More than a debit order: Why your medical aid matters

Your medical aid has announced next year’s contribution, and your first question is probably: how much more will I pay? When budgets are stretched, it is understandable to question the expense. But before making any changes to your budget, consider what an unexpected illness, injury or ongoing condition could mean for your finances.

Medical aid helps fund healthcare expenses that may be difficult to meet from your salary or savings alone. Its value extends beyond a hospital admission to the consultations, medication and ongoing care covered by your chosen option.

The challenge is finding cover you can afford to maintain, while understanding the cover it provides and what you may still need to pay yourself.

“Choosing medical aid should involve more than comparing monthly contributions. Consumers need to understand what their option covers, which benefits they can access and what costs they may still need to pay themselves. The aim is to find cover that meets your healthcare needs while remaining affordable over time,” says Lee Callakoppen, Principal Officer at Bonitas.

Medical Aid Increase 2027: Five Questions Worth Asking

To balance that protection with affordability, consider these five questions.

1. What care do you and your family need?

Review your healthcare expenses over the past year, including consultations, medication and any costs you had to pay out of pocket because the medical aid option did not cover them. A family with young children and someone managing a chronic condition may need different benefits. It is recommended that one considers changes ahead, such as adding a dependant or an existing beneficiary needing planned treatment which could bring on added expenses.

2. What could you pay beyond the contribution?

Co-payments may result for certain procedures, the use of non-network facilities, limited benefits, shortfalls between what providers charge and what your fund pays and items that are not generally covered by a medical fund. Ask what happens when your day-to-day benefits or medical savings run out. A lower contribution may help you maintain cover, provided you understand and can manage the additional costs.

3. Can you access the healthcare providers you need?

Check whether your doctors, pharmacy and nearest hospital are included in the option’s networks. Find out what you could be paying for using providers outside the option’s network. Consider travel costs and convenience too: your cover needs to work for you wherever you live or work.

4. How will ongoing treatment be covered?

For someone living with a chronic condition, access to regular care is an important part of medical aid’s value. Check how consultations, tests and medication will be funded, including registration requirements and pharmacy rules. Ask how Prescribed Minimum Benefits (PMBs) apply and whether care programmes are available to help you manage treatment. Consider whether the option your contribution pays for, covers the required formulary to manage your or your dependant’s chronic condition.

5. What support is available before you become ill?

Screening benefits can help identify health risks that need further assessment. Bonitas’ screening data found that 73% of health risk assessments identified at least one elevated risk marker. Of the flagged assessments, 71% were among members under 50. This tells us that potential health risks are being identified among younger members too, highlighting the value of screening rather than waiting until you feel unwell.

Check which screening tests your option covers, whether they use your day-to-day benefits and what follow-up support is available.

As you review your cover for 2027, ask your scheme or a qualified healthcare advisor to explain any changes to contributions, healthcare benefits and networks.

When every rand counts, medical aid is a significant commitment. Understanding what it provides helps you choose an option you can afford and make the most of your benefits when you or your family need healthcare.

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