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The Ultimate Guide on Downgrading to a Hospital Plan in South Africa!
Reduce Your Medical Aid Cost
- Who: Members considering more affordable medical aid without losing hospital protection.
- What: Compare hospital plans, benefits, exclusions, networks and contribution costs.
- When & Where: Available across South Africa with online comparisons and expert advice.
- Why & How: Understand the advantages, trade-offs, waiting periods and benefit changes before switching to the right hospital plan.
Compare South Africa's best hospital plans and request your free personalised quote today.
The Key Benefits of Hospital Plans in South Africa.
If you are already a medical aid member and are concerned about rising premiums, there are ways for you to keep your medical aid while managing costs.
You can join an in-hospital only benefit plan and self-fund day-to-day costs.
Downgrading to a hospital plan can reduce your medical aid premium while making sure you have unlimited hospitalisation and chronic illness benefits along with the essential cover you need for emergencies.
You then have benefits for large, unforeseen in hospital medical expenses and control over your lower, daily healthcare costs.
Naturally the premiums are a lot less than comprehensive benefit plans.
Most medical aid schemes offer hospital only plans.
This guide gives you information from trusted sources and will help you to understand why a hospital plan is vital, its pros and cons, and how to use your healthcare savings effectively.
Fully Licensed and Accredited for medical aid and other Personalised financial advice.
FSP Licence 2995 and Medical Aid Accreditation BR 7428.
Why Choose a Hospital Plan?
In South Africa, private healthcare is essential because of unreliable government healthcare services.
Medical inflation is way higher than normal inflation.
The cost of healthcare is unaffordable for most people, and they land up in state facilities with longer waiting times and limited resources.
A medical aid is the only way to fund expensive healthcare needs.
However, a comprehensive medical aid plan can be extremely expensive and Hospital plans offer a cost-effective way for you to afford unforeseen major medical events and chronic conditions.
There is an urgent need for you to, at least, join an affordable hospital plan, because joining a hospital plan is the only way to ensure the finest hospitalisation care when you need it most.
Is downgrading to a hospital only benefit plan the right choice for you?
During the 'open season' for medical aids, cash-strapped South Africans have the option to change their healthcare plan to save on premiums.
But does downgrading to a hospital plan make financial sense, and what are the potential risks and considerations?
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.
An excellent idea if you can self-fund day-to-day costs is, instead of being tied to a comprehensive plan with a savings fund (and higher premium), look to joining a hospital-only benefit plan.
A hospital plan takes care of your hospital bills from admission to discharge and covers everything from your ward and theatre fees, surgeon, anaesthetist, doctor, specialist, physio, pathology, radiology, emergency treatment and so on.
They are more affordable than comprehensive plans, which also cover day-to-day medical costs like GP consultations, dentistry and optical benefits, but have higher premiums.
Choosing between a hospital and comprehensive plan depends on your health needs and budget.
If you can self-pay day-to-day medical costs (as they are not generally too high) then this is an ideal way for healthy members, who have low out of hospital costs, to lower their total medical aid premium.
By self-paying your day-to-day costs, you can enjoy the benefits of hospital cover without the added expense of a savings fund.
Remember, a comprehensive plan or a plan with medical savings, does not give you a better bed in hospital!
Remember, a comprehensive plan or a plan with medical savings, does not give you a better bed in hospital!
Pros and Cons of Downgrading
Pros:
- Lower Premium: Hospital plans have lower premiums.
- Emergency Benefits: Although they do not cover day-to-day medical expenses, hospital plans do provide benefits for emergencies and some for casualty treatment.
- Prescribed Minimum Benefits (PMBs): Hospital plans give guaranteed cover for 270 life-threatening conditions and 26 chronic conditions that include emergencies, diabetes, and asthma.
- Network hospitals are private hospitals
Cons:
- No Day-to-Day Costs Benefit: However, if you are healthy and have no need for extensive treatments, you should be able to self-fund these expenses.
