Getting sick is a bit of a bogy, and can often include numerous doctors’ bills and a hefty price for all the medicine you’ll need to get better. In South Africa, finding affordable basic medical aid is essential to ensure that individuals and families can access healthcare without straining their budgets. Fortunately, there are insurance providers and financial institutions that offer cost-effective solutions, providing access to essential medical care at more affordable rates.
Healthcare costs can quickly accumulate, and unexpected medical expenses can cause significant financial strain. However, understanding each and every available option and choosing a medical aid plan that suits your budget and healthcare needs can provide much-needed peace of mind.
Before we dive right into the top 5 most affordable basic medical aids in South Africa, let’s try make sure you are up to speed with all things medical aid related.
Why do I need medical insurance in South Africa?
In 2019, it was estimated that approximately that only 17% of South Africa’s population had medical aid coverage. Having health coverage is essential to ensure that your medical bills remain manageable and within your means. In certain instances, private healthcare institutions may collaborate with debt collectors to recover outstanding debts. However, it’s worth noting that their approach is primarily focused on resolving financial matters rather than being overly aggressive. Legal processes and summonses are employed as necessary steps to address outstanding balances.
By obtaining health coverage and exploring available assistance programs, you can proactively manage your medical expenses and work towards a positive resolution. Having medical insurance in South Africa is crucial for various practical reasons. Firstly, it ensures access to quality healthcare services in a country where the public healthcare system faces challenges such as overcrowding and limited resources. With insurance, you can benefit from private healthcare facilities that offer better infrastructure, specialist care, and shorter waiting times. Secondly, medical expenses can be substantial, especially for complex procedures or ongoing treatments. Without insurance, these costs can quickly accumulate and become a significant financial burden. Insurance coverage helps mitigate this by covering a portion or all of the expenses. Thirdly, it provides access to specialist care, diagnostic tests, and treatments, which can be expensive without insurance. Moreover, insurance is beneficial during hospitalization as it covers expenses related to hospital stays, surgeries, medication, and nursing care. It is also vital for individuals with chronic conditions who require regular medication or ongoing treatments. Furthermore, medical insurance often covers emergency medical services, ensuring prompt and appropriate care during emergencies. Finally, it provides coverage for maternity and childcare, including prenatal care, childbirth, postnatal care, consultations, tests, and vaccinations. By having medical insurance, you can effectively manage your healthcare costs and access the necessary medical services without incurring excessive financial burdens.
Here’s a sneak peek of the most affordable medical aids in South Africa:
What are important terms I should understand before I take out medical insurance?
Insurance Premium: The amount you pay to the insurance provider regularly (monthly, quarterly, or annually) to maintain your medical insurance coverage.
Waiting Period: The period during which certain benefits, such as coverage for pre-existing conditions or specific treatments, may not be immediately available after obtaining the insurance policy. Waiting periods vary among insurance providers.
In-Network Providers: Medical facilities, doctors, specialists, hospitals, or clinics that have a contracted agreement with your insurance provider. Choosing in-network providers often results in reduced out-of-pocket expenses as the insurance company has negotiated lower rates with these providers.
Out-of-Network Providers: Medical facilities or healthcare professionals who do not have a contractual agreement with your insurance provider. Seeking treatment from out-of-network providers may result in higher out-of-pocket expenses or limited coverage, depending on your insurance policy.
Co-payment or Co-pay: A fixed amount or percentage of the medical expenses that you are responsible for paying out of pocket at the time of receiving medical services. This amount varies depending on the specific service or treatment.
Deductible: The amount you need to pay out of pocket for medical expenses before your insurance coverage begins. Once the deductible is met, the insurance company starts covering a portion or all of the eligible expenses as per your policy.
Pre-authorization: The process of obtaining approval from your insurance provider before receiving certain medical services, treatments, or procedures. Failure to obtain pre-authorization may result in reduced or denied coverage.
Exclusions and Limitations: Specific medical services, treatments, or conditions that are not covered or have limited coverage under your insurance policy. It is crucial to review these exclusions and limitations to understand the scope of your coverage.
Preferred Provider Organization (PPO): A network of medical providers, hospitals, and healthcare facilities that have agreed to provide services at discounted rates to members of the insurance plan. PPO plans offer more flexibility in choosing providers, both in-network and out-of-network, but generally have higher premiums.
Co-insurance: The percentage of medical expenses you are responsible for paying after meeting the deductible. For example, if your insurance policy has a 20% co-insurance, you would be responsible for paying 20% of the eligible expenses, while the insurance company covers the remaining 80%.
Gap cover: Gap cover, also known as medical gap insurance or medical shortfall cover, is a type of supplementary insurance designed to complement existing medical aid or health insurance plans. It is specifically aimed at covering the “gap” between what healthcare providers charge for their services and the amount covered by the primary medical aid scheme.
Great, now that we’ve covered all the basics let’s take a look at who the most affordable medical insurance providers are in South Africa.
Top 5 most affordable (and best) medical aids in South Africa
1. Discovery Health
Discovery Health is one of the largest and most recognized medical insurance providers in South Africa. They offer a range of medical aid plans to suit different needs and budgets. While their comprehensive plans may be more expensive, they also have options that provide basic coverage at more affordable rates. Discovery Health’s plans are known for their emphasis on preventive care and wellness programs.
Affordable plan: Discovery KeyCare Series – This series offers several options (KeyCare Access, KeyCare Plus, KeyCare Start) with varying levels of benefits and affordability, focusing on essential healthcare needs.
Monthly cost: from R1003 for main member
2. Momentum Health
Momentum Health is a prominent medical insurance provider in South Africa. They offer comprehensive medical aid options along with more affordable plans designed to cater to basic medical needs. Momentum Health emphasizes preventive care and personalized wellness programs.
