Best Advice when Choosing and Joining a Medical Aid
Save Thousands on Healthcare Now!
The finest advice when looking to choose and join a medical aid in South Africa.
This guide will help you through the process of looking for and understanding the benefits, limits and exclusions of a medical aid plans that best meet your needs.
Private healthcare is expensive, and you need to join a medical aid in order to afford the finest private healthcare when you need it.
As your foundation, we recommend you at least join a hospital-only benefit plan (to help pay for unexpected high medical costs), while self-paying your day-to-day costs, especially so if you are healthy.
Choose plans with unlimited private hospital cover.
Dental cover is also important as these areas have highest costs.
Consider plans with unlimited private hospital and dental cover, as these are the 2 areas of highest medical cost.
strong>bestmedicalaid.co.za offers practical advice when choosing medical aid in South Africa.
We offer free, expert help to guide you when choosing the most suitable medical aid for your needs and budget.
We make it simple to find, apply and join the right medical aid.
Do You Need a Medical Aid?
The Covid-19 pandemic reinforced how important it is to have some form of medical aid, whether a comprehensive or basic hospital-only plan.
South Africans cannot rely on government medical care and unfortunately, private healthcare can be very expensive.
The cost of life-saving treatment in a private facility will far exceed an annual medical aid premium cost and expensive emergencies can happen to anyone, at any time, irrespective of age and health.
You will need help to pay the costs!
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 will ensure you get the finest care when you need it most.
And remember, admission to a private hospital without medical aid can require a substantial cash deposit.
A medical aid isn't just about emergencies, as even routine procedures like wisdom teeth removal can cost upwards of R13,000.
In addition, the number of good healthcare providers in South Africa is shrinking, making private healthcare even more expensive.
Healthcare will become extremely expensive so you must act now and join a medical aid before you face an unexpected, expensive medical expense.
Consider at least joining in-Hospital only benefit plan.
It covers your greatest threat of high medical costs at a very affordable premium.
Keeping Your Medical Aid
Cancelling your medical aid has serious consequences.
If the premium is too high, rather than having no medical aid, switch to a more affordable plan or even downgrade to a hospital-only option.
Your plan must have full benefits for private hospitalisation and dental care, as these are the greatest medical financial threats we face.
Before deciding to self-fund your medical costs and stopping your medical aid, consider the risks you will face.
Not having medical aid will be way more expensive than any saving you think you are getting.
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, please fully understand the in-hospital and day-to-day benefits of the new medical plan.
The hospital benefits should be unlimited and comprehensive.
Joining an expensive medical aid 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 be a better option.
Joining a medical aid ensures your peace of mind by securing money for high private healthcare costs.
Hospitalisation can easily cost hundreds of thousands or even millions of rand.
Always ensure that you have enough hospital cover in place to pay for unforeseen expenses.
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 are the in-hospital benefits.
A hospital plan provides cover from admission until discharge and pays for major treatments like surgeries, specialist fees, ward expenses and chronic illness treatment.
You self pay day-to-day medical costs like GP consultations, physiotherapy, medications, and optical.
Please note that insurance-based hospital plans do not offer anywhere near the benefits of a medical aid hospital plan.
Medical aid hospital plans pay claims based on actual hospital costs, whereas insurance plans pay set amounts for defined treatments.
Medical aid plans are far more predictable and reliable than an insurance plan.
Hospital plans take care of various expenses related to your treatment, like theatre costs, X-rays, medication, blood tests, and blood transfusions.
These services are generally fully covered.
However, private providers like doctors and specialists, charge up to five times more than what medical aids pay.
To try meet the shortfall between the fees and medical aid rates paid, schemes offer varying payment percentages, usually at 100%, 200%, or even 300% of medical aid fees.
The higher the payment percentage, the higher the premium.
It is highly recommended that you consider joining a Gap or top-up plan to help pay any claim shortfall.
TIP: If you join a Gap plan, you can consider joining a "lower" benefit/lower premium hospital plan, knowing that you have sufficient cover from the addition of a Gap plan.
And in most cases, the money saved from the lower hospital plan premium can pay for the Gap plan premium.
Hospital plan benefits are usually the same as those offered by a more comprehensive medical plan.
Do You Want Protection for Out of Hospital costs?
Day-to-day costs can be high, with specialised dentistry and glasses being expensive and you may want help in paying these costs?
Medical aids offer 2 ways of paying out of hospital costs:
- set benefits per treatment
- a savings fund you can use to pay costs. This is made up from an added amount on your premium.
More expensive plans offer a safety net to cover additional claims when your savings are spent.