If you frequently require doctor visits, medication, or other non-hospital care, a comprehensive plan covering these costs might be more cost-effective in, even with a higher premium. - Deciding if a hospital plan or comprehensive plan is best to join depends on your individual needs and budget.
If you can you comfortably manage out-of-hospital expenses yourself, joining a hospital-only plan could offer significant premium savings while providing you with essential hospital benefits.
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.
The Costs of Private Healthcare
How you can afford private healthcare?
We never know when we may need private hospitalisation. That care is unpredictable, and costs can quickly escalate.
A week in high care can cost upwards of R86,500, while maternity care can exceed R60,000
Major procedures, such as a heart bypass or hip replacement, can range from R150,000 to R350,000.
If anything, these costs highlight the critical need for a hospital plan to protect you against unforeseen and expensive medical emergencies.
- Treatment of a Gunshot Wound: R25,000.
- Hip Replacement: R150,000
- Renal Dialysis: R200,000
- CT Scan: R10,000
- Heart Bypass: R350,000
- Tonsillectomy: R8,000
- Grommets: R6,500
- Hernia Repair: R25,000
- Even casualty costs for broken bones, stitches, x-ray are expensive and highlight the importance of joining a basic hospital plan!
Choosing the Best Hospital Plan Schemes
Here are 4 schemes to consider and they all offer:
- unlimited in-hospital cover at any hospital you choose.
- cover for in-hospital ward, theatre, specialists, physio, medicines, MRI and CT scans and more.
- emergency treatment and transport.
- certain chronic medicines.
They all offer "added benefits" to differentiate themselves.
Fedhealth Medical Aid is truly an exceptional medical aid because they really do offer the best, affordable, unique, value-added benefits of any scheme in South Africa.
The Fedhealth flexiFED plans offer unlimited hospital cover combined with a day-to-day savings fund that you only repay once you spend it!
Your premium remains that of a hospital plan until you spend from your savings.
If you choose NOT to use the savings, your premium remains that of a hospital plan until you do use your savings.
A portion (1/12th) of what you spend is then repaid monthly, interest free over the following year, as an additional amount to your premium.
When it is repaid your premium drops back down to that of a hospital plan.
(Other medical aid plans force you to repay a portion of the savings from the start of your plan, whether you have spent them or not. That is money you cannot use as you wish. A forced loan!)
All plans have excellent in-hospital benefits and the offer of day-to-day savings which are re-paid only when you spend them! Fedhealth gives you the option of a safety net of funds for high out-of-hospital costs, but only paying for that benefit when you use it!
Just look at their hospital benefits:
- No overall annual limit private hospital cover, for emergencies and planned procedures.
- Unlimited network GP and Specialist covered at cost in-hospital.
- Treatment for selected procedures in a day ward, day clinic or doctors' rooms.
- Unlimited Specialised radiology.
- Unlimited accident and emergency treatment.
- Emergency treatment at a trauma unit of a clinic or hospital, like stitches and broken bones – whether you're admitted to the hospital or not.
- Costs paid for treatment at a clinic or hospital with a life-threatening condition where you are admitted immediately for further treatment.
- If medicines are not readily available Fedhealth will arrange for medicine or blood products to be delivered to the facility where you are being treated.
- Unlimited maternity covered at cost with network GPs and specialists.
- Specialised radiology, like MRI/CT scans done in or out-of-hospital, is paid by the scheme and not you!
- Chronic illness.
Premiums range from as little as R 1,055 pm for a single member.
Now you can have one of the finest hospital plans and the resources to pay high, unforeseen day-to-day costs.
You can cover your healthcare risks in one plan, where you control what it costs you!
Fedhealth also gives you a safety net of funds once savings are spent and your claims have added up to a predetermined amount. So, you always have funds to pay for healthcare needs.
The Genesis Hospital plan is a hospital plan that pays essential dental costs as well.
Rated as one of the best hospital plans in South Africa by the GTC Medical Aid Survey: Benefit and cost comparisons.
