Hospital cover or medical aid scheme: which is right for you
As you grow older and reach adulthood, the time comes to take care of your health on your own.
However, deciding between a hospital plan and a medical aid can be difficult when you are unsure of what the differences are between them.
Below you will find information on both, including the advantages and disadvantages to take into consideration.
Hospital cover
A hospital plan or hospital cover provides you with basic but vital medical cover. It ensures that when you are admitted into the hospital for an emergency, your expenses are covered – within the limits set by your particular plan.
Many hospital plans offer cover for 27 chronic conditions, and this cover is mandatory. A hospital plan does not cover you for day-to-day GP visits and often offers very little in the way of dental benefits, but you can rest assured knowing that if you are involved in an accident, you will be able to go to hospital and have your fees covered.
Advantages
Affordable access to medical care: A hospital plan is often considered as a ‘beginner’s’ foray into medical aid schemes, but it is also an effective way for those who earn lower salaries to gain access to medical care. You will not have to wait at a government hospital if you need help, as a hospital plan allows you to afford private medical care which is especially beneficial to those with children or pregnant mothers.
It can bridge the gap: A hospital plan can be used to bridge the gap between the coverage that medical aid provides and what it does not. For some schemes, you can have both hospital cover and a medical aid, using the hospital cover to pay the difference of what you owe which can provide immense relief after a stressful period. However, you will find that there is a product known as ‘gap cover’ that is also used for this purpose.
Disadvantages
No day-to-day benefits: Some hospital cover options offer no day-to-day benefits or cover, meaning that you will have to spend your own money to pay for these visits. This can become costly if you are earning a lower salary. If you know that you need day-to-day coverage, a comprehensive medical aid may be a better option for your needs.
Pre-existing conditions are excluded: Many hospital plans do not offer coverage for pre-existing conditions. The medical bills for treating these conditions can become highly expensive, and not having cover for them can become debilitating. Some hospital plans can even permanently exclude certain pre-existing conditions, whereas a medical aid may not be allowed to do so.
Medical aid
A medical aid is a healthcare scheme that you purchase as monthly premiums in order to afford treatment from private medical practitioners. It typically provides cover for both procedures and daily medication, depending on the scheme that you choose.
If you need daily medication or have to visit a doctor regularly, a medical aid is an ideal choice for you. A medical aid offers minimum benefits, regardless of the scheme you choose, including emergency medical conditions, a defined list of 270 diagnoses, and a defined list of 27 chronic conditions as mentioned previously.
Advantages
Savings on medical procedures: Medical procedures, such as surgeries can cost a lot of money, especially if you have to stay overnight in the hospital. Your medical aid scheme will give you peace of mind that this hospitalisation and the procedure are covered. You may have to take out gap cover if the medical aid scheme only covers 100% of your fees but this is an affordable monthly extra.
Day-to-day cover is part and parcel: One of the major benefits of having a medical aid scheme is that day-to-day benefits are included. This includes a set number of GP visits, a list of medications that you may need and dental benefits from chosen practitioners. Having these benefits available is ideal for families or for older people who want to remain healthy in their golden years.
Disadvantages
Strict rules apply: Some medical aid schemes charge a hefty ‘latecomers fee’ for those who are over 39 years-of-age and who are signing up for a medical aid. This fee is also applicable to those who were previously on a medical aid scheme and had to cancel it for some reason. This fee is added to your monthly premiums, which can become highly expensive.
Co-payments can be involved: Along with the other expenses tied to having a medical aid, one that you will need to consider is the co-payment. This means that you may have to pay along with your medical aid for certain procedures. Your chosen scheme may only pay for a certain portion of your medical costs, while you will have to repay the rest.
The verdict?
Deciding on a hospital plan or medical is a highly subjective issue and is relative to your situation. If you feel that you are young and healthy enough not to need GP visits on a regular basis, then a hospital plan is an ideal choice. However, if you have a family or are no longer in your twenties (and lack the vim and vigour that comes with this age) then a medical aid scheme is a better option. Look carefully at what benefits you are offered for each one and weigh out the pros and cons before you come to your decision.