits being used on one member only!
Dental treatment is something we all need and it is vital you consider the Best Dental Insurance Plan OR Most Affordable Dental Planin South Africa.
No Medical Aid or have a Hospital Plan only? This plan will help you meet the high costs of both normal and specialised dentistry!
Want more information? Go here ...
Use preferred provider networks to get premium discounts of up to 35%!
Schemes who contract with providers can control costs. If you use these providers (chemists, GP, specialist or hospital networks), you can get discounted contributions - as much as 35% lower - even on high-end options with comprehensive benefits!And the scheme may continue paying GP costs, when your savings have been spent!
Medical schemes offer these preferred provider network plans at a lower premium and we can help you investigate them.
If the providers are acceptable, then joining these plans is your answer!
Choosing a hospital plan that uses networks brings your medical aid costs down even further, because the medical aid has negotiated tariffs with those providers and they pass that discount onto you as a lower premium!
Momentum Health Medical Aid is a fine example of this type of plan.
Chronic medicines
Are you on regular medication to treat a chronic illness?
Medical schemes have to cover the costs related to the diagnosis, treatment and care of an emergency medical condition, a defined list of 270 diagnoses and a defined list of 27 chronic conditions.
Maybe you qualify for chronic medication benefits, where the scheme pays costs - without spending your savings.
Ask your doctor to motivate this and by completing a simple form, you could save yourself hundreds of rand a month!
A medical scheme that offers lower rates depending upon where you source your chronic medicines is available. Contributions differ depending on where you get your medicine - any chemist, a network supplier or the state.
If you do not need chronic medicine, the plan offering the state as your chronic supplier (which is not a problem considering you have no chronic medication need), has a significantly discounted premium!
Please note that your medical aid only pays for authorised chronic medication up to a certain level of cover and higher-priced medicines will use up your cover much faster.Consider using generic equivalent medicines as you can save up to 30% of the cost of these medicines and extend your benefits!
Why move to a network plan?
When a scheme is able to control provider costs - through linking them in a network - your premium is cheaper.Most medical schemes offer network provider plans and if you are happy with the networks, you can get good benefits for a reasonable cost!
Some network plan premiums are based upon your income and are the lowest cost medical scheme plans available. However, they can be restrictive in the benefits they offer, but do offer life-threatening and life-sustaining benefits for extremely affordable premiums!
They are ideal for pensioners, children who become adult dependants, students and those who earn low-incomes, but want access to private healthcare.
INGWE Medical Aid - offers an ANY hospital option as well!
KEYCARE Medical Aid - the most popular and largest plan in South Africa!
Student Medical Aid
There are plans specifically designed for full-time students, offering excellent benefits at a really good price!
Moving students onto their own plan, which you can pay for, is first prize in reducing your overall cost! Although they have cheaper premiums, they don’t compromise on quality of cover!
Your child’s healthcare needs are covered but, at a much more affordable rate, but you do need to submit proof of full-time study to qualify as a student.
Adult children
A child aged 21 can no longer be listed as a child dependant with most medical aids. This means their contribution will increase substantially, maybe even double!Some schemes do offer child rates - for financially dependant children up to age 27, as long as they are unmarried and not earning more than the maximum social pension.
Child is studying part-time and earning an income, then s/he will not qualify as a child dependant and will pay a higher premium. (Any income precludes them from joining a student plan.)
Join their own income-related network plan (above), as the premium will be very competitive. You can pay the contribution if needs be.
These plans allow access to private providers, have unlimited hospitalisation and mostly unlimited basic day-to-day benefits!
Is your child is working full-time, but earning an entry-level salary?
Again, consider the income-related plans (above) or investigate more affordable medical aid cover such as hospital plans with gap cover.
The premiums on these plans are lower than comprehensive plans, but they still cover the most important medical needs.
With both these plans, even if you keep on paying your child’s contribution, you should still end up saving hundreds each month!
Add parents as dependants
In today's world, we are fortunate to live longer lives.However, with aging comes the potential for increased healthcare expenses, and it's essential to plan ahead, especially when it comes to our parents' well-being. They face the possibility of chronic conditions and age-related illnesses, and providing them with financial support for their medical needs becomes vital.
There are ways to ensure your parents' medical aid needs are taken care of like Prescribed minimum benefits (PMBs) mandated by the government.
These benefits encompass a range of conditions, including high blood pressure, type 2 diabetes, or cholesterol.
Even basic medical schemes are required by law to cover these 270 conditions, ensuring that essential medication and treatments are provided.
Regardless of what form of medical cover you and your parents choose, at least their PMB chronic medication are paid for!
Another option is to make your parents dependants on your medical plan. By proving their dependency on you or your partner, they can join your plan at dependent premium rates, securing access to medical benefits and PMB chronic medication.
If your parents already have their own medical plan, and are earning a low incomes, look at income-related plans that may suit their needs.
You can even help by contributing to their premiums.
For comprehensive benefits, consider the Best, Affordable Hospital Plan with Dental benefits. This plan addresses two critical areas of healthcare – in-hospital care and essential dental treatments, along with PMBs and provides peace of mind for potential hospitalisation or dental procedures.
While look at options, be cautious about Hospital cash-back plans, as they are insurance-based products and may not offer the same benefits as medical aids. Claims can be restrictive and challenging to get paid.
Realistically, many of us may need to support our parents financially in their later years. It's wise to research medical scheme options beforehand, as waiting until the last moment can limit choices and lead to higher premiums.
Investing in the right medical aid now will ensure that your parents' health is well-taken care of in the future, granting them the support and quality care they deserve.
Help with your medical aid - for free
- Are you struggling to get answers from your broker or scheme?
- Do you have concerns over what benefits you may not be aware of?
- Do you have queries and complaints that are never answered?
- Do you never receive a promised follow-up?
I can resolve these concerns for you at no charge! Yes, you pay what you are currently paying – nothing more.
I do need to be appointed as your broker, as this gives me and my team access to your problems.
I only deal with certain schemes, but can certainly stop your worry and frustration!
Complete the appointment and return to me.
In a couple of days, I will confirm acceptance and we can quickly get onto your concerns.
Medical aid is a complicated product. We do need to have it, but we must fully understand what the benefits and limits are.
This is where we can help! We know these products... all the fine print.
And we can show you what cover you have!
I am a fully licenced and accredited broker with over 30-years of experience.
Do you experience unnecessary stress at year-end when the time comes to select your plan for the following year? This is when you need help!
We work with medical schemes all day. I know the in's and out's of a good plan and can readily show you options to suit both your needs and pockets.
It is NOT always ideal to change medical plan. as you can get waiting periods joining a new scheme.
Rather investigate moving to a different plan, within your current scheme
Talk to me .... I am here to help you - at no charge!
Send me your questions and concerns. I'll answer them for you.
083 655 2164
You must consult the schemes/company product brochures and rules for comprehensive benefit descriptions.
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Disclaimer, Medical Disclosure South African rights reserved. Last update:January 18, 2025
YOUR TRUSTED, QUALIFIED ADVISOR:
Peter Pyburn - Authorised Financial Services Provider, fully licensed to render financial services since 1991. Death and Disability Planning; Retirement Planning; Investment Planning; Healthcare and Estate Planning.
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