If you’re looking for cheap medical aid‚ these are the best places to find it

Medica aids in South Africa have new cheaper plans.
Medica aids in South Africa have new cheaper plans.
Image: Stock Photo

The cheapest medical aid for low salary earners is CompCare Networx‚ giving the consumers best bang for their buck.

But for those who want a more expensive medical aid that is usually described as offering "comprehensive" cover‚ Fedhealth Maxima plans are the cheapest.

This is according to GTC Annual Medical Aid Survey 2018.

GTC Healthcare broker Jill Larkan compares and analyses 272 medical aid plans from 21 open schemes that are available for anyone to join‚ as well as Profmed‚ which is only for people with degrees.

After her analysis‚ Larkan said that she always felt that “Fedhealth is good value for money”.

The data Larkan uses for her survey comes from the medical aid regulator‚ the Council for Medical Schemes and website Hello Peter‚ where consumers can complain about various products and services‚ including medical aids.

The medical aid survey also shows which medical aids force members to use a state hospital for hospital care and only provide private doctors for out of hospital care. These are on Keycare Access from Discovery‚ Makoti Primary Plan and the Momentum Ingwe State hospital medical plan.

Larkan said: “People join Keycare Access as it is cheapest [and cheaper than Keycare Plus] and don’t realise they have to use to a state hospital.”

Larkan tells people to use her survey with their medical aid broker to help them understand which procedures their medical aid won't pay for‚ often referred to as "exclusions".

For example‚ medical aid plan Discovery Keycare Plus doesn't pay for hip replacements or back operations – and Larkan said medical aid members don't always know what exclusions their plans has in place. The report looks at two element: the macro-elements and the micro-elements of the scheme.

The macro-elements measure its long-term sustainability. To do this Larkan analyses the level of reserves – or savings - it has‚ if it has members who are aging or have it has enough young healthy‚ cheaper members.

The macro-elements may not matter to consumers‚ but do show if the scheme is likely to be around in five years’ time‚ explained Larkan.

If the medical aid is unsustainable with aging‚ sicker members‚ then there will be more and more health bills - translating into higher annual premiums making it unaffordable in five years from now.

Then Larkan looks at the micro-elements of a scheme‚ which is the price of the plan and if it offers value for money.

The combination survey results combine a medical aids' long term sustainability with its current cost.

In these combination results‚ Bonitas BonCap‚ Discovery Keycare Plus‚ Momentum Ingwe Network Hospital and CompCare Networx‚ and Fedhealth Blue Door Plus plans perform well in terms of price and long term sustainability.

Any of these options is usually a safe bet‚ she explained.

Many Discovery plans do well when she takes long-term prospects and current affordability into account.

But Larkan's survey has one assumption‚ which is that every person must have gap cover.

This is an insurance policy usually costing between R100 to R200 and it ensures any doctors bills in hospital – not covered by medical aid – will be paid for.

Medical schemes offer to pay 100% or 200% or 300% of doctors' bills in hospital. This is confusing for consumers as 100% does not mean the bill is covered entirely‚ but people think it is‚ said Larkan.

Gap cover always covers the shortfall for doctor's used in hospital and means consumers can choose cheaper medical aids with the 100% option.

The medical aids to avoid as they have the lowest macro scores – meaning they are likely to become way more expensive each year – are Resolution Health medical scheme and Medshield and Medihelp.

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