How to Choose Which Medical Cover is Best Suited to You

How do I choose medical cover that’s best?

  1. Ask yourself how often you visit the doctor
  2. Do you require specialised treatment?
  3. What’s lined up for you in 2018? Pregnancy or elective surgery?
  4. Choose medical cover that covers the costs of the operation, hospitalisation as well as post-operative care.
  5. Make sure you’re content with using doctors and hospitals within the network
  6. Medical aid costs have increased more than inflation. For 2018 compare medical aid’s for costs and benefits
  7. There are always changes to a medical scheme for the new year – will they affect you negatively?

Are you Downgrading or Upgrading?

South Africa has some excellent medical schemes. However, they require thorough research to understand their take on monthly premiums, co-payments and exclusions.

When looking to choose which medical cover is best for you, take into account whether your needs have changed over the last year. This will determine whether you choose to downgrade, upgrade or change to another scheme.

Age and Milestones a Deciding Factor

Consider how things look in the future. If you’re young, you may be planning a family and require maternity coverage. You Choose Medical Cover That's Rightmay even want to add a student-child of yours up to age 26. Certainly your age will determine how you choose medical cover.

You may have reached a particular milestone in your life and as you get older you begin to realise that you’ll be better off with a more comprehensive plan. You may simply have come to the conclusion that its time to upgrade your medical aid plan.

Willing to use Network Doctors?

Before electing a different plan, you’ll want to see whether the doctor and specialists you use are included in the provider network. Efficiency Discounted Options or EDOs are valued by medical aid members as this is a means to save money.

The medical aid member makes use of a network of healthcare providers and you end up paying far less for exactly the same benefits than were you to choose your own expensive doctor. If you want to be able to visit any doctor you please, there is a price.

In the long run, members receive discounts because the medical scheme is able to use more affordable but highly professional staff from the network.

Is Medical Aid a Viable Option?

Medical scheme contribution rates have been increasing at above-inflation rates and the affordability of medical cover has come under pressure. People are wondering if its still a viable option.

Another reason why you have to choose medical cover carefully is that during the year, your plan may have dropped certain drugs that were previously covered. You may need to move to a plan that caters for the treatments and medications you need.

It is true that the medical aids of South Africa are facing a tough 2018, what with the government’s National Health Insurance plans. Some medical aids will no longer exist while other will be forced to change significantly.

Research is more Important than Ever

In fact the Council for Medical Schemes will have to do away with smaller medical aids – those with less than 6,000 principal members. Also, without tax credits, medical aid is just going to become too expensive for ordinary South Africans. If you do choose to join a medical scheme, always go with one that is financially stable and run according to the Medical Schemes Act.

Conclusion: Choose Medical Cover Wisely

With so much change awaiting in 2018, choose your medical scheme and medical aid plan carefully. Take time to understand your needs before you make your selection, as you can only make changes at the end of the year.


All info was correct at time of publishing