Can’t afford a medical aid in South Africa? Here are some options to consider
South Africa has some of the most expensive medical aids in the world. Only 16% of South Africans can afford private healthcare at all – and with inflation and unemployment on the rise, that number is likely to shrink even further.
According to the World Health Organization:
“South Africa spends more on voluntary private health insurance (42%) as a share of total health expenditure than any other country in the world. It serves, however, only 16% of the population.”
Sadly, this means there are lots of people left without any medical cover at all. If illness strikes or an accident happens, their only option is to receive care from State hospitals – which do their very best but have extremely limited resources and huge numbers of patients to try and assist.
Thankfully, there are also a growing number of ways you can access quality healthcare and cover yourself and your loved ones against medical emergencies and dread illnesses without breaking the bank. In this post, we take a quick look at why medical aids in SA are so expensive, and what the alternatives are.
Why are medical aids in South Africa so expensive?
In a nutshell, it all comes down to something called Prescribed Minimum Benefits, or PMBs. To be allowed to call themselves a ‘medical scheme’, medical aids need to cover all of these. (Members of a ‘medical scheme’ can claim some of their premiums back in tax, while those with a ‘hospital plan’ or ‘health insurance cannot.)
What are PMBs?
According to the Medical Schemes Act, medical schemes must cover the costs related to the diagnosis, care, and treatment of:
- Any emergency medical condition
- A limited set of 271 medical conditions
- 26 chronic conditions
Many of these PMBs can only be treated by specialists, whose services are not regulated, and as a result may charge as much as 700% of the medical scheme rate.
What this means is that medical aids, on average, spend about R866 per member in order to cover PMBs. In other words, if they don’t charge at least R866 per month, they can’t make any profit at all.
What other options do I have?
If you’re one of the many South Africans looking for affordable medical aid, a number of services are offered to bridge the gap. Namely:
Hospital plans:
As the name suggests, these cover unforeseen emergencies, accidents, or illnesses which require hospitalisation. At the most basic level, these offer cheap healthcare, and allow you to access private hospitals affordably if the worst happens.
Health insurance:
Either as standalone or as an add-on product to a hospital plan, these give you some additional healthcare benefits. For a higher premium, you can access services like GPs, opticians, and dentists as part of your cover.
Here at EMERGIVAC, we take things one step further by partnering with the Clientele as an underwriter. In medical emergencies, we’ll be by your side to make sure you get access to the best possible healthcare.
This includes arranging for you to be attended by paramedics, and transported to the nearest private hospital. Your cover includes:
- R150 000 individual cover, or R375 000 family insurance cover limit per annum
- Life insurance – Accidental death cover of R20 000 per individual
- Accidental disability insurance of R20 000 per individual
Our pricing starts from just R249 for an individual, including medical and trauma assist, armed response cover, roadside, and household assist services. EMERGIVAC is not a medical aid, but thanks to our partnership with Clientele, we can give you peace of mind that you and your loved ones are covered in a crisis.
See our pricing or benefits page for more details, or reach out to one of our friendly advisors for more information.
Affordable Medical Aid – FAQ’s ( Frequently Asked Questions)
What options are available for people who can’t afford a traditional medical aid plan?
In South Africa, many people can’t afford the monthly premiums that come with a full-scale medical aid plan. Thankfully, more and more options are becoming available. Here are some of them:
- Health insurance plan
- Hospital plan
- Emergency medical cover from a provider like EMERGIVAC
- Basic healthcare at state hospitals and government clinics is free of charge if you really cannot afford to pay, but the quality of care is not as good as at private facilities.
How do hospital plans differ from medical aid plans?
Hospital plans typically offer lower monthly premiums but may require higher out-of-pocket payments for services not covered by the plan. These plans tend to cover only costs that are associated with hospitalization and certain other medical expenses such as surgery and emergency room visits.
