Learn More About How To Go About Choosing the Best Medical Aid Cover

February 26, 2022

Why You Need the Best Medical Aid Cover

There are many medical aid options for you to choose. Before you make a decision on the one you choose, you need to ask yourself a few questions. What is the state of your health, what are you willing to part with for a premium each month? Are there co-payments and will your medical aid pay for your hospital stay in full? By asking these questions, you will be able to choose the best medical aid cover for yourself.

best medical aid cover

100% doesn’t mean Comprehensive

An important aspect to think about is that if a medical scheme says it will pay 100% of the scheme tariff for a stay in the hospital, this doesn’t mean your bills are paid in full. Your medical plan will only pay up to a certain amount.

Your specialist will charge what they want, which is always well above the medical scheme tariff guidelines. The medical aid that you are with won’t pay for this excess amount, leaving you to pay the differences. It is, therefore, a good idea to always use network hospitals – it will certainly keep your bills lower.

The Medical Aid Schemes Act directs medical aid schemes to pay for the diagnosis and treatment of some 270 conditions, also known as PMBs. These Prescribed Minimum Benefits have caused massive problems. Now the government is going to re-look at the PMB legislation and make changes.

The Best Medical Aids aren’t always the Largest

It is always a good idea to go for the best medical aid cover. The largest medical schemes, however, aren’t always the best ones. Some of the smaller medical schemes such as Fedhealth do very well against their larger rivals. That is according to GTC Healthcare, which recently went public with surveys on which are the best medical aids.

Jill Larkan of GTC Healthcare says that with the comprehensive options, Fedhealth came out tops with its Maxima options. A spokesperson for Fedhealth stated that a huge challenge for the medical scheme is to keep things affordable while still providing quality health care.

Your choices Effect levels of Health Care

Choosing the best medical aid is important because your choice will affect your level of health care. Medical aid comparison sites don’t recommend a blanket best plan. They rather try to provide you with as much useful information as possible so you can make a decision that works well for you.

You have to choose your medical scheme carefully as some plans pay at 100-, 200- or 300% of the scheme rate. That, however, does not mean full cover.

Whether you have what is considered the best medical scheme or not, it may still come as a shock to you to discover that most medical schemes don’t fully cover you when you’re hospitalized. The medical aids limit cover according to the Medical Scheme Tariff (MST). That is always well below what the specialists charge you, and they won’t pay for the excess amount.

Having Medical Aid is NOT Enough

The truth is, if you don’t have Gap Cover, depending on the treatment you have, you could have an enormous shortfall to pay should you end up in the hospital. Having medical aid isn’t enough – you simply have to have medical gap cover because your medical aid has inadequacies.


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All info was correct at time of publishing