Affordable plan: Momentum Ingwe – This plan is designed to provide affordable basic medical aid coverage, including hospitalization, chronic medication, and day-to-day benefits, at a relatively lower cost.
Monthly cost: starting from R455 depending on your income, for main member
3. Liberty Health
Liberty Health is a well-known medical insurance provider that offers a variety of medical aid plans, including options for affordable coverage. They aim to provide accessible healthcare solutions with flexible benefits.
Affordable plan: Gold Focus Select – Liberty Health offers different plans under their medical scheme, including options with more basic benefits that are relatively affordable while still covering essential medical needs, the Gold Focus Select is their most basic coverage.
Monthly cost: starting from R1000 for main member
4. Bonitas Medical Fund
Bonitas Medical Fund is a popular medical aid provider in South Africa. They offer a range of medical aid plans, including options designed to provide affordable basic coverage to individuals and families.
Affordable plan: BonFit – Bonitas offers the BonFit plan, which is designed to provide basic, cost-effective coverage for essential medical needs, including hospitalization, chronic medication, and primary care.
Monthly cost: starting from R1674 for main member
5. Fedhealth Medical Scheme
Fedhealth Medical Scheme is a reputable medical aid provider known for its innovative offerings. They have different plans designed to accommodate various budgets and healthcare needs.
Affordable plan: Fedhealth Maxima EntryZone – This plan offers affordable basic medical aid coverage, including hospitalization, chronic medication, and limited day-to-day benefits, making it suitable for individuals seeking cost-effective options.
Monthly cost: starting from R1326 for main member
It’s important to note that affordability can vary based on personal circumstances and the specific coverage requirements. Therefore, it is recommended to thoroughly review the details of each plan, including premiums, benefits, limits, and any additional costs, to determine the most suitable and affordable option for your needs. Consulting with the insurance providers directly or seeking advice from a qualified insurance advisor can help you navigate the available options and find the best fit for you.
BONUS: Basic (and cheap) medical aids available in South Africa
Elixi
Elixi is committed to ensuring individuals have access to private medical treatment when they need it most. The company understands the profound impact unforeseen medical problems, such as illness or injury, can have on people’s lives. Elixi acknowledges the burden placed on individuals and their families, as well as the fear and frustration that arise when access to necessary treatment is limited.
Elixi stands apart by offering unique and affordable solutions tailored to meet individual needs. The company’s core belief is that every individual matters, and they strive to prioritize the well-being of their clients. Elixi is dedicated to providing accessible and timely healthcare options that make a tangible difference in people’s healthcare journeys.
Monthly cost:
Starting from R399 Blue Plan – Primary Care benefits
Starting from R537 Purple Plan – Primary Care benefit + hospital plan
Dischem Health
Dischem Health offers a range of affordable private Day-to-Day Insurance options and Additional Cover options designed to meet the healthcare needs of individuals and their families. With Dischem Health, individuals can access comprehensive coverage for their day-to-day medical expenses at an affordable cost.
The Day-to-Day Insurance options provided by Dischem Health typically include benefits such as unlimited GP consultations, acute medication, chronic medication cover, basic dentistry, optometry benefits, and maternity benefits. These options are designed to ensure that individuals have access to essential healthcare services without incurring significant out-of-pocket expenses.
Monthly cost: starting from R450 for main member
GetSavvi Health
GetSavvi Health serves as a vital bridge between the 72% of individuals who do not have medical cover and the quality healthcare they deserve. Recognizing the significant portion of the population without medical insurance, GetSavvi Health aims to provide accessible solutions that address this healthcare gap.
The company offers affordable medical insurance options that cater to the diverse needs of individuals and their families. These options are designed to be cost-effective while still providing comprehensive benefits and coverage. By making quality healthcare accessible and affordable, GetSavvi Health aims to ensure that everyone can access the medical services they require without facing excessive financial burdens.
With GetSavvi Health, individuals can easily explore and select suitable medical insurance options tailored to their specific needs.
Monthly cost: starting from R542 – primary care benefits
What is the National Health Insurance Bill?
The primary objective of the NHI Bill is to ensure universal access to quality healthcare for all South Africans, aligning with the principles enshrined in the Constitution. The Constitution recognizes healthcare as a fundamental human right, emphasizing that every individual has the right to access healthcare services. It further states that the state must take reasonable measures, within available resources, to progressively realize these rights and must not deny emergency medical treatment to anyone.
The NHI Bill aims to fulfill these constitutional rights by addressing key principles:
Socio-Economic Equality: The bill aims to prevent the deprivation of healthcare rights based on an individual’s socio-economic status. It seeks to provide equitable access to healthcare services, ensuring that quality care is available to all South Africans, regardless of their financial circumstances.
Unified Public Health Fund: The NHI Bill proposes the creation of a single public health fund with sufficient resources. This fund would be responsible for comprehensive planning and effectively meeting the healthcare needs of the entire population, rather than serving only a select few. By consolidating resources, the aim is to improve healthcare infrastructure, enhance service delivery, and ensure fair distribution of healthcare resources across the country.
Universal Health Coverage (UHC): The ultimate goal of the NHI Bill is to achieve Universal Health Coverage. This means that every individual in South Africa should have access to a comprehensive range of essential healthcare services, including prevention, promotion, treatment, and rehabilitation, without facing financial hardships or barriers.
Through these measures, the NHI Bill seeks to create a healthcare system that promotes equal access to quality care, regardless of socio-economic status, and ultimately works towards achieving Universal Health Coverage for all South Africans.
Although the National Health Insurance Bill in South Africa is a long way from being implemented, it’s advisable to keep an eye on the government’s website for my recent updates.
