Hippo Staff Writer · Published 5 November 2025 · Updated 4 July 2026 · 1 min read

Closing the gap between what your Medical Aid covers and your healthcare costs for in-hospital expenses

Medical aid is there to protect us when we need it most, whether it's to cover the cost of that periodic visit to the doctor or prescriptions, or most importantly, to pay for a visit to the hospital that may arise from an unexpected illness. And while you may do a lot of research when deciding which medical aid will best cover your particular healthcare needs, it is not possible to predict the future. If you are admitted to hospital for treatment and the various specialists charge more than your medical aid covers, you will need to cover the gap.

What you get charged may be much higher than your medical scheme's rate

It's cost-effective to buy a medical aid plan that covers you at 100% of the medical aid rate for hospitalisation expenses and to add gap cover, instead of choosing a plan that covers you at 300% of the medical aid rate. Depending on your choice of gap cover, you could be covered for up to 500% of the medical aid rates through your gap cover policy. Most medical aids also charge co-payments on certain procedures in-hospital that your gap cover policy may also cover. It's important to remember that your gap cover policy will pay you the shortfall, which you will then settle with the healthcare provider.

Medical gap cover isn't an additional medical aid

Medical gap cover is short-term insurance to cover a shortfall or the gap between your healthcare costs and what your current medical aid will pay. It is an affordable way of avoiding a big bill you did not budget for down the line.

The likelihood of you finding yourself with a shortfall after receiving necessary treatment in hospital depends entirely on your personal profile, i.e. what plan you are on, what your medical needs may be and what the treating medical specialists charge. Use the Hippo.co.za free comparative tool to evaluate the available medical gap cover offers and find the one that suits your medical needs.

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