Medical Aid versus Hospital Plan

ndy

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Nov 6, 2014
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27
We have a family of 5, myself + wife + twin girls 15 and a 5 year old boy.

We are looking for a cost effective insurance, a lot of people have been advising me about not taking medical aid as they also do not always pay for certain medication or do not pay full amount. We are not a family that get sick a lot, particularly us as adults. Some friends told me to only get hospital plan and pay for day to day visits to Doctor and medicine. At the end of the day you will get that back from SARS, anyone to confirm this?

Lastly either you advising medical aid or hospital plan, which companies do you recommend that have worked for you?

We would appreciate advise, please do not hesitate to ask me further information so you are in a position to better advise.

I thank you in advance
 

MickeyD

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At this stage of your family life I would advise you to have a medical aid - the best one that you can afford. Even if it is an entry level MA with a hospital plan attached.
 

Kosmik

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At this stage of your family life I would advise you to have a medical aid - the best one that you can afford. Even if it is an entry level MA with a hospital plan attached.

Or a basic plan like KeyCare etc. Not having aid is actually dangerous.
 

Pitbull

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Apr 8, 2006
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We have a family of 5, myself + wife + twin girls 15 and a 5 year old boy.

We are looking for a cost effective insurance, a lot of people have been advising me about not taking medical aid as they also do not always pay for certain medication or do not pay full amount. We are not a family that get sick a lot, particularly us as adults. Some friends told me to only get hospital plan and pay for day to day visits to Doctor and medicine. At the end of the day you will get that back from SARS, anyone to confirm this?

Lastly either you advising medical aid or hospital plan, which companies do you recommend that have worked for you?

We would appreciate advise, please do not hesitate to ask me further information so you are in a position to better advise.

I thank you in advance

Depends on what is easier for you.

I prefer paying the Dr's cash and saving on the monthly costs of medical aid. Just bare in mind, a specialist can cost around R1k and you need to have funds stored to cover such things. For anything in hospital or emergencies you're covered on your hospital plan. Just make sure to get gap cover as the normal Hospital plans are only 200%. And have at least R 10k saved somewhere to cover Dr visits and the like if needed.
 

TheSlinger

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I agree with the consensus here. Medical Aid is important, specially with kids! Lots of bugs and accidents waiting to happen.
 

Pitbull

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Your friends are idiots, as said above get the best medical aid you can reasonably afford. Skimping on medical aid is a time bomb waiting to happen.

Whoooo haaaaa...

You can't call them idiots. Have you done the maths yet? It does save me money having a Hospital plan only. But it's all dependent on your needs and requirements.
 
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Whoooo haaaaa...

You can't call them idiots. Have you done the maths yet? It does save me money having a Hospital plan only. But it's all dependent on your needs and requirements.

I don't know your specific circumstances but advising the OP to only take a hospital plan with 3 kids is idiotic....
 

MickeyD

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Whoooo haaaaa...

You can't call them idiots. Have you done the maths yet? It does save me money having a Hospital plan only. But it's all dependent on your needs and requirements.
And discipline... You must never dip into that medical savings account.
 

Pitbull

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I don't know your specific circumstances but advising the OP to only take a hospital plan with 3 kids is idiotic....

Again: Not true.

My medical expenses last year was just shy of R 12k.
I would have paid over R50k for a medical aid. Currently it's just shy of R 30k so in total last year Medical aid costs total was R 42k. a saving of R 8k. This year is way less (expenses) so should be even cheaper this year. Add to that Cash is king at Dr's, massive savings too.
 
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Again: Not true.

My medical expenses last year was just shy of R 12k.
I would have paid over R50k for a medical aid. Currently it's just shy of R 30k so in total last year Medical aid costs total was R 42k. a saving of R 8k. This year is way less (expenses) so should be even cheaper this year. Add to that Cash is king at Dr's, massive savings too.

Again: I'm not commenting on your situation but the OP's...

Sure a hospital plan covers A&E but what about serious long term illnesses? Cancer, heart problems, undiagnosed genetic disorders in the 5 year old etc etc etc. Your system clearly works for you, advising it for the OP on the other hand is idiotic...
 

