Can’t afford to join a medical scheme? You’ll take your chances and get free treatment in public hospitals, if you need it? Think again, because public hospitals may charge you if you earn above a certain amount.

If you use government clinics and hospitals, you are supposed to pay in line with your income.

With written proof of unemployment from the Department of Labour, or proof that you receive a grant, you don't pay. But the minute you earn an income, they’ll do a means test to decide if you’re in one of the three bands with the lowest band paying the least. 

The first band (H1) is for single people earning less than R70,000 or a family income of less than R100,000 a year.

You will fall into the second band (H2) if you earn between R70,000 and R250,000 or your family income is between R100,000 and R350,000 a year. 

If you earn more than R250,000 a year on a single income or more than R350,000 a year as a family you will be in the highest band (H3).

Remember that if you are employed, you need proof that you were hospitalised to claim sick leave from your employer which is not issued to those who are unemployed.

Are hospitals actually billing?

You should get a bill, but some hospitals don’t implement this. 

“There is little or no capacity to bill patients at district and regional hospitals; only central and tertiary hospitals may bill as they have computerised systems,” says Dr Ozayr Mahomed, public health medicine specialist at the College of Health Sciences, University of KwaZulu-Natal. 

The Western Cape and Gauteng do bill, he says. So expect one if you live there. What's more, they charge interest on overdue invoices.

Also, steps are being taken to bill more efficiently. For example, “the Government Employee Medical Scheme has a project with the Department of Health to improve billing where members received services in these hospitals," says GEMS COO Dr Stanley Moloabi.

How much do they charge?

If you fall into the first income band (H1) and land up in intensive care, you’ll pay R160 at most, for 30 days, or part of 30 days all costs included.

But if you are in the second income band, and you land up in ICU treated by a specialist for 10 days, you could be billed R4,950 for your bed. Fees for medication and radiology procedures need to be added, and the consultation fee is R355 for every 12 hours, Dr Mahomed says.

At the highest level, there’s a huge jump in costs. “If you have a serious or catastrophic medical condition, it becomes a major financial burden,” says Dr Mahomed. “For intensive care at an academic hospital, you currently pay R1,467 a day in facility fees, so if you're there for 10 days, that’s R14,670. Again, there are other costs to add, like consultation fees, imaging and medication.

“As a young single person earning just over the threshold of R20,833 monthly (before tax), how long would you take to pay it off?” 

Won’t National Health Insurance give me free care? 

That’s the idea: necessary health care, no matter your income. There will probably be a tax in line with your income, though. This is meant to kick in by 2026, but is unlikely to be fully in place then because it involves legislative changes, Dr Mahomed says.

In the meantime, a big hospital bill is your problem. Weigh up the cost of medical scheme contributions against the cost if you end up seriously ill in a government hospital, he advises. 

“Ideally patients in the upper tier should be on a low-cost medical scheme that covers hospitalisation costs,” Dr Mohamed says.

What does medical aid offer? 

Basic medical scheme options cover your hospital bills and might give you day-to-day cover (like GP consultations). You also get cover for prescribed minimum benefits (PMBs): 270 listed conditions, and 27 chronic conditions like asthma, diabetes, epilepsy, schizophrenia, and high blood pressure. Even if you are old or unhealthy, you can still join. 

Can I wait until I’m sick to join?

To discourage this, schemes charge an ongoing “late-joiner” penalty, on top of your contribution, if you join after age 35. The older you are, the more you pay. Schemes also apply waiting periods: you pay contributions, but have to wait to get benefits.

So what does medical aid cost?

On a monthly salary of up to about R7,000 or R8,000, you can get basic cover for monthly contributions of about R850 (main member only).

These are the 2019 monthly contributions for basic plans from the three largest open medical schemes before any employer subsidy is taken into account:

• Discovery Medical Scheme, KeyCare Core, for those earning R13,051 or more: R1,661 (main member and adult dependant), R376 (child)
• Bonitas, BonEssential Select: R1,477 (main member), R1,130 (adult dependant), R433 (child dependant)
• Momentum Health, Custom: R1,515 (main member), R1,146 (spouse/adult dependant), R537 (child).