South Africa is home to “80 different open and closed medical aid schemes, with 4.02 million registered members, serving a total of 8.87 million beneficiaries” (Business Tech, 2020). Sadly, further research indicates most South African’s are dissatisfied with their medical aid service provider. Many feel resentful and ripped off when thinking about how much they pay versus how much they still have to pay out of pocket when they need care.
It’s no wonder most South Africans on a private medical scheme are wanting to cut down on these expenses. A medical aid is a grudge purchase that takes a big portion of hard-earned monthly income from its members for what most feel is not adequate cover.
The South African economy, along with its high unemployment rate means that most of its citizens are unable to afford private healthcare cover, which in turn puts greater strain onto those that can. The harsh reality is that people cannot afford to be without it either.
Cutting down on your medical aid is a major disinvestment
The government system in SA that was designed to provide free or low-cost treatment for all, is failing, and declining by the day and it seems there is little chance that it can continue to provide more than basic primary care. This against a backdrop where there appears to be a growing need for advanced diagnostic services such as MRI or CAT scans. The severe and often life-threatening impact on a patient waiting for service from a government health facility is distressing.
Not many South Africans have R9000 lying around in case they need to pay for an MRI, and by the off chance you need bypass surgery you could find yourself looking for R300 000 or more in your budget. Still wondering if you should give up or cut back on your medical aid?
Do not give up your medical aid
If you have the means, it pays to invest in the most comprehensive cover that you can afford. Of course, you should consider your circumstances. For example, if you are young and in good health, a hospital plan for unforeseen emergencies should prove to be an effective and affordable option.
However, those with children or those with chronic illness and regular healthcare expenses should opt for the most comprehensive product they can afford.
If you are struggling to maintain your medical aid repayment each month you could look at ways to reduce this monthly expense by downgrading to a hospital plan and then taking out medical insurance and gap cover separately. This is a far less risky approach than cancelling your medical aid cover altogether.
Another option is to get an expert to assist you. You could reduce costs by reducing benefits that you do not need.
What you need to know when downgrading
The number of benefits you opt for will determine how much you pay. However, one of the key challenges you may face with trying to downgrade to cheaper cover is that most schemes only allow members to change to a different option once a year, usually towards the end of the year. Changing before then could result in you having to pay back any savings that were advanced to you at the beginning of the year.
Some of the more common downgrade options that you could consider include;
- dropping down to a cheaper option with limited out-of-hospital cover.
- opting for a smaller medical savings plan or no savings plan at all.
- moving to a plan that allows you to pay less if you use medical service providers (doctors) that are listed as part of the scheme’s doctor network.
Before deciding, ask yourself – Are you being driven by price or by need?
Remember, when deciding to downgrade your cover, you must be mindful of your own and your family’s current and possible future needs. Don’t fall into the trap of making a decision based on price alone. Find an option that has suitable cover and that fits your budget. If you don’t have enough cover or the right cover or you haven’t understood the fine print – you could still be crippled financially by an accident or unexpected health crisis.
The three main things to review and consider when choosing your medical scheme:
- Hospitalisation costs
- Day to day savings
- Chronic care: including medication costs
Also Remember PMB’s (Prescribed Minimum Benefits)
In terms of the Medical Schemes Act, regardless of the benefit option you have selected, there is a defined list of benefits/treatments for which all Medical Aid schemes in South Africa have to provide cover for. This includes covering the costs related to the diagnosis, treatment and care of any emergency medical condition; a limited set of 270 medical conditions; and 25 chronic conditions.
It is important to note when it comes to chronic medication that schemes can impose preferred providers and sometimes only pay for generic versions of medication. This means that you need to get your medication from the medical scheme’s appointed service provider, or you will need to fund a co-payment out of your own pocket for your chronic medication.
If you have a persistent condition, check if it is listed as a chronic condition and then check that the medication you use is also covered. Some medical schemes have additional chronic conditions that they cover over and above the 25 that they are obligated by law to cover. These additional conditions could change, so again if you were covered this year, don’t assume it will be covered next year. Rather double check to avoid surprise expenses.
Beware of out of Network penalties
Most Medical Schemes have service provider networks with whom they have negotiated rates to contain costs. These networks include pharmacies, GP’s, specialists and hospitals. If your healthcare provider is not one of these network providers, you will be liable for a co-payment.
If the network is convenient for you to use, then changing to a ‘network’ plan could mean substantial discounts on your monthly medical aid premium. If saving money is a major priority for you, then find out if the medical scheme provider you are currently with has a network and if they are in your area. Then if they are acceptable to you, consider downgrading your option.
We can help!
Medicalaid.co.za is South Africa’s best medical scheme comparison website where we help you to find the best medical cover for your healthcare needs and budget (at no cost to you). In three easy steps you can compare your current medical scheme premium or get a quotation comparison based on your needs.
If you want to be able to search for, and compare, personalised medical schemes and healthcare options across multiple service providers with just one click, then visit medicalaid.co.za now.