The Best Advice and Ideas for Medical Aid.
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Frequently Asked Questions: Best Medical Aid Advice
1. Do i really need medical aid?Yes, especially in South Africa, where relying on the government healthcare system isn't sufficient.
Medical aid gives you immediate access to private healthcare, so important in an emergency or events like a pandemic.
Even basic hospital plans give you the best financial protection should you be hospitalized.
2. How do i choose the right medical aid plan for my needs and budget?
List your needs and budget and look for plans with the finest benefits at the most affordable cost. You can choose from in-hospital only to comprehensive plans, which offer day-to-day benefits as well.
If you need chronic illness benefits, then select a plan that offers cover for your condition.
An unlimited hospital plan is the foundation of your medical aid. Private hospitalisation and dental care are our biggest expenses and Genesis, Discovery, and Fedhealth offer excellent benefits to protect you from these costs.
3. What are the benefits of hospital-only plans?
Hospital plans provide comprehensive in-hospital benefits, covering major treatments like surgeries and specialist fees. If you are healthy and can self-fund your day-to-day expenses, joining a hospital only plan is an extremely cost-effective way of protecting you and your family from high, unexpected medical expenses.
4. How can i control day-to-day medical costs?
Consider self-funding your day-to-day expenses if you are healthy and do not really need GP, dentist and optical benefits. In this way, you control your savings, can earn interest, and use funds as needed. Not like in a medical aid savings fund, where you can only use the savings through the medical aid. Use a simple bank savings account, access bond, or specialized debit cards for healthcare expenses.
5. What should i look at when downgrading a medical aid plan?
List your health conditions and adjust your expectations, as the downgraded plan will have lower benefits. Then investigate the benefits of that medical aid plan. Look at network providers and income-related plans, as they cost less. Above all, make sure you know what benefits you will have reduced or lose and weigh that up against a potential premium saving. You do not want to land up self-paying more than any premium saving.
Do You Need a Medical Aid?
Medical aid can be a complicated purchase, and it is important that you understand the benefits, limits and exclusions of the plan you are investigating.This article will help you through the process of looking for a medical aid that bests suite your needs.
Do You Really Need a Medical Aid?
In a world full of surprises, having a good medical aid plan isn't just smart it's necessary.The recent Covid-19 pandemic showed how important it is to have some form of medical aid, whether comprehensive or a basic hospital-only option.
In South Africa, relying only on state medical care isn't enough. Private care, though pricey, can sometimes make all the difference in saving lives.
The cost of life-saving treatment in a private facility can far exceed an annual medical aid premium cost. Emergencies can happen to anyone, at any time, irrespective of age. And the cost can be crippling.
Protecting Yourself and Your Family
Having medical aid means you won't have to worry about crowded public hospitals during emergencies.
It secures your well-being and your family's future against uncertainties.
Without it, getting into a suitable trauma centre can be tough.
Your medical aid ensures you get top-notch care when you need it most.
Admission to a private hospital without medical aid can require a substantial cash deposit, an unbearable burden on your financial situation, not to mention your health.
And a medical aid isn't just about emergencies. Even routine procedures like wisdom teeth removal can cost upwards of R13,000 in private hospitals.
Plus, the number of good healthcare providers in South Africa is shrinking, making private healthcare even pricier.
Healthcare will become extremely expensive.
Act now and join a medical aid before you face an unexpected, expensive medical expense.
At least, consider joining in-Hospital only benefit plan.
It covers your greatest threat of high medical costs at a very affordable premium.
Keeping Your Lifeline
Cancelling your medical aid can have serious consequences.
If premiums are too much, rather switch to a more affordable plan or downgrade to a hospital-only option.
Your plan must have exceptional benefits in two areas: Private hospitalisation and dental care, for these are the greatest medical financial threats you face.
Before deciding to self-fund medical expenses, by terminating your medical aid, weigh the risks.
Going without medical aid often outweighs perceived savings.
If you are not yet a member – best you join a plan today!
How to “buy down” a medical aid.
When considering "buying-down" a medical aid plan, understanding the in-hospital and day-to-day benefits, is key.
Hospital benefits should be unlimited and comprehensive.
However, certain procedures might come with co-payments.
Joining an expensive medical aid plan with out of hospital savings may not always yield better overall benefits.
