Are your medical aid savings running out?
Or are they already spent?
The new type of comprehensive medical aid plans – those with in and out-of-hospital benefits – have a savings fund that is used for all out-of-hospital claims such as doctors’ consultations, medicines and glasses.
The fund is known as a Medical savings Account (MSA) and it is funded from part of your medical aid premium.
The initial amount, that is allocated to you at the beginning of a year, (and paid off through your monthly premium), depends upon your plan and your membership profile.
By law, it can range from 15% to 25% of your monthly contribution.
The amount may seem high, but it is spent very quickly as medical care is expensive, and many members have no savings left halfway during the year, yet still must pay for those savings and ongoing medical costs!
What to do when your MSA runs out
Although you will now have to self-fund some of your costs, you will still have chronic medication and hospital cover in place.You may also have additional, defined rand amounts available, or a safety net that kicks in once your savings are spent and claims have added up to a pre-determined amount.
The above threshold benefits (ATB)
Once your claims have added up to a pre-determined amount and your savings are spent this benefit applies, and depending upon your plan, you may have further limited or unlimited out-of-hospital claims paid.
You may need to self-fund claims (and continues submitting them to your medical aid) from the time your savings are used up until you reach your threshold level.
This is known as the self-payment gap.
But what if you cannot afford to join these expensive “threshold plans” and have a simple medical aid with a savings fund?
12 ways to help your savings last longer.
- Use a qualified medical aid broker.
We can help you compare and do the necessary calculations. - It is critical that you understand what you plan offers you.
Make sure you check your monthly medical aid statement.
Read you plan rules and know what you’re entitled to claim.
Some medical aids deduct the cost of radiology and pathology from your savings account, while others do not. - If you want your savings to last longer, you need to make good decisions about how to use the money.
Make a budget and make sure that you do not spend everything on one member or too early in a year. - Medical aids must pay for certain conditions, known as the Prescribed Minimum Benefits and not use your savings. Conditions such as diabetes, pneumonia, depression or hypertension.
Ensure your doctor bills PMB conditions correctly, using the right ICD 10 codes for PMB treatments.
This can save a great deal of savings. - Many schemes offer benefits for children, should your savings be spent.
Investigate this for your plan. - Do not pay for over-the-counter medicines with your savings.
Try using your credit card or cash of these incidental costs. Hopefully they are not too high. - Always check if your prescribed medicine has a generic equivalent.
If you can safely use them, do so as it will save you money. - Use doctors and dentists who charge lower rates.
And if your plan has listed providers, use them as they may be fully paid at very negotiable, low rates. - Choose cheaper frames for glasses.
Your medical aid is not designed to pay for designer frames! - Try choose more affordable dental procedures.
- Join a low-cost Dental Insurance plan and conserve your savings for other medical expenses.
- All plans have chronic medicine benefits, but you must apply for them.
Please make sure your prescribing doctor correctly fills in the chronic medicine application for your plan, otherwise these medicines/consultations will be paid from your savings. - Use your medical aid preventative care benefits. Most schemes offer benefits for preventive care like a Pap smear, prostrate cancer screening, dental check-ups and flu vaccine among others.
By using these benefits early, you lessen the chance (and costs) of medical treatment at an advanced stage of illness, like avoiding a trip to the doctor and an expensive prescription.
These steps should make your savings last longer, but there may be times when you to save funds in your own bank accounts.
But you need to be a disciplined saver and use an account that is easily to pay with.
If you use a credit card, make sure you budget for those expenses and pay them in the required period.
You can use the money to pay for medical costs when your savings are spent, but you can also use it on other costs like holidays – which you cannot with left over MSA savings!
There are medical aids that offer savings accounts that are outside of the scheme.
These funds are separate from your plan and may also include loyalty or rewards schemes.
It may be time to upgrade your plan or look for another medical aid plan?
If you are on a lower-cost medical aid option, the benefits will also be low.
If your medical needs are high and they are not covered by the PMBs, your savings may soon run out.
A new plan will offer greater benefit amounts, but you need to weigh up the increased premium against the added savings.
Start by determining how much have you spent on out-of-hospital costs in the last 3-years?
If it is excessive and looks like that will not change in the future, then a plan upgrade is your answer.
What to do if you want to switch medical plans.
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!
Contact me as I have been a professional medical aid broker for more than 30 years.
I know the difficulty of understanding the "small print" around medical aids! I can help you discover a plan that will make sense to you and that will meet your needs and wants. I will confirm everything with the scheme you choose to join - quickly!
We promote more than 5 medical schemes.
By authorising us to deal with your medical plan - at no added cost for you – we can help you with any concerns you may have.
From benefit queries to administrative problems. And assist with your annual renewal process.
Talk to me .... I am here to help you - at no charge!
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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
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Last verified: September 3, 2025