Is Downgrading to a Hospital Plan Right for You?

Saving Money on Healthcare

During the 'open season' for medical aids, cash-strapped South Africans have the option to change their healthcare plan to save on premiums.

Does downgrading to a hospital plan make financial sense, and what are the potential risks and considerations?

Understanding Your Plan Options

The Difference between Comprehensive Cover and a Hospital Plan.
Comprehensive medical cover offers hospitalisation benefits as well as a savings account to pay for day to day expenses.

A hospital plan is more affordable and covers only hospital-related procedures and chronic illness.
You self-pay your day-to-day costs.

Using a Financial Planner is highly recommended. Before making any decisions, you should talk to a financial planner, because they can help you assess your current and future healthcare needs and provide valuable ideas as to the best plan for you.

Pros and Cons of Downgrading to a Hospital Plan

Pros:

Lower Premium: Hospital plans have lower premiums, leading to premium savings for healthy members.
Emergency Benefits: Despite not covering day-to-day medical expenses, hospital plans do provide benefits for emergencies and some for casualty treatment.
Prescribed Minimum Benefits (PMBs): Medical aids are legally required to cover certain chronic illnesses, ensuring access to minimum health services and hospital plans do so.

Cons

No Cover for Day-to-Day Expenses: One drawbacks of a hospital plan is the lack of benefits for day-to-day medical expenses.
However, if you are healthy, you should be able to self-fund these expenses.

Look at buying Gap Cover

Medical aid plans do not fully cover certain treatments, specialists, and procedure co-payments, because private providers charge more than medical aid rates.

Gap cover helps bridge the gap between what your medical scheme covers and the actual cost of treatment.

Top-up medical insurance to cover shortfalls

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!

One medical aid that offers you the best of in hospital benefits... Fedhealth's flexiFED Hospital Plans

Fedhealth's hospital plans offer many additional benefits, including benefits for certain day-to-day expenses paid by the plan and the ability to upgrade to a higher plan within 30-days of a life-changing event (such as pregnancy or the diagnosis of a serious illness).

FAQs

When is the best time to re-consider my medical aid?
It's advisable to re-consider your medical aid plan annually during the 'open season' to ensure it still meets your needs.
What factors should I consider before downgrading to a hospital plan?
Consider your current health status, future healthcare needs, and ability to cover day-to-day medical expenses.
Does gap cover replace my medical aid?
No, gap cover supplements your existing medical aid by covering the shortfall between what your medical scheme covers and the actual cost of treatment.
Can I switch back to comprehensive cover in the future?
Yes, you can upgrade to comprehensive cover or a higher-tier plan if your healthcare needs change.
Will I still have access to quality healthcare on a hospital plan?
Certain, hospital plans provide benefits for hospitalisation, emergencies, and PMB conditions, ensuring access to essential healthcare services.
How do I choose the right gap cover for my needs?
Talk to us. We can help you select gap cover that aligns with your medical 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.

Medical aid pays healthcare costs.
What if a disability stops your income?

Peter Pyburn - Authorised Financial Services Provider, fully licensed to render financial services since 1991.
Death, Disability, Retirement, Investment, Healthcare and Estate Planning.
FSP Licence 2995 and Medical Aid Accreditation BR 7428
Based in Sandton.

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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 me before making any decisions.