Medical aid plans, however, provide more comprehensive coverage for a wider range of services including hospitalization, doctor’s visits, and medications. While monthly premiums tend to be higher for these types of plans, the out-of-pocket expenses can be much lower than those associated with hospital plans. Therefore it is important to weigh the pros and cons of each option in order to decide which plan is right for your needs.
How can I compare different medical aid options to find the best fit for my needs and budget?
Websites like Hippo.co.za can be useful for this, but you should try and get quotes from as many different providers as possible. It’s also a good idea to ask friends and family about their experience with certain brands before you decide. You can also try Googling more specific terms that suit your needs, such as ‘best medical aid for large family’, ‘affordable medical aid for single person’ etc. It’s a time-consuming process, but the more options you explore the better!
Are there any tax benefits or incentives for getting a medical aid in South Africa?
If you belong to a medical aid regulated by the Council for Medical Schemes in South Africa, you can claim a tax credit. These are called MTCs or Medical Tax Credits. More information can be found on the SARS website here.
Is a health policy as good as a medical aid in South Africa?
In short – no. Of course, this depends on your needs, budget, and overall health. If you are relatively healthy, it might not make financial sense to pay the higher fees associated with a medical aid.
What happens if I can’t pay my medical bills in South Africa?
Medical practices have the legal right to sue patients who cannot or will not pay their medical bills. In the worst instance, this can result in your assets being seized or even jail time. However, a debt counsellor can help you arrange an affordable payment plan, which health providers are usually happy to accept.
Can a person have two medical aids in South Africa?
No, you may not legally join more than one medical aid scheme in South Africa. However, you can take out additional health insurance products like gap cover, a hospital plan, or emergency medical cover, as these are regulated differently.
Which is better, a hospital plan or medical aid?
That’s a tough question to answer, and really depends on your unique circumstances. If your finances are limited, a hospital plan is certainly better than nothing at all. However, if you need to cover several family members or are in poor health, it may be prudent to pay for the broader coverage that a medical aid scheme provides.
How much does medical aid cost per month in South Africa?
The cost for a medical aid scheme of covering the Prescribed Minimum Benefits they need to offer by law is roughly R860 per month, which means they need to charge at least this amount per member to cover their own expenses. As a result, most cheap medical aids will cost about R1000 per month at the very least. The most comprehensive plans can cost upwards of R18,000 a month.
Is medical aid worth it in South Africa?
Again, this depends on your situation. If you need medical attention on a regular basis, have chronic conditions, or have children to consider, a medical aid is probably worth it. If you are young and healthy and don’t have dependents to care for, you may never use the benefits a full medical aid provides. In this case, an emergency medical cover plan like EMERGIVAC’s is a good idea, should you have an accident or be diagnosed with a serious illness.
What to do if you can’t afford to go to a doctor?
In South Africa, care at government-run clinics and hospitals is very affordable, or even free of charge if you cannot afford to pay.
Can I go to a private hospital in South Africa without medical aid?
Yes. If you can afford them, you can use a private hospital in South Africa without being a member of a medical aid scheme, but the fees are generally prohibitive.
How much is a private hospital per day?
Depending on your area and the facility, a hospital bed costs around R2000 per day, excluding your actual treatment.
What does a hospital plan cover in South Africa?
While all plans vary, a typical hospital plan in South Africa will provide financial coverage for medical costs associated with hospital care. These could include doctor’s fees and charges for procedures, tests, scans, or medications while the insured person is receiving treatment in the hospital. They generally don’t cover any treatment outside the hospital, although some plans include coverage for chronic medications or a set amount of GP visits per year.
How can I make sure I’m covered for a medical emergency if I can’t afford medical aid in South Africa?
From just R249 per month, you can get cover for medical emergencies and accidents through EMERGIVAC. This rate includes private hospital admission, ambulance transport to the nearest facility, (or helicopter transfer if necessary) and even accidental death and disability insurance. If you’re not able to afford a medical aid in South Africa, then having this cover as a backup in a crisis can give you peace of mind.
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