How to compare Medical Aid plans

How to compare Medical Aid plans -

Choosing the right Medical Aid plan can be one of the most important decisions you make for yourself and your family. Here's how to do it wisely.


Finding the best Medical Aid plan to suit your needs should not be a snap decision, especially if you have little ones stumbling their way into the one sharp corner you forgot to baby-proof. And, in a medical emergency, it's only the lucky few who have a mountain of cash just begging for the chance to be used.


That's why, whether you're in the market for a hospital plan, full coverage or are simply changing plans, it pays to compare Medical Aid quotes. Limiting unnecessary financial stress at a time when you're already emotionally depleted is vital. So, which factors should you be considering when it comes to finding the best Medical Aid scheme?


Calculating the costs of Medical Aid

When making a commitment that requires significant monthly payments, first consider your budget. Calculate just how much flies out of your account each month and see what you're left with. It's also a matter of prioritising: you may have to put away those takeaway menus and reallocate the funds to your Medical Aid scheme. As a rough guideline, you should allocate up to 10% of your monthly income to Medical Aid.


Once you've determined how much you can afford, calculate how much your ideal plan costs. Here, a needs assessment based on your and your family's health needs and associated costs is helpful. You may want to consider the following:

  • how much medical expenses have cost you over the past year
  • how often you and your family visit the doctor and see specialists
  • how much medication you require and how frequently
  • whether anyone in your family suffers from chronic conditions
  • once-off costs like childbirth


Based on these considerations, investigate which Medical Aid scheme offers the best value for money and covers your family's annual medical needs. Costs will be lower if you decide to sign up for a hospital plan that covers only in-hospital procedures, and they will increase if you go for a specific tier of comprehensive cover that includes medical savings that cover doctor's visits and medication.


Also consider the reputation, customer service and user-friendly online resources offered by the different Medical Aid schemes. Before you commit, also determine what co-payments (a fixed amount that your scheme requires you to cover for certain treatments or procedures) you'll need to cough up.


Read more:What exactly is Gap Cover and why you need it

Plans with benefits

Before you sign on the dotted line, educate yourself on how Medical Aid works. Different plans offer various in- and out-of-hospital benefits. These include a certain number of day-to-day benefits like free wellness screenings (blood pressure, cholesterol, blood sugar, mammograms, HIV, etc), vaccinations, chronic and acute medication and major medical expenses like hospitalisation, maternity benefits or the management of chronic conditions.

Exclusions and Medical Aid waiting periods

Always read that inescapable fine print, rather than discover that your pregnancy costs are not covered just as the contractions begin. In fact, all Medical Aids have a pre-defined list of exclusions (general and dental services and products) that they don't pay for.


What's more, when new members join a new Medical Aid scheme there is usually a three-month general waiting period before you can claim for any medical expenses or a 12-month waiting period. For example, if you:

  • have a pre-existing condition
  • have never belonged to a medical scheme before
  • have had a break in your medical scheme membership of 90 days or more

Provider networks

Finally, investigate which doctors are included if a provider network, ie a restricted list of certain GPs, hospital networks and preferred medical providers is specified in your plan. Your Medical Aid scheme will have negotiated special rates with the practitioners on the network and will only pay for the use of their services. You'd hate to have to abandon beloved Dr Ferreira if you've been seeing him since you were in nappies or to have to travel to Fourways to see a GP if you live in Boksburg.


Read more: The difference between Medical Insurance and Medical Aid

Now that you know what to look for, use's free online Medical Aid quotes comparison tool to compare plans and find the best Medical Aid option for you and your family.

This article is for informational purposes only and should not be construed as financial, legal or medical advice.

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