7 Ways To Choose The Right Medical Aid


Cost of living in South Africa seems to be getting more and more expensive, VAT has increased, petrol prices are constantly going up. To top it all, it seems like most people I know are cutting down on things that are thought to be essential.

For instance Medical Aid schemes are said to be five times more expensive In South African than elsewhere in the world, when our purchasing power is taken into consideration. I mean the cost of private medical care has been higher than the normal inflation rate for the last few years, how crazy is that?  

A comprehensive medical scheme just for yourself could easily cost you between 10% and 20% of your income every month. Due to this, many people are now opting for a hospital plan to save money, and many others are taking cheaper medical aids or taking GAP covers to supplement them. Others are simply doing without a medical scheme of any kind - and hoping for the best.

Which then got me thinking: “how does one choose a right Medical scheme?” Are there practical ways to cut down on medical aid expenses?

For most companies, it is compulsory for all employees belong to a medical aid with a minimum hospital plan option. But in the case of those who have no cover, the cost of injury or emergency surgery could be crippling. While some state hospitals offer excellent services and facilities, many don't. And paying for a private hospital out of your own pocket is definitely going to cost you an arm and a leg. It is thus advisable to get some sort of medical cover.

I know that having a Medical cover can take a huge chunk out of your income every month. But, there are ways to reduce this.


The following are a couple of the things you should do before joining a medical aid scheme

Full cover vs. a hospital plan.

Decide if whether you can afford the normal day-to-day medical expenses, such as GP visits yourself. Hospital plans are often far more affordable than full medical cover. But do remember that even hospital plans cover you for 25 specified chronic conditions (known as PMBs). Therefore, before taking any hospital plan check what they do not cover.

Assess your health.

If you have ongoing health problems, you might need a full medical cover rather than only a hospital plan. If you are generally healthy, but have an eye or dental problems, choose a plan that makes suitable provision for this.

Stick with the company medical scheme.

This is often cheaper than going for an open-market medical scheme, where you as an individual may have little bargaining power. Also, closed schemes often charge you according to your income, but everyone gets the same benefits. So it's good for lower and middle income earners. Open schemes charge a set fee for a particular option, regardless of your income. 

 Stick together.

If you have two children and a spouse, it will be cheaper for all to be on the same medical scheme than if you or your spouse join different schemes as principal members. Even if your company insists on your joining their scheme, you can usually get out of it if you're on your partner's scheme as an adult dependant. There are some options where you only pay for one or two children and the rest are free. Just check that you won't get a better deal if you move everyone into your in-house scheme.


Check a scheme's payment record.

If you have to choose an open scheme, phone your GP's secretary, or the nearest private hospital, to find out whether they have experienced problems with payouts from that particular scheme. This is very important as some medical aids are not accepted at some hospitals and GPs. I once had a minor accident and had to be taken to a hospital for checkups. I was shocked when I was asked to pay cash for consultation as my medical plan was not accepted at that hospital.

Assess your finances.

Full medical cover can be expensive, and if you can't afford it, you can't afford it. If you have a monthly income of R6000, you cannot spend R2000 of it on medical cover, no matter what your peers say. If you do decide to join a scheme, also check who gives you the best deal for yourself and your beneficiaries, and exactly what your monthly contributions would be.

Be careful of medical insurance plans

Though insurance plans are very cheap you might end up paying extra for consultations and most of them are not accepted by specialists. The insurance plans that pay you out per day you spend in hospital very seldom cover even a fraction of the medical costs

“A scheme may look wonderful on paper, as they appear to pay 100% of the cost for a variety of things, but do check what the day-to-day limits are and how much your Medical Savings Account (MSA) is per year. If the MSA is small, you could exhaust your day-to-day cover by April like I used to in the past. In addition, many private hospitals do not charge medical scheme rates - you could be landed with a nasty bill after your hospital stay, despite having hospital cover. Check what co-payments you will have to make on all bills. It might be an idea to go for an option that pays 200% or 300% of the medical aid rate for hospital treatment”- Tendani Muthelo advices