Fedhealth offer unique hospital plans with optional savings fund, that you only repay when you spend from it, unlike like other schemes (who offer savings), but add a repayment portion to your premium whether you spend funds or not.
Fedhealth gives you control over your premiums whilst enjoying the benefits of an in-hospital only plan.
The 3 Best Hospital Plans in South Africa.
1. Genesis premiums starting from R 1,680 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 14 years, they've delivered the lowest average contribution increases in the country and in 2026 their 2026 increase is only 4.7%!
Generous, essential dentistry benefits are included with the hospital only plans and this is unique in the market.
They provide full freedom to choose hospitals, doctors, and specialists with unlimited in-hospital benefits.
Hospital bills, including those for Prescribed Minimum Benefits (PMBs), are covered fully.
Attending doctor/specialist fees, in private hospitals are reimbursed at either 100% or 200% of the Scheme Tariff, depending on the plan.
Plans include surgical procedures done in a doctor's rooms.
Benefits includes preventative screening benefits such as mammograms, cervical (PAP) smears and prostate specific antigen (PSA) tests.
The Med-200 plan includes out-of-hospital cover for plain radiography (e.g. X-rays and ultra-sound) / MRI / CT scans.
Their hospital plans have been highly rated in the GTC Healthcare Consulting Medical Aid Survey.
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 2,029 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 offer discounted premiums depending upon your choice of using listed hospitals or from where you source any chronic medication you may require.
Option to add day-to-day savings should you require them.
Free preventative screening benefits and cover for 26 chronic conditions.
3. Discovery premiums starting from R 1,490 pm.
All Discovery Health plans offer comprehensive, no overall limit cover for hospital admissions in any hospital.
- No overall limit hospitalisation and guaranteed full cover for life-threatening emergencies, including transport.
- Discounted premiums for plans that use a listed hospital network.
- Listed in hospital GP and Specialists are paid in full. Others are paid at the Discovery rate or 2 or 3 times that rate depending on the plan you join.
- Benefits for specific day surgery procedures and specialist-room treatments.
Just look at what Discovery offers you...
- Savings fund, from which you pay all your day-to-day costs like GP, medicine (except for registered and approved chronic medicine), optometry and dentistry.
- Safety nets and extended benefits from listed providers, should you spend all your savings, ensuring you are never out of cover.
- Comprehensive benefits for maternity and early childhood that cover certain healthcare services before and after birth.
- Unlimited cover for biokineticists, acousticians, social workers, physiotherapists or chiropractors, psychologists, occupational therapists, speech and language therapists and external medical items, for pre-defined conditions.
- Low cost, network plans that have mostly unlimited day-to-day benefits with listed providers.
- Full chronic medication cover, including generic and non-generic medicines.
- Special care programs for diabetes, mental health, HIV, and heart conditions.
- Screening and prevention benefits that pay for tests to detect early warning signs of serious illness, so you can get the best care as early as possible.
- Blood glucose, cholesterol, HIV, Pap smear or HPV test for cervical screening, mammograms and/or ultrasounds and prostate screenings at listed providers.
Why you haven't switched to Discovery Health yet?
Read: Discovery Health 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 in 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 to be Aware of 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.
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.
Private healthcare providers can charge up to 500% of medical scheme rates.
Medical aids add procedure co-payments as well.
These are significant costs you must consider.
Protect yourself by joining Zest's 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 enough to cover medical treatments, without having to pay for unexpected costs.
Joining a hospital plan with Gap Cover is the most affordable way for families to protect against rising costs in 2026.
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, and are paid 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 Plan in 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.
Get Your Free Quote
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!
Easy-to-understand articles on medical aid.
Medical aid pays healthcare costs.
What if a disability stops your income?
Peter Pyburn - Authorised Financial Services Provider has been fully licensed to provide expert financial services since 1991.Based in Sandton, Johannesburg, Gauteng, we specialise in comprehensive financial planning including: Death and Disability Cover, Retirement Planning, Investment Strategies, Medical Aid, Estate Planning
FSP Licence 2995 and Medical Aid Accreditation BR 7428.
Why Choose Peter Pyburn?
Over 30 years of experience in financial services - Fully Licensed and Accredited for medical aid and other Personalised financial advice.
Council of Medical Schemes
Medical Disclosure
By submitting an enquiry you agree to us collecting the information in the fields above. Please refer to our POPI Manual.
Your data will be processed according to the Protection of Personal Information Act (POPIA) guidelines.
Important Disclaimer: This content is for informational purposes only and does not constitute financial or healthcare advice.
Medical aid benefits are subject to change. Please consult the medical aid brochure and speak to strong>bestmedicalaid.co.za before making any decisions.
South African rights reserved.