In healthcare, facing an illness can wreak havoc on your finances. Even though the National Health Insurance (NHI) is now law, experts say it will take years to implement it fully. Medical aid is there to offer support, however, the affordability of coverage remains a challenge for many seeking better healthcare.
Ayanda Gumede from Durban says she decided to get medical aid to prioritise her health and wellbeing and that of her loved ones. Although financially straining at times, she believes it is an important expense.
“With my grandmother requiring regular check-ups, I realised that unexpected medical expenses can be a significant financial burden.
“By investing in medical aid, I’m not only preparing for any situation that may arise but also ensuring that we have access to quality healthcare and financial security.”
Ayanda Gumede
A necessary expense
“Medical aid is not affordable but while it is a significant expense for me, I feel it’s a necessary one. The alternative of paying medical bills in cash would be even more financially burdensome. I’m prioritising my health and well-being by investing in medical aid, even though it’s a stretch for my budget.
“I hope to find ways to make it more affordable in the future but for now, it’s a necessary expense for me,” says Gumede.
After losing a few family members at government hospitals, John Doe from Johannesburg says he was encouraged to get medical aid to potentially get better health treatment.
“Government hospitals are my biggest phobia. In most companies I have worked for, it’s compulsory to have medical aid, and my son has been very ill a few times and has gotten the best treatment at private hospitals.
“The preauthorisation of medical aid can be stressful when you need to do something urgent. If something is not on the plan, chances are you’ll have to cover the rest. It is also not affordable and is currently very expensive, especially if you have dependents on it as well.
“There are also a lot of terms and conditions that you end up finding along the way or at a later stage,” he says.
Benefits of medical aid
According to Collette D’Araujo, a medical aid consultant from Krugersdorp, medical aid in South Africa offers several key benefits which include:
- Private healthcare access: Shorter waiting times and better-quality care in private hospitals and clinics.
- Comprehensive coverage: Includes hospitalisation, outpatient care, emergency services, and chronic medication.
- Financial protection: Covers high medical costs from unexpected illnesses or injuries.
- Preventive care: Covers vaccinations, screenings, and wellness programmes.
- Chronic disease management: Specialised programmes for chronic conditions like diabetes and hypertension.
- Access to specialists: A network of specialists and advanced treatments.
- Mental health services: Coverage for therapy and psychiatric consultations.
- Maternity benefits: Covers prenatal care, delivery, and postnatal care.
- Peace of mind: Assurance of a safety net for medical emergencies.
- Tax benefits: Contributions can qualify for tax deductions.
What can you afford?
Additionally, she underlines factors that determine the affordability of a medical aid plan, which include:
- Coverage level: Plans with more comprehensive coverage, including day-to-day benefits like doctors’ visits, specialist visits, dentistry, optometry, and chronic medication, tend to be more expensive.
- Benefit limits: Higher benefit limits usually increase the cost of the plan.
- Network restrictions: Plans that restrict members to specific networks of doctors and hospitals often cost less than those with broader networks.
- Member’s age and health status: Members who have not been on medical aid for the right period of years will have a late joiner penalty. Existing conditions will be excluded for one year.
- Family size: Plans covering more family members typically cost more.
- Co-payments and deductibles: Plans with higher co-payments and deductibles generally have lower premiums.
- Plan type: Basic plans or hospital-only plans are usually more affordable than comprehensive plans.
- Income: Some plans have income-based premiums, with higher-income earners paying more.
“These factors collectively influence the cost of medical aid plans, allowing individuals to choose a plan that fits their budget and healthcare needs, which is why it is better to go through a medical aid broker.”
Collette D’Araujo
Checklist when you get medical aid
When deciding on which medical aid to consider, she advises people to consider important points such as:
- Coverage needs: Ensure that the plan you choose meets all of your and your family’s healthcare needs.
- Benefit limits: Check the annual limits for different services to ensure they meet your healthcare needs.
- Network restrictions: Verify if the plan restricts you to a specific network of doctors and hospitals, and ensure these providers are conveniently located and reputable.
- Co-payments and deductibles: Understand the out-of-pocket costs you will need to pay for various services. Take a gap cover.
- Exclusions and waiting periods: Look for any exclusions in the plan and waiting periods for certain treatments or conditions.
- Premium costs: Assess the monthly premiums to ensure they fit within your budget.
Furthermore, she adds that most of the medical aid brands in South Africa are highly recommended, although she advises that a person go through a medical aid consultant to assess the client, which would give one a guideline of which medical aid and option to join.
“One must make sure that you are dealing with medical aid and not medical insurance, as there is a difference. I am available to assist companies and individuals and do not charge professional fees, so there are no additional costs involved.”
“I would really advise people to also consider taking out a gap cover, which is very reasonable to cover hospital shortfalls as well as co-payments. For those unable to afford medical aid, the only other option would be medical insurance; however, a person needs to ensure that they are aware of what is covered.”
ALSO READ: NHI: President signs new bill into law despite outcries
Get the Health For Mzansi newsletter: Your bi-weekly dose of kasi health, wellness and self-care inspiration.