Sometimes, opting for a hospital-only plan and self-funding day-to-day costs can prove more advantageous.
The primary goal of joining a medical aid is to ensure peace of mind and secure access to funds for significant private healthcare expenses.
Hospitalisation costs can easily reach hundreds of thousands or even millions of Rand.
Always ensure that you have sufficient hospital cover in place to handle these unforeseeable cost threats.
Day-to-day expenses, though important, can often be managed separately on an as-and-when basis.
Understanding Hospital Only benefit Plans
The foundation of any medical aid is the in-hospital benefit cover. A hospital only benefit plan provides comprehensive benefits from the moment of admission until your discharge from hospital.Joining an in-hospital only plan provides you with benefits covering major in-hospital treatments like surgeries, specialist fees, and ward expenses. However, day-to-day medical costs such as GP consultations, physiotherapy, medications, and optical are self-funded.
Unlike insurance-based hospital plans that offer Comprehensive cash benefits for treatments, in-hospital only medical aid plans operate under strict regulations. They determine claims based on actual healthcare expenses, ensuring a more predictable and reliable benefits structure than an insurance plan. This shields you from unexpected costs.
Please see: Is a Hospital Cash Plan (not a medical aid hospital plan) worth it?
Hospital plans take care of various expenses related to your treatment, like theatre costs, X-rays, medication, blood tests, and blood transfusions.
These essential services are typically covered in full, as hospitals align their charges with what medical aids pay.
It's important to be aware that private providers, such as doctors and specialists, have the freedom to set their own fees, which can be significantly higher, sometimes up to five times more than what medical aids cover.
To bridge the gap between what medical aids pay and what private providers charge, different medical aid plans offer varying payment percentages, usually at 100%, 200%, or even 300% of medical aid fees.
Naturally, the higher the payment percentage, the higher the premium you'll pay.
With private providers often charging more than what medical aids cover, shortfalls in benefits are quite common.
To safeguard yourself from potential claim shortfalls or procedure co-payments, it's advisable to consider a Gap or top-up plan.
Such a plan will cover any shortfall, ensuring you have up to five times medical aid cover, without unexpected financial burden!
TIP: If you join a Gap plan, you can then consider moving to a "lower" benefit or lower premium hospital plan, knowing that you still have the necessary cover through the addition of the Gap plan.
In most cases, the money saved from the lower hospital plan premium can even cover the Gap plan premium.
Because hospital plans offer only in-hospital benefits, they have significantly lower premiums.
Whether you choose a hospital plan or a more comprehensive medical aid option with savings, your qualifying hospital claims will be funded by your medical scheme in the same manner.
Day-to-day expenses are covered through a savings fund in your plan. All your day-to-day costs are drawn from this fund. More expensive plans often offer a safety net to cover additional claims if your savings are exhausted.
While handling these day-to-day expenses might involve some financial responsibility, the potential risks are notably lower compared to the potentially staggering costs associated with prolonged hospital stays or intensive care treatments.
If you are concerned about funding day-to-day costs, Fedhealth offer hospital plans with savings funds, to provide the money for these costs.
They advance you the money for to pay these costs, and you only repay that advance once you spend it. Not like other schemes who offer savings funds, but charge a repayment whether you spend funds or not.
This flexibility lets you maintain control over your premiums while still enjoying the benefits of an in-hospital only plan.
The 3 Best Hospital Plans in South Africa.
1. Genesis premiums starting from R 1,610 pm.This is a scheme that recognises the financial strain most members face. They prioritize affordability and understand the need to reduce medical expenses. For 10 years, they've maintained a lower average contribution than other schemes.
Essential dentistry benefits are included with the hospital only plans - unique in the market.
Their Private Choice hospital plan has been highly rated in the GTC Healthcare Consulting Medical Aid Survey. It provides full freedom to choose hospitals, doctors, and specialists with unlimited in-hospital benefits. Hospital bills, including those for Prescribed Minimum Benefits (PMBs), are typically covered fully. Additionally, expenses incurred with attending doctors/specialists in private hospitals are reimbursed at either 100% or 200% of the Scheme Tariff, depending on the plan chosen.
Genesis prides itself on a strong claims paying ability and high solvency, assuring customers that their claims will be met. This plan is suitable for those who can cover out-of-hospital expenses themselves.