Genesis offer you:
- full cover for private hospital expenses, including ward and theatre fees, specialists, medication, and more, from admission to discharge.
- hospital and related accounts (e.g. theatre costs, x-rays, pathology, physiotherapy, blood transfusion, medicines, etc.) are covered at 100% of Scheme Tariff, including day clinic or the recovery room charges of an unattached operating theatre
- General practitioners and specialists are reimbursed at cost up to 200% of Scheme Tariff. (plan-dependent)
- Emergency pre-hospital treatment, evacuation and transport.
- the lowest annual contribution increase of all South African medical aids over the last 10 years. Only 4.7% this year!
- one of the lowest child contribution rates!
- the use of any doctor or specialist you choose as there are no compulsory networks!
- psychiatric treatment, so vital during this pandemic.
- out-of-hospital MRI and CT scans as well!
- diagnostic endoscopes
- pain relief for conservative back and/or neck (spinal/vertebral) conditions.
- surgical procedures done in doctors' rooms
- cancer, stroke, motor-neuron disease, organ transplant and Hospice.
- Chronic illness.
- screening tests.
AND
- Basic dentistry - yes cover for day-to-day and in-hospital dentistry!
Premiums range from as little as R 1,610 pm for a single member!
Genesis does not "authorise" treatment for any admission to hospital. Instead, you are issued with a hospital admission reference number because, nor do they interfere with any clinical decisions or protocols made by or recommended by your doctor(s).
This medical aid is really a hidden gem!
They are the smart choice when it comes to affordable, hospital only cover!
Discovery Health Medical Aid offers up to 12 hospital plans with no overall limit for hospital cover and a wide range of benefits that will meet your personal needs and budget.
- Guaranteed full cover in hospital for linked specialists.
- Private ward benefit (plan-dependent).
- Extensive listed hospitals for plans with reduced premiums.
- Income-related premium plan.
- Comprehensive pre-and postnatal healthcare services for maternity and treatment for the first two years of your baby's life
- Cover for relevant healthcare services, as well as a defined basket of care for out-of-hospital healthcare services, related to global World Health Organization (WHO) recognised disease outbreaks such as COVID-19.
- Africa evacuation benefit.
- International second opinion benefit.
- Care at home, including a Home Monitoring Device Benefit
- Vitality wellness rewards programme.
Premiums range from as little as R 1,350 pm for a single member.
Discovery Health is the top ranking open medical scheme owning more than 60% of the market.
Save up to R1,000 per month when you choose to use an Associated provider.
Momentum Health offers you:
- a discount on your contribution if you elect to use a specific, listed private hospital!
- cover for certain specialised procedures/treatments, when clinically appropriate, in and out-of-hospital.
- Netcare 911.
- chronic benefits, at a discount premium depending on your choice of associated doctors or suppliers!
- no annual limit on maternity confinement and neonatal intensive care.
- maternity programme with 12 antenatal visits, including a urine test, 2 pregnancy scans and 2 visits to the paediatrician during the baby's first year, plus a home visit from a nurse!
- no annual limit for MRI and CT scans, magnetic resonance cholangiopancreatography, whole body radioisotope and PET scans.
- preventative screening tests, certain check-ups and more.
- free talk to a doctor, anytime, anywhere!
Momentum offer you great cash-back rewards and partner discounts with Multiply.
Make healthier lifestyle choices, so you can reap the benefits like, rewards for being active - up to R3,000 per family per month to help pay for day-to-day healthcare expenses - free yearly health assessment at a Dis-Chem, Clicks or Pick n Pay Pharmacy or Multiply-affiliated pharmacies!
Premiums range from as little as R 2,353 pm for a single member.
Momentum Health ranks among the top 3 open medical schemes and are administered by one of the biggest and most credible healthcare solutions companies in South Africa.
Here are some important things to think about when choosing a medical aid, hospital plan:
- Make sure you have unlimited in private hospital cover.