EMAM

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Again: I'm not commenting on your situation but the OP's...

Sure a hospital plan covers A&E but what about serious long term illnesses? Cancer, heart problems, undiagnosed genetic disorders in the 5 year old etc etc etc. Your system clearly works for you, advising it for the OP on the other hand is idiotic...

I have cancer. I'm on a Discovery hospital plan. It covers R300 000 in oncology, out of hospital, annually.
 

Pitbull

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I have cancer. I'm on a Discovery hospital plan. It covers R300 000 in oncology, out of hospital, annually.

True some things does bite you pocket a bit like Specialist visits and the like. But as you noted dreaded diseases are covered up to a certain amount. Sure if I have to use chronic meds I'll weigh my views again. But as it stands this is working for me more than 100%. But on one thing I agree with Scottulus. It's not a one solution fits all. One has to look at your requirements and whether or not your family uses a Dr a lot. Or if you have kids with chronic illnesses.

But there is a benefit to both and one needs to weigh your options carefully.
 

Paul_S

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Jun 4, 2006
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I'm going to downgrade my entire family to a hospital plan plus gap cover.
Most of the hospital plans cover dreaded disease and a decent gap cover covers what the hospital plan doesn't (like 20% co-payments for oncology once a specific thresh hold has been reached).

I simply can not afford R7000+ per month for medical aid escalating at over 10% per annum. That's nearly 30% of my nett salary.
Private medical treatment is fast becoming a luxury that only the rich can afford.
 

The_Ogre

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I will never settle for a comprehensive medical aid. Hospital cover is more than sufficient in my case.

We haven't had medical incidents for almost 5 years now - that's a few hundred grand saving vs comprehensive.

We also pay cash for GP visits.
 

Pitbull

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I will never settle for a comprehensive medical aid. Hospital cover is more than sufficient in my case.

We haven't had medical incidents for almost 5 years now - that's a few hundred grand saving vs comprehensive.

We also pay cash for GP visits.

Discount for paying cash, and can claim back the tax :)

Win/Win
 

JackWhite

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You can only claim back tax if you exceed a certain amount in medical expenses for the year. I have been on medical aid for last 10 years and have never come near that amount.
 

Goliath

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Or a basic plan like KeyCare etc. Not having aid is actually dangerous.

What these guys said, at the MINIMUM you should have a Hospital Plan but if can afford bit more then get Medical Aid plan, it's one of those things you just can't afford to go without (well in my case I think I'm still in the green given all my experiences with health and car insurance claims) and will definitely not skimp on it.
 
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cerebus

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We've done pretty well with a family of 5 on the Coastal Core hospital plan. That includes 3 childbirths by c-sec being paid for and plenty of minor events and hospitalisations and still managed to come out ahead of a comparable medical aid plan. Thankfully nothing very serious has happened, but to suggest that a healthy young family would be stupid and irresponsible to only get a hospital plan is just plain mistaken. Savings schemes are a racket and there's no co-contribution from the MA so you may as well just put the money into a savings pocket and if it doesn't get used, you still have it. The savings plan just encourages you to blow through it like a credit card.

As for chronic issues should they arise, as mrs_ant_man says, in-hospital stuff is covered for pretty much everything that any other MA would cover. Add to that, we're all young and healthy. In any case there's a ton of fringe stuff like specialist visits and over a certain number of regular doctor visits that a medical aid won't cover. The difference between for instance Classic Comprehensive and Coastal Core is around R3500 a month, so you need to consider whether you're realistically going to require that extra R3500 worth of benefits a month - we've had maybe one month this whole year where we've hit to that amount because of a ridiculous number of consecutive illnesses of very small children.
 
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the eskimo

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Nov 5, 2007
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The general advice I always give is at least have a hospital plan. If you happen to be in a car accident or suffer a stroke you do not want a hospital bill of R300,000 if you go private or be at the mercy of state hospitals.

This can be supplemented with gap cover that covers any shortfall for in-hospital.

Unless you have a condition which is not on the PMB list or is not covered under you current option, or your company pays your medical aid, or you want some regularity in your cash flow (as a GP visit + blood tests + meds can easily cost R2,000) you do not really need a better medical aid.
 
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