Full Medical Aid Cover or Hospital Plan Only

Deciding on whether to opt for full (comprehensive) medical aid cover or a hospital plan only, depends largely on the individual and one’s budget. A hospital plan is more affordable and offers protection for the most expensive of services – hospital care. However, one’s medical needs may not require hospitalisation and can still be costly to the point that it can be unaffordable. In this respect, comprehensive cover or full medical aid cover offers the best of both worlds. Fortunately recent changes in private healthcare legislation has now offered the consumer, even those without full medical aid cover, the protection for certain life-threatening chronic ailments.

Full Medical Aid Cover

Full medical aid cover has both an out-of-hospital and in-hospital benefit. A chronic benefit is usually available in both full medical aid cover and hospital plans. The difference lies in the out-of-hospital benefit. This is also known as the day-to-day cover or medical savings. It is this benefit that covers a person for the medical costs incurred when not in hospital. This may include the consultation fees for doctors and other healthcare providers, tests and procedures that do not require hospitalisation, medicines and certain medical devices. Although the costs of these services and products are not as staggering as the costs associated with hospitalisation, it can still be very costly and even unaffordable to some. Full medical aid cover may be the only option to access private healthcare on a daily basis when hospitalisation is not required.

However, it is important to note that out-of-hospital medical cover is not as large as the in-hospital benefit. It is restricted to an overall pool for the year or divided into sub-limits for different medical services. This benefit can be easily exhausted after which one has to pay for medical costs in cash despite being bound to the monthly medical aid contribution. New benefits become effective at the start of the next year.  Ongoing care for more common and life-threatening chronic conditions is not usually a problem as it may be covered for an unlimited amount if it falls within the prescribed minimum benefits (PMBs) despite the out-of-hospital cover being exhausted for that year. Most people will not require the same level of out-of-hospital care on an annual basis. The medical savings account therefore allows a person to carry the unused benefits for the year, over to the next calender year.

Hospital Plan Medical Aid Only

A medical aid hospital plan is essentially only the in-hospital benefit of a full medical aid cover. It is cheaper than a full medical aid cover and chronic benefits are usually included in the hospital plan cover. While it is the more attractive option for many, one has to  be sure that they can cover the out-of-hospital costs in cash. A hospital plan does not cover these costs and without the financial means to do so, one has to turn to the public healthcare system. Hospital medical aids are not the same as hospital cash plans. The latter provides cash in the hand for each day of hospitalisation and are not recognised by hospitals and doctors as a form of medical aid.

There are many considerations when one has to compare a full medical aid cover to a hospital plan only. While the latter is cheaper, it does not offer any out-of-hospital protection. Paying cash for out-of-hospital medical costs for a single person or couple may be affordable but in the event of a large family, these costs can quickly spiral out of control if many fall ill at the same time. On the other hand the ever diminishing benefits for out-of-hospital care means that a person with a full medical aid is not getting the same level of cover as in previous years. Medical aid members are having to fork out cash sometimes after just a few months into a new year yet be committed to paying a full medical aid contribution for the rest of the year.

Both types of cover has its pros and cons. One should consider which is affordable and sustainable in the long term. The needs of the members, whether a single person, couple or family, has to also be factored in before making a decision between full medical aid cover and a hospital plan.