- Doctors' fees should be paid at the scheme rates or up to twice those rates.
- Private providers often charge more, so having a top-up plan is important.
You'll need a Gap Plan. to cover any extra costs not paid by your medical aid. - Consider if MRI and CT scans, day clinic benefits, pregnancy and maternity care, and other procedures are covered.
- Look at the limits on specific procedures, co-payments, and benefits for chronic illnesses.
- Check if you can use certain hospitals to save money without losing benefits.
- See if the plan covers screenings and preventive care.
Some of these concerns may impact your decision, depending on your individual circumstances and medical history.
If you also join a top-up, it will greatly enhance your benefits.
It goes without saying that you need at least a hospital benefit medical aid.
A plan that will guarantee you admission to a private hospital with no up-front deposits to pay and unlimited cover.
1. If you do not have a hospital plan ... join today!
You are taking a high risk without cover. You know that!
Get a quote or contact me if you have questions by using the form below...
2. If you are a medical aid member and want to reduce your premium, investigate whether your scheme will allow you to downgrade to a hospital only plan.
All medical schemes allow a change of plan during a window period at year-end and some will allow a change during the year, with sufficient motivation for such a move.
3. If you are unable to change plans, look to an alternative scheme.
Just be aware you could get waiting periods when joining a new scheme, but that may be acceptable when considering no medical aid at all!
Many members of comprehensive medical aid plans, who change to in-hospital benefit only plans, have great enough premium saving, to join a top-up plan as well!
That means they then have a healthcare plan that pays hospital costs in full - no shortfalls and no procedure co-payments!
Better hospital benefits than with their old, comprehensive plan and at a lower combined premium!
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.
A Gap or Top-Up plan is a separate insurance that covers 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.
Protect yourself by joining Zest's GAP/Top-up insurance plan.
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!
FAQs
How can I reduce my medical aid cost by downgrading to a hospital plan?
Downgrading to a hospital plan slashes your premiums significantly while securing unlimited hospitalisation and chronic illness benefits for emergencies, perfect if you can self-fund day-to-day costs. Get a personalised quote now and join a hospital plan to start saving on your medical aid premium.
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.
Why choose a hospital plan for unlimited hospitalisation and chronic illness benefits?
A hospital plan delivers essential cover for unforeseen major medical events and 26 chronic conditions via Prescribed Minimum Benefits (PMBs), all at a fraction of comprehensive plan costs, ensuring top private care without high premiums. Investigate schemes like Fedhealth's flexiFED plans and contact us to help you.
What is the difference between comprehensive cover and a hospital plan?
Comprehensive plans have hospital benefits with a savings account for day-to-day expenses, but have higher premiums; a hospital plan offers unlimited in-hospital cover—from ward fees to specialists, and you self-pay routine costs for total medical aid premium savings. Make the switch by talking to us today, we will help you find the right hospital plan for you and downgrade seamlessly.
Will I still have access to quality healthcare on a hospital plan?
Certainly, hospital plans provide benefits for hospitalisation, emergencies, and PMB conditions, ensuring access to essential healthcare services.
Which hospital plan schemes offer unlimited private hospital cover at any hospital?
Top schemes like Fedhealth, Genesis, Discovery Health, and Momentum Health provide unlimited in-hospital cover, including emergencies, MRI/CT scans, and chronic medicines, with Genesis offering basic dentistry or Fedhealth's repay-only-when-used savings benefits.
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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.
Why Choose Peter Pyburn?
- ✔ FSCA Registered Financial Services Provider
- ✔ Over a decade of hands-on experience
- ✔ Independent advice across multiple schemes like Discovery, Momentum, Bonitas, Fedhealth, Genesis, CompCare and Medshield.
- ✔ Focused on your long-term outcomes
- ✔ No Broker fee as the medical aid pay us.
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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 bestmedicalaid.co.za before making any decisions.
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Last verified: September 12, 2026