2. Momentum Health starting from R 3,033 pm
Offering comprehensive, no overall annual limit in-hospital and chronic illness cover on all plans, they give you the option of using any hospital or listed private hospitals.
They also offer discounted premiums depending upon your choice of using listed hospitals or from where you source any chronic medication you may require.
3. Fedhealth premiums starting from R 1,055 pm.
All Fedhealth plans are essentially unlimited hospital plans, but with the OPTION of using day-to-day savings if you really need them. And only repaying those savings when you spend them!
That’s not all … Fedhealth offer you even lower premiums if you choose either of two discounts!
10% if you use listed hospitals (outside of an emergency) and 25% if you accept a R 15,470 admission excess for planned procedures at a hospital of your choice. (not for emergencies.)
Just look at what Fedhealth offer you...
Only Fedhealth pays for all of these benefits:
- Unlimited network GP visits once you have reached a pre-determined claim amount!
- 7-days take home from hospital medicines!
- Unlimited Specialised radiology (MRI/CT scan) in and out of the hospital!
- Unlimited 30-days post-hospitalisation treatment!
- Female contraceptives!
- You only pay for 3 children!
- Financially dependant children pay child rates up to age 27!
- Unlimited Trauma Casualty!
- Certain post-hospitalisation treatments for 30-days!
- Upgrades any time of the year within 30 days of a life-changing event
Ask yourself “WHY” other medical schemes make you take a more expensive option “just in case”, instead of letting you upgrade if something actually happens?
Then ask yourself why you haven’t switched to Fedhealth yet?
Control Your Day-to-Day Costs
If you can manage your day-to-day costs, you can significantly reduce your medical aid premiums.
While a savings account might seem convenient, you can only use those fund through the medical aid and never on any other financial need.
Joining a hospital plan and self-funding your day-to-day costs can offer several advantages:
- You control your savings and can pay claims as you wish, without restrictions from a medical aid.
- Spend savings as you wish like paying premiums when your income is low.
- Earning interest on your savings, which does not happen in a medical aid savings fund.
- Stop the savings for whatever reason may befall you. You cannot do that within a medical aid.
Smart Places to Save for Your Day-to-Day Medical Expenses
You must have easy and immediate access to your money from your savings fund, so consider these options:- Simple Bank Savings Account: Linking a savings account to a debit card provides easy access to your savings.
- Credit Card (use cautiously): A credit card can act as a safety net for higher costs, but self-control is important to avoid high interest charges. Paying off any credit used within the statement period is best tin avoiding extra charges.
- Access Bond: An access bond is an excellent way to save for medical expenses. And once you pay off the bond - keep it open - as it can provide a substantial emergency fund for medical needs.
- Debit Health Card: (recommended) A specialised debit card is an excellent way to save money for healthcare expenses. It is easy to use and other family members can be linked to it as well.
When deciding between having no medical aid or choosing a hospital plan, the latter is undoubtedly the wiser decision.
Concerns When Downgrading a Medical Aid
When considering downgrading your medical aid (for lower premiums), it's important to identify other concerns that may influence your decision, like:- Health conditions: what is your health and your family's health status? Downgrading plans might leave you with low benefits for unexpected events or chronic conditions, resulting in you having to self-fund some of those expenses.
- Adjust your expectations: be aware of the limitations a lower benefit plan has. Understand them before you make a decision to downgrade.
- Even look at upgrading your plan: sometimes, upgrading could be the best choice, especially for growing mature families.
Although it involves higher costs, the peace of mind better benefits offer could outweigh the higher premium. - Network providers: plans that require you to use specific listed providers normally offer discounted premiums and full in-hospital cover. However, this means losing your freedom to choose who to use, which may be inconvenient..
- Income-Related plans: designed for low-income earners, these plans offer private healthcare benefits at subsidised premiums. But they do have limitations, such as using linked providers and restrictions on specialised treatments. Some may also require the use of state hospitals. You must have a clear understanding of their conditions.
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!
I am a licenced Healthcare Adviser, here to ensure you get the very best out of your cover.
We can advise on a plan that suits your needs and budget!
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.
We will offer you the best help at no cost!
Medical aid pays healthcare costs.
What if a disability stops your income?
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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Last update: January 18, 2025