5 Reasons Not to Give Up Your Medical Aid

Medical aid is not cheap. But the benefits of a medical aid, and the situations you may face without it, is often motivation enough for most of us to pay the premiums. When times are tough and your budget is close to breaking point, giving up your medical aid may seem like a consideration. A recent survey by Just Money (1) has revealed that about 1 in 4 South Africans can no longer afford medical aid. But before you abandon medical aid altogether, consider some of the points discussed below. It may help motivate you to find another way to keep some level of medical aid cover in these tough economic times.

1. Private Healthcare is Unaffordable

You may be paying your doctor cash already. You may be able to afford the dentist’s fees and your new prescription spectacles. But without medical aid, most private health services are just unaffordable to the average South African. Cancer treatments, major surgical procedures, implants and prosthetics, chronic medication or even a prolonged ICU stay in the event of a serious traffic accident can mean tens, if not hundreds of thousands of rands in medical bills. And it may not be over a long period of time.

Consider that coronary bypass surgery and the hospital stay that follows may cost around R250,000. And you are only in hospital for 3 to 4 weeks. What about your premature baby who may be in neonatal ICU for 2 to 3 weeks? It can set you back around R100,000 if not more. Some new generation cancer drugs can set you back around R30,000 to R40,000 per month. The list goes on but the point is that unless you have large cash reserves and a very healthy salary, chances are that you cannot afford private health services indefinitely without a medical aid.

2. Public Health Without Medical Aid

South Africa has an extensive public health system. Despite the efforts of government to cater for the population’s healthcare needs, there are major shortfalls in the system. From poorly equipped hospitals to understaffed facilities, government hospitals are not often the first choice for most South Africans. Without medical aid, you may have no choice but to use a public hospital should the need arise. Private hospitals in South Africa are quite sticky about admitting patients without medical aid cover. You will need to pay an upfront cash deposit, the amount of which can vary depending upon the reason you are being hospitalised.

If you cannot afford services upfront and if you do not have a medical aid then you will quickly be transported to a public hospital. Despite your pleas and assurances, a private hospital will not negotiate with you. At most they will stabilise you in the event of an emergency and have you transported to a state facility. Should you be in a situation where you cannot speak for yourself and if emergency services cannot find any proof of medical aid membership, you are immediately transported to the nearest government hospital. No questions asked.

3. Medical Aid is Unique

There is no other product like a medical aid. Although there many health-related financial products being aggressively marketed at the moment, medical aid is unique, both within South Africa and globally. Medical schemes are regulated by the Council of Medical Schemes and ensure that members are adequately protected for essential private health care costs. A medical aid accepts every person of every age irrespective of their health status. Although people older than 35 years of age may be liable for a late joiner penalty, medical aids do not charge people who are ill any extra fees.

Medical aid pays service providers, like hospitals, directly for the costs that are accrued when you are hospitalised. Doctors and other healthcare practitioners are also covered. An optional out-of-hospital benefit pays for your day-to-day medical bills up to an annual limit. Hospital cover and chronic care will pay for treatment within hospital as well as the management of any chronic diseases. Even pregnancy and childbirth is covered. No other product provides the same level of cover as medical aid.

4. Range of Different Plans

Medical schemes offer a range of different plans to suit your budget. The level of cover varies accordingly. If you cannot afford your current medical aid plan then you should speak to your scheme or broker about switching to another plan that is more affordable. Schemes even cater for low income earners with medical aid cover starting from as little as R450 per month. You should consider all your options before giving up your medical aid. There are a number of implications should you consider starting up on medical aid again at a later stage.

5. Save Now, Pay Later

If you start up on medical aid after the age of 35 years, you will be liable for a later joiner fee. This penalty is included into your monthly medical aid premium as long as you remain a member. It can even double the premium that you would have paid had you stayed on a medical aid from a younger age. In addition, different exclusion clauses for new members will take effect. These waiting periods will not cover you for the first 3 months for any healthcare services. Then there is a 12 month pre-existing condition waiting period where the scheme will not pay for bills relating to any medical condition that you have had prior to joining the medical aid. Rather sign up for a medical aid while you are still young and healthy and you can rest assured of cover when you need it.


1. One in four can no longer afford medical aid. JustMoney.co.za