Looking to change medical aids in 2021? Here’s what you should know

Looking to change medical aids in 2021? Here’s what you should know
Looking to change medical aids in 2021? Here’s what you should know

With all the changes that 2020 has brought, you may be rethinking your medical aid needs to better suit your priorities. Perhaps you’re realising you need more comprehensive cover after the health scares the Covid-19 pandemic has brought, or maybe you’re now under more financial pressure as a result of a change in your work situation, so you want to reduce your monthly medical costs. Whatever your circumstances, it’s important to strike a balance between having adequate medical cover for you and your family, and not crippling yourself financially with what you spend on your health.

If you’re considering changing plans within your current medical aid scheme, or you’re thinking of changing providers altogether, here are the four most important questions you should ask yourself:

  1. How much cover do you really need?

If you’re young, single and healthy, a medical aid plan that just covers the basics may be perfectly adequate. But if you have dependants, are older or have a chronic condition, you may find that the peace of mind you get from more comprehensive cover is worth the higher monthly contributions you’ll pay. To work out what’s right for you, do an assessment of your previous year’s medical costs, including things like doctor’s visits, medication you’ve needed, and other expenses you’ve incurred such as optometry and dental bills. Then, make adjustments to account for changes in your health status or family situation this year. Then weigh up the medical plans you’re considering, to see whether the cover you get is likely to account for the expenses you will have in the coming year.

  1. Do you know what your real health costs are?

The decision to change your medical aid plan or provider is often driven by a need to cut down on monthly costs. But the reality is that while you may pay less for a lower coverage plan, it may cost you more in the long run if you need to cover out-of-plan expenses out of your own pocket for whatever reason. Ideally, you should be paying for the best possible cover that you can afford, while seeing the bigger picture of how a comprehensive plan can save you from having to pay large medical bills in future. Also remember that it’s much easier to downgrade a plan than to upgrade if you have a specific health condition, so do your research into this. Some medical aids may let you upgrade for a specific condition (Fedhealth, for example, lets you upgrade any time of the year within 30 days of being diagnosed with a dread disease or a life changing event such as pregnancy).

  1. Do you or your dependants take chronic medication?

If you or a family member suffers from a chronic illness such as diabetes or high blood pressure that requires regular medication to control, how much of this will be covered by the new medical aid option you’re considering? Some medical aid plans automatically cover chronic medication, while others may be subject to a co-payment, or how much medical savings you have. As part of this, you should also check the limits on how much chronic medication is covered each month, and what the co-payments might be.

  1. How much choice do you want in your health providers and hospitals?

Most medical aids have a network of health providers and specialists that they use, where if you use providers within this network, their costs may be covered in full by the medical aid you belong to. On the other hand, if you want the choice and flexibility of choosing any health provider you like, you may need to pay a higher monthly contribution to be able to do this – and you may still be in for a co-payment. Weigh up how important this flexibility is for you, versus what you can afford to pay each month.

By asking yourself these questions, you can make sure your health needs are still optimally covered, while making provision for any changes in your personal circumstances. Finally, remember that medical aid schemes have different windows of time in which you can change plans within the same scheme – usually towards the end of the year. For most medical aids in South Africa, you can downgrade whenever you like. Make sure you know these dates so you can make the changes without disruption in cover through things like waiting periods. Here’s to a happier, healthier 2021!