Medical Aids vs Hospital plans vs savings

[Christel]

Hi there,
Both my children got sick the past week - had to take them to the Dr eventually and got anti-biotics etc. Yesterday I was told by the chemist that my funds are depleted... Our Medical Aid normally dries up end Oct/Nov every year, but not in JUNE.... We had no funnies this year, no big medicine scripts.... I pay around R3200 monthly (private medical)... I'm seriously wondering if medical aid is still the way to go? Maybe just have a hospital plan or just save via a money market the monthly R3200 and then pay for everything myself? Could anybody please give me advice? I obviously need something...

[daveob]

Personal opinion - a hospital plan should be the absolute minimum. I had a kidney stone removed a few months back. I had to cough up R5k in total. The actual total bills were in excess of R60K. Thank goodness for the MA. Yes, savings are almost gone, but the hospital plan is still in place.

Yes, you could save R3k per month yourself, but as long as nothing happens for, lets see, R60k / R3k = 20 months, you'll be OK.

If you have a second kidney stone ( a minor thing compared to others ) in that same time, you're sunk.

And just hope you don't have some serious ailment or condition .....

[Nickolai Naydenov]

Christel do you mind sharing what medical aid and plan are you on and how old are your kids?

Generally to give you an idea medical aid is split into 3 parts, lets say that you contributing R1500 pm what actually happens is imagine 3 pools of money: 1 - in hospital cover, 2 - savings, 3 - treshold. So hypothetically speaking your contributions will be divided between those 3 pools, say R500 in each pool, that means that you have 500pm x 12 so you have R6000 for the year in savings then you will have a self payment gap and then your treshold which is another R6000 for the year so basically it's your money anyway it's just they give it to you in advance at the begining of the year. The money that goes towards hospital is also a pool but in this pool will be the contributions of all members and when a person gets admitted into hospital bills will be paid from that pool. So end of the day if you pay for a hospital plan save your money that you would have been paying for a comprehensive plan for when you need to see doctors. I hope that explains the basic concept of how med aid works.

I must be honest up until this year I was always on a comprehensive plan but it was a waste because I never used the day to day benefits so from this year I moved to a hospital plan and I took a gap cover for R128pm (that's the price for a whole family) and that covers me for up to 400% med aid rates in hospital, in other words I wouldn't need to pay in for specialists out of my pocket. On the hospital plan I have the following out-of hospital free benefits: 2 x MRI/CAT scans per year, casualty benefit whcih means if say I break an arm I go to casualty they put on a cast and send me home, in other words I'm not admitted to hospital, generally on other medical aids you'll have to pay out of your pocket if you are on a pure hospital plan, I also get free trauma benefit which means I get counselors/psychologists in case of me being a victim of a serious crime. These are just few of the benefits for which I don't have to pay for.

[Blurock]

I also found that a comprehensive plan is a waste of time. I pay for my own doctor's visits and medicine. No getting shampoo and tanning lotion on medical aid like some people do!!! Fees dropped from R4000 to R1700 pm.

I hospital plan with a gap cover or top up should be adequate. Very often a pharmacist can give you the same or better medicine for a cold as your GP. Save your medical aid for when you really need it.

Medical aids should stop paying for visits to GP's. Why should the other members pay for the guy who wants a sick certificate because he has a babelaas on Monday?

[Christel]

Thanks for all the advice so far...
Nickolai, I'm on Primary Care from Sizwe. My children are 8 and 12 years respectively. Sizwe do not offer a medical savings or GAP cover. We've been with them since Jan 2002. We are a blessed family w.r.t. being healthy - My husband has only once had kidney stones removed, otherwise never been to a dr or dentist in the almost 18 years that we have been married, my daughter (12) has now been ill for the first time in her life, and my son normally gets a light cold every year. Our only "normal" monthly expense is Concerta (for ADHD treatment) & now and then some asthma medication for myself (Chronic benefit).
Nickolai - are you on Discovery? I think that might be the route that I should go for - I have been looking on the website, hospital Coastal or something to that effect. It will still work out to about R2400, but then I can save R800 pm in a money market or something for day to day & gp expenses.
Baie dankie!

[Imp]

I am on discovery. I was on the comprehensive plan for a while - but I was stung quite badly with that one. I have had medical savings for a while. Last year i had twins and my savings were gobbled up by about May with all the gynae visits. This year we seem to be doing much better, not too much travelling to the docs except for one or two bugs doing the rounds, so it is lasting us.
I hate that medical aid and medical costs are so expensive in this country!

[wynn]

Ithis year I moved to a hospital plan and I took a gap cover for R128pm (that's the price for a whole family) and that covers me for up to 400% med aid rates in hospital,.

Nickolai
Which scheme, I need to do research??

[Nickolai Naydenov]

First here's a website where you can compare medical aids http://www.msit.org.za/newsite/index...compareschemes

I mist be honest I'm not familiar with Sizwe so I can't tell you to stay on it or change it. However I can tell you that up until 2007 I was on discovery classic and I had only one issue and that was when I wasn't admitted to hospital but had stitches, MRI scan and etc and it was all taken from my savings plus I had to pay in. Then in 2008 I moved to Liberty titan plan which I haven't really used and from this year I moved to liberty gold focus which is a hospital plan. What's good with that is that I get all the out-of hospital benefits that I mentioned earlier. In your case it will also pay for the astma and adhd medications, but then it will cost you R2777 for the whole family, on this plan you have unlimited cover to any hospital, just remember that I'd get gap cover for specialists in hospital fees. There's also a new option that was introduced called gold focus select and that option is about 15% cheaper but you'll have to get your chronic meications from a government hospital and you have a network of hospitals that you need to go to, this would be very similar with discovery coastal core but you still get all the out of hospital benefits.

With regards to a gap cover that is more like an insurance product, there are a few companies that offer that, I use zest life.

I deal with med aid as well so let me know if there's anything else you need to know

[tec0]

Have a look, is your doctor; is he accepted by your medical aid? If not then I would start there. Follow the money and you will find that you're "day to day" is limited to a few thousand rand and the doctors just suck that up because it is easy money. They overcharge the medical aid about double to three times as much as what you would pay cash for.

Also have a look if your blood tests, tests and emergencies. They love to take this out of your day to day as well leaving you with nothing.

Thing is I am really upset I had to go to a "new" specialist on his counter he stated that R500 must be paid in cash and that all visitations will be cash only. Now I paid cash and they still demanded to put my Medical aid on record. Now if this specialist takes any amount of money from my medical aid I will report him for fraud as he's reception was too busy to explain anything and actually got upset if you asked any questions at all. So I promise you today I will report him. You cannot state "Cash only" and take money from the medical!

I wouldn’t blame the medical aid. It is the doctors they are making thousands per day and that is still not enough. It is actually a good argument to give the lot of them an enforced set fee. They have no respect for life.

[Nickolai Naydenov]

I wouldn’t blame the medical aid. It is the doctors they are making thousands per day and that is still not enough. It is actually a good argument to give the lot of them an enforced set fee. They have no respect for life.

I know what you mean,the problem thou is that there is a shortage ofndoctors in SA,they study for at least 7 years then theyhave to practice under supervision and end of the day they save lives so they can do as they please

[Christel]

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I deal with med aid as well so let me know if there's anything else you need to know

Thanks Nickolai, I will follow the link in your post tonight - (they block most sites here at work) and I'll be in contact - I need to make a decision sooner rather than later.

Thanks to everyone else that has responded too!