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Health Insurance vs Medical Aid - Know the difference! Get your health insurance quote here.

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Health Insurance vs Medical Aid 



Are you confident that you know what to do when you get sick? Before you go on any holiday, do you know who to call and where to turn in case of an emergency? Do you know the difference between benefits of medical aid vs health insurance also?


The most important thing is to be prepared. But with what? Health insurance vs medical aid?  


Health care is dreadfully expensive in South Africa. So expensive in fact, that some people simply die. They never had the means to afford the treatment that they so badly needed.  


If you are financially able, you should at least have some kind of medical cover. This will require you comparing the more affordable health insurance with the more expensive medical aid plan. There are some major differences between them.  


Huge differences in costs and benefits


It’s not just a case of cost, you have to look at the benefits too.


The Medical Schemes Act in South Africa regulates all the different closed- and open medical aid schemes. These schemes all have to comply with their rules and regulations. One rule is that people looking to join a medical aid can’t be turned away in terms of illness or their age.


When comparing medical aids and health insurance, you could say that one of the more noticeable differences is the price. Medical aid plans are notably more expensive. Their monthly premiums can be 3 or 4 times higher than health insurance premiums.


Health Insurance vs Medical Aid


Yes, medical insurance is far more affordable, but paying less means you also get less.


That is why before you get lured by the lower prices, you need to look deeply at your health needs. Yes, some of the more comprehensive  health insurance plans may include more. They may offer  hospital care for an accident or emergency, up to a certain amount.  You have to check all this out.


Medical aid schemes offer a full quota of hospital cover, and depending on your plan, they will offer a huge selection of  in-hospital treatments.


Gap cover – paying for medical aid inadequacies 


These days there is always a  shortfall between medical aid rates and those rates that the medical specialist charges. So essentially medical aid policy holders have to pay their huge medical aid premium each month and then still pay for gap cover.


Gap cover is what covers these shortfalls. This makes medical aid members feel that medical aids aren’t doing their job properly. They’re taking more money but offer less and less services. Health insurance offers less services but their premiums are far less.


In South Africa, most people don’t have the financial means to belong to a medical aid, and then health insurance offers this affordable healthcare option. With health insurance you get a fixed, lump sum, regardless of the treatment you receive.


Does the lack of PMB’s concern you?


Unlike medical schemes, health insurance is regulated by the Short-term Insurance Act. Also, unlike a medical scheme that has to include cover for prescribed minimum benefits or PMBs, health insurance plans don’t have to  include cover for the prescribed minimum benefits.  Does this concern you?


As an insurance policy, these health insurance plans also provide the benefit of death and funeral cover, whereas a medical aid can’t include these benefits. Something else to consider is that medical aid contributions are deductible for tax purposes. Health insurance premiums aren’t.



Whatever your choice, be informed


Medical schemes are expensive and it is exactly why so many South Africans are looking at the more cost-effective health insurance. It is important to discover everything you can about health insurance vs medical aid just so that you minimise your risk of not being covered the way you expected. 







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