Choosing between some of the best Medical Aid Plans in South Africa

According to the Council of Medical Aid Schemes, only 14.6% of South Africans had medical aid in 2024. Medical Aid offers financial protection when health issues arise and medical bills pile up.

With a myriad of options, benefits, and cost structures, settling on the right medical aid can seem like an admin-heavy task. But, like a doctor you’ve trusted for years with a great bedside manner, let Hippo help simplify and clarify your choices – empowering you to make the right decisions.

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Why Medical Aid matters in Mzansi

If you are amongst those who are fortunate enough to be able to afford Medical Aid in South Africa, it offers you other options over and above our often-overburdened public health services. Your monthly medical aid payment buys you not only a choice of hospitals, specialists and doctors but also speed – by prioritising your care. This level of access to private healthcare comes at a premium price, which medical aid covers, and all medical aid companies are overseen by the Council for Medical Schemes (CMS). The CMS regulates 71 medical schemes and serves over 9.1 million beneficiaries. Think of them as a referee who monitors their conduct and financial stability and protects consumers.

Steps to consider when considering Medical Aid.

STEP 1: Reality check

It’s important to do an honest audit of what medical expenses have cost you over the last 12 months and what needs you have that have to be covered.

• How frequently do you visit GPs, dentists, optometrists or other specialists?
• Are you on any chronic medication?
• How many dependents do you have? Spouses, partners, kids or ageing parents.
• Life events. Do you travel often, play high-risk sports or planning for pregnancy?
• Do you require day-to-day comprehensive cover or only a hospital plan?

Remember to think of medical aid as a financial tool, which helps out when those medical bills pile in like the Bokke in a rolling maul.

STEP 2: Choose the type of plan

A hospital plan does exactly as it suggests; it covers you for when you have to actually go into hospital for an operation or procedure – although some can have limited day-to-day cover too.

Comprehensive plans cover both your day-to-day medical needs and hospital fees, which means a higher price for more cover.

Here are two different types of comprehensive plans:

• Saver (Or Savings) Plans: Hospital cover plus a medical savings account.
• Traditional (Or Priority) Plans: Usually have set annual limits, not an MSA (Medical Savings Account)

Network (or capitated) plans cover you but only within a specific network of clinics and hospitals, meaning you have access to any of their affiliated branches across the country.

STEP 3: Acronym and terminology checklist

Medical aids do enjoy an acronym, so to make sure you know what the major ones mean, here’s a handy checklist.

MSA (Medical Savings Account):

Money is put aside from your monthly contributions into a “savings” account linked to your policy. Any day-to-day medical expenses are then taken from this account.

NOTE: The Council for Medical Schemes limits the amount that can be accumulated in an MSA.

PMB (Prescribed Minimum Benefit):

A prescribed minimum benefit is the minimum set of healthcare services that every registered medical scheme in South Africa must cover by law, no matter which plan you’re on.

DSP (Designated Service Providers):
Most medical aids stipulate that you must use specific service providers who have partnered with the medical scheme. By not using a DSP, you may be in for higher costs.

Waiting Periods:
Depending on your current health status and medical aid membership history, they can either apply a 3-month general or 12-month condition-specific waiting period, or both. It will never be more than 12 months.

Late-Joiner Penalties:
These will apply if you have been without cover, and the percentage is dependent on the years without cover from the age of 35 and ranges from a 5% to a 75% late joiner penalty fee applied to your risk premium. This penalty will be for life no matter which medical aid you choose.

Pre-Authorisation:
For certain procedures which are outside of day-to-day consultations, you will need to pre-authorise this with your medical aid.

Limits and Sub-limits:
Things like dentistry, optometry and scans may be covered but often only up to a certain amount.

Co-payments:
A co-payment is a fixed amount you pay yourself for a specific healthcare service or medicine at the time of the appointment or when you collect treatment, and it is separate from your monthly medical aid contribution.

STEP 4: Compare to find the best Medical Aid plan for you

Without comparing plans and schemes, you wouldn’t know if you could be getting the same cover or possibly more of what you need for a lower premium.

Compare quotes side-by-side from some of SA’s top medical aid providers in minutes.

• Find medical aid that suits your health needs, lifestyle, and budget.
• It’s completely free, with no hidden costs or unexpected terms.
• Your personal information stays private. Hippo will never share or sell your data.
• We only partner with trusted, registered medical aid providers, vetted by us.

This article is for informational purposes only and should not be construed as financial, legal, or medical advice. Coverage terms, pricing, and availability may vary. Always review policy documents carefully and confirm current pricing with providers before making any decisions.