When the petrol price goes up, the price of everything goes up, and you won’t be alone if you’re looking to scale back, cut down or cancel what you can to save money.

While there’s little we can do about the cost of debt like home or vehicle loans, there are ways to play smarter with things like medical aid.
By understanding the cover you’ve signed up for – and looking at your medical history and needs – you can make changes that could save you money, or help you make the most of all your benefits.

Get to know your benefits

The best way to come to grips with your medical aid is to read your policy document carefully, and draw up a table of everything for which you’re covered. This will show the rate at which your medical scheme pays your costs, and whether there are contracted-in providers you could use that will help you to save.

Two important features to understand, including when the New Year’s allocation kicks in, are:

• Your medical savings account (MSA), if you have one. Each time your new benefit cycle starts, an amount is allocated to your MSA for out-of-hospital costs such as doctors’ visits or medicine. Manage your MSA carefully, as it’s easy to use up the allocated amount quickly.

It’s usually better to pay for small over-the-counter purchases such as headache tablets yourself, and keep your MSA for more expensive prescribed medication or unexpected treatments.

• Your benefits for optometry, dentistry and maternity – even some scans and mobility aids. Understanding them, and knowing how to use them, can be a great help. Don’t be too stingy with them as they are ‘use them or lose them’ benefits that, like your MSA, will reset when your next medical-aid cycle starts.

Medical aid vs hospital plan vs medical insurance

A medical aid is, on average, more expensive than a hospital plan – which is, in turn, more expensive than medical insurance. The costs vary so much because each covers a different range of benefits.

A medical aid plan

This pays for healthcare costs, such as hospitalisation, treatment and medicine. How much they will pay will depend on the type of plan you chose, and the rules of the medical scheme.

If you decide to start with the most affordable plan, compare what the different schemes offer for their entry-level products as these tend to vary.
If you have been hospitalised, your medical aid will pay the hospital and doctors directly. When there is a shortfall, you will have to pay the difference.

Who is it for? A medical aid is usually a good choice for parents and children, who tend to have several out-of-hospital doctor and/or dentist visits each year. If you have a chronic illness and need to visit specialists and take expensive medication each day, it may be a better choice for you too.

A hospital plan

This is usually seen as the most basic cover. It’s not as comprehensive as a medical-aid plan, but it will pay for in-hospital treatment when you’re admitted for surgery, treatment or in an emergency – how much, however, varies from scheme to scheme.

A hospital plan won’t cover out-of-hospital treatment, or prescribed medicine, aside from PMBs.

Who is it for? Hospital plans are best suited to healthy people who hardly ever need a doctor, or those who are happy to pay for check-ups, screenings, and visits to the dentist out of their own pocket.
A medical insurance plan

This tends to be the most affordable option on the market, but also offers limited cover. It’s important to understand, though, that medical insurance is governed by insurance law and not medical aid regulations.

This means you won’t have access to prescribed minimum benefits (PMBs), and it typically pays a predetermined amount per day, regardless of the cost of any treatment you may need.

Who is it for? While this is the most affordable option available, you should think carefully about your needs before choosing to go this route.

Don’t miss out on PMBs
Prescribed minimum benefits (PMBs) apply to conditions covered in varying degrees by all medical schemes and plans. There are nearly 300 of them, and you can find the full list here.