What are the best ideas to control the cost of your medical aid for in South Africa?
South Africa has extremely high private healthcare costs and it is vital you consider joining a medical aid to help fund unexpected health expenses like hospitalisation and specialised dentistry.
You cannot consider to self-insure, as a week in ICU can cost over R160,000.
You need to, at least, join a hospital plan to avoid having to pay high hospital admission deposits and ensure access to quality care.
Network plans can reduce premiums, but do restrict provider choice, and may have overall annual limits.
In an attempt to reduce premiums, you can consider self-paying day-to-day costs or creating your own savings fund and joining a hospital plan to cover unforseen high costs.
You need to consider a Gap/Top-up insurance to cover in-hospital shortfalls and procedure co-payments.
We offer free, expert help to choose a suitable medical aid plan, so please contact us.
How do you get the finest hospital and dental benefits at the right price?
We are all only too aware of the high cost of healthcare in South Africa. And high premiums in are no exception. Many people are considering self-insuring for medical expenses.
However, this method exposes them to a great financial threat!
According to a research paper in the SA Medical Journal, “The cost per patient day in the two ICUs was R22 870.” PER DAY!
That included trauma and combined neurosurgical, medical and surgical treatment.
A week in ICU could be R 160,000.
After that, you need to add the costs of recovery wards and treatments.
Can you afford to pay for this?
Another direct consequence of high medical costs is that, with no medical cover, hospitals will demand a substantial deposit from you upon admission.
Do you have that cash at hand?
Considering just these 2 points, you cannot be without at least a basic hospital plan!
Planning to use government providers for healthcare needs is not advisable and along with the high cost of private care, make joining a medical scheme a necessity!
What can you do?
1. Consider Network plans.
Where medical aids can negotiate reasonable fees with providers, they pass these “savings” onto the member.
Some schemes even offer income-related premiums.
The contribution is based on your income and generally, network plans are the lowest premium forms of medical cover.
However, the network of providers may be unsuitable for you to use, as they may be situated a long way from you. That can lead to significant transport costs in order to see them.
By design, these plans do have a high number of exclusions - like no joint replacements, specialised dentistry, hiatus hernia treatment and more.
These procedures are expensive and you will have to pay for them.
- They do offer life-threatening cover for things like car accidents, or heart attack and life-sustaining cover for illnesses like cancer and kidney treatments.
- They offer mostly unlimited network GP, basic dentist and eye care as well.
- And specific cover for 27 chronic illness conditions.
Overall, if you accept the use of specific providers, they do offer great value at a reasonable cost.
2. Join an in-Hospital only benefit plan.
Our greatest threats of high medical costs are from private hospitalisation and dental treatments.
These are the two areas where you need to have medical cover.
Private hospitalisation can be a life-changing expense!
We don’t know when we will need to go to hospital, how long that may be for or what it will cost.
The only way to ensure the finest hospital care is by joining a medical aid hospital plan.
There are hospital insurance plans available, however they are really a “last resort” to consider.
They cannot compare to a hospital only, medical plan!
Try not to join a plan that has a maximum annual limit.
Although it may be cheaper, it is too much of a risk for you and your family.
Day-to-day costs can be controlled by paying them yourself, especially if you are healthy and don’t need to use medical providers that often.
Or, create your own savings fund, that is independent of medical aid.
Save in a bank account, or add to an access type bond and use that when you have high costs to meet.
Saving in a home bond has significant future benefits for you, least of all shortening your bond term and saving you huge interest!
You can then use these monies as you want and not be restricted as with your savings in a medical plan.
Yes, the medical scheme does offer savings fund credit upfront and it takes time for your own fund to grow.
But after a relatively short time, you will be way better off with free access to your monies.
By investing the "saved" premium of a lower-cost hospital plan – compared to a comprehensive medical plan – you may be able to create your savings fund at no added costs to you!
You may also be able to pay for a vital Gap/top-up plan from this “saved” premium?
Now, this idea becomes very attractive!
There is a plan that pays unlimited private hospitalisation - at any provider you want.
And they pay essential dental costs as well, further reducing your worry about self-funding out-of-hospital costs!
They have many other significant benefits for you to consider, like:
- offer affordable premiums, starting from R 1,465 pm!
- give you full flexibility and freedom of choice in choosing your hospital, specialists or doctors!
- are financially stable and solvent!
- are rated as one of the best value-for-money medical scheme benefit options in South Africa!
- have the lowest contribution increase over the last 9-years!
- provide generous basic and some enhanced dental benefits, paid by the plan!
There are other ideas you can look at, when considering what to do for medical aid in 2025.
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.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, 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!
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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.
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Over 30 ears of experience in financial services - Fully Licensed and Accredited for medical aid and other Personalised financial advice.
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Last verified: September 1, 2025