Medical Aid vs. Medical Insurance

Make an informed decision and get the cover you need

It is easy to assume that medical aid and medical insurance are similar concepts, as both offerings aid in covering expenses incurred in respect of healthcare services, but in truth, the two offerings are very different. Although medical aid schemes do charge a higher monthly contribution, they offer access to different healthcare services and important benefits that this article aims to explain as simply as possible.

Medical insurance cover

Medical insurance pays out a fixed amount for each day you spend in hospital, or a fixed amount per medical incident, irrespective of the type of treatment you may require. Most medical insurance providers will pay the predetermined lump sum directly into your bank account, leaving you responsible to settle the account with the healthcare provider, whether the lump sum covers the entire account or not. For example: should you have medical insurance and suddenly suffer a stroke or heart attack for which you receive medical treatment, your medical insurance will pay out a lump sum, in the same way that your car insurance will pay out if your car got stolen.

Medical aid cover

In addition to cover and benefits for day-to-day healthcare needs, medical aid ensures that, when unexpected health issues arise and you need to go to hospital, or see your family practitioner and/or specialist, your medical treatment will not be delayed.  You will have access to the best networks of healthcare providers, and you will be protected financially if you are suddenly faced with large, unexpected medical expenses. With medical aid, the payment for your medical treatment is usually made directly to the hospital and/or provider.

Why is medical insurance less expensive than medical aid?

Several people are sceptical towards membership of a medical aid scheme when they notice the difference in monthly premiums, but it is important to consider the reasons for the difference in costs.  Medical aid schemes are governed by the Council for Medical Schemes (CMS), and an important benefit thereof is that registered schemes are legally required to provide cover for 240+ Prescribed Minimum Benefits (PMB), including almost all the emergencies, cancers as well as 27 listed chronic conditions.  In the case of chronic conditions such as asthma, diabetes, epilepsy and Parkinson’s disease, cover is provided for the diagnosis, medical management and medicines for the treatment of chronic conditions.  You are entitled to these medical scheme benefits, whether you have selected an expensive comprehensive or less expensive basic healthcare option.

Although it is the more expensive option, medical aid offers comprehensive cover and benefits when it comes to day-to-day healthcare appointments and medication, depending on the medical aid option you choose. Another important benefit is that members need not be admitted to hospital for a certain number of days to claim benefits. This is a key difference, as the high costs of hospitalisation could in all probability be incurred during the first two to three days after being admitted.

This type of wide-ranging cover is not necessarily included in medical insurance and it is not a regulatory requirement for insurance providers to include it.  Medical insurance products are rather focussed towards providing limited cover for day-to-day costs resulting in the member having to cover most of their unexpected high-cost medical expenses, for example hospitalisation, themselves.

Get the cover you need

Unfortunately, many consumers with medical insurance only discover that they have limited cover once they are admitted to hospital.  Therefore, be informed about your healthcare cover options and do not fall short when it comes to your own and your family’s healthcare needs. Bestmed has a comprehensive range of 10 unique healthcare options to choose from, guaranteeing that any individual should be able to select a healthcare option that best suits their healthcare needs and budget.

A summary of other differences to consider when making the choice between medical aid and medical insurance
Governance Medical aid schemes are governed by the Council for Medical Schemes (CMS) and the Medical Schemes Act, while medical insurance providers are regulated by the Long-Term Insurance Act.
Tax deductions Medical aid contributions are tax deductible, while medical insurance premiums are not.
Death and/or funeral cover Medical aid schemes are not authorised to include death and/or funeral cover, while medical insurance provides you with an option to include this type of cover.
Costs The cost to take out medical insurance is lower than that of a medical aid, because it offers fewer and less comprehensive healthcare benefits. The best way to decide which offering is right for you, is to assess your own and your family’s healthcare requirements and choose an offering that best suit your life stage, lifestyle and needs to ensure you have access to quality healthcare benefits when you need it most.


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