Do you need a fancy shmancy medical aid?

The truth is that you might not need the fanciest medical aid on the market. The truth is that a basic level of hospital cover might actually be enough for you. So how do you know what type of medical aid cover you really need? It all starts with asking yourself a few honest questions:

What can you really afford?
Unless you start with this question, you are wasting your time! We would all love a house in Clifton with a Porsche in the garage, but the reality is most of us can’t afford that. Where you live, what type of car you drive, the schools your kids go to and which restaurants you frequent, are all dependent on the amount of money you make.

So what can you comfortably spend on a medical aid plan? If your budget allows for R1500 per month, then that’s what you have to spend, right? Working out what you can spend on your health care is the best starting point.

How healthy are you?
What type of shape are you in? Are you the type of person who occasionally gets the flu in winter and might only need to a see a dentist once a year, for a filling? Or do you have kids who are in and out of hospital, with all types of ailments? Perhaps you have a chronic illness?

Asking these types of questions, and doing a personal health analysis is going to lead you down a decision making process which will match you with the correct level of medical aid coverage. The younger and healthier you are, the less coverage you need. The older and sicklier you are, the more comprehensive your coverage needs to be.

Can you fund out-of-hospital type expenses?
Medical aid cover is pretty much broken down into two parts: In-hospital expenses (that is when you are admitted into hospital) and out-of-hospital expenses (might be medication you need to pick up at your pharmacy). In-hospital expenses are usually the back-breakers! A night’s stay in a private hospital can cost upwards of R10 000. These types of expenses can bankrupt you if you don’t have any medical aid cover in place? For most of us, having a medical aid means covering these potentially crippling in-hospital expenses.

But there are also out-of-hospital medical expenses we all incur, at some point or another, during the year. It could be a dentist appointment or some physio treatment for a sporting injury.

The question you need to ask yourself is - Do I have enough money, in my back pocket, to fund these out of hospital expenses?

If yes, then look for a medical aid plan that just covers your in-hospital requirements. If you don’t have enough money to pick up out-of-hospital expenses, then consider a medical aid plan with a medical savings account (MSA) attached to it.

Would you consider a network hospital for a discounted rate?
Is there a decent hospital in your area which you would be comfortable visiting? The reason we ask this question is because more and more medical schemes are introducing network hospital options.

That means, they are happy to give you a discount, on your medical aid premium, provided you use the services of a network hospital. It makes sense if:-
  1. You are comfortable with the hospital you are networked to
  2. The network hospital is in a close enough proximity to where you live
Once you have answered the above questions, you will be in the following position:
  1. I know what I can afford to spend
  2. I know how healthy I am
  3. I know if I simply need in-hospital coverage (big expenses) or full coverage to include out-of-hospital expenses
  4. I know if a network hospital option is going to suit me
This now allows you to start shopping around and comparing various medical aid options.