The Ins and Outs of Medical Aid Co-Payments – and How to Avoid Them

December 9, 2021

Medical aid co-payments tend to be one of those little things that sneak up on you. The chances are that you won’t even know about them until you get the bill.

And then it’s too late – you are on the hook for whatever portion of your medical bill is classified as a medical aid co-payment.

Medical aid co-payments represent the amount the member must pay out of their pocket for medical bills.

Think of it as a deductible on your car insurance. You are liable for the deduction, and it is only after this is paid that your main insurance kicks in.

Size of Medical Aid Co-Payments

The amount of the co-payment will depend on your medical aid rules. Though, it will usually only apply to more specialized procedures or cases where the doctor is charging more than standard medical aid rates.

That is why it is crucial to ascertain upfront what your medical aid will and will not pay. Doing research before choosing a medical aid option has never been more important.

You could look for a medical aid that has no co-payments or one that has fewer co-payments. However, these tend to be expensive.Medical Aid Co-Payments

The reason I suggested finding out ahead of time what the co-payment is is that these can be quite steep. And if you are dealing with a specialized procedure that is even truer.

That is why your medical aid might not quite be enough cover for you. While they may be fine for day to day procedures, you need extra peace of mind for hospital visits, etc.

Gap cover can give you that peace of mind. It will cover the difference between what your medical aid will pay and what the actual bill is.

Check Out Your Medical Aid Rules

When choosing a new medical aid, it is important to do proper research. Make sure that you understand what cover you will get and what costs you will need to pay for yourself.

Compare the different schemes carefully so that you can make a fully informed decision. Choose the scheme that is best suited to your needs.

You are looking for one that offers good value rather than just the lowest price. Also, choose a scheme that has a firmly established reputation.

Also, ensure that you establish up front what the fine print in the contract is. In cases where 100% cover is offered, for example, what do they mean by 100%? Is this 100% of standard medical aid rates, or 100% of the bill? The difference can be significant.

If you are unsure of which to choose, it would be wise to see and independent broker who can advise you on several medical aids.

Knowledge is Power

It is also important that you do some research into the “language” of insurance. Get to know what the technical terms mean so that you fully understand what you are dealing with.

Knowledge in this instance is power – remember that you are going to have a long-standing relationship with your medical aid and a little bit of research now will save you years of heartache later on.

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All info was correct at time of publishing