Do You Know the Difference Between Medical Aid and a Hospital Plan?

No matter if you are healthy now or living with a long-lasting medical condition, you will need to have the resources in place to pay for both your current and your future healthcare expenses. You will want to protect both yourself and your family’s wellbeing. 

In South Africa there are two main options available, those being medical aid and hospital plans, which can both help to give you cover when medical costs arise, however, they do not both offer the same level of cover. 

In an emergency or an accident where you are admitted to hospital then you will need a hospital plan. If you need cover for out-of-hospital expenses like visiting a private GP, dentist or optometrist then a medical aid plan is probably better for you. 

Here is a look at both of these options, so you can choose the health plan that is best suited to you. 

Know More About Medical Aid

Medical aid is a healthcare plan where you will pay monthly premiums, so that you can access private medical practitioners. A medical aid scheme usually offers cover for procedures and related medication. Therefore, if you need medical attention due to illness or injuries then your medical needs will be taken care of. 

Medical aid generally offers minimum health benefits no matter the level of coverage that you signed up for. These benefits include emergency medical conditions, a defined list of 27 chronic conditions and a list of 270 diagnoses. If you have a comprehensive medical aid policy then you will also get cover for dental procedures, GP appointments and chronic prescription medication. 

Medical aid can give you peace of mind as your healthcare needs are paid for when you need it. Funds are readily available so that you can get quick access to healthcare and you will be able to access private healthcare that usually offers better quality care. 

You can get medical aid quotes online, which can help you to find the scheme that best suits your needs and your budget. However, when you are looking for medical aid first evaluate you and your family’s general health that includes past illnesses in your family as well as the level of cover that you can afford.

You will need to consider hospital cover, chronic medication cover, day to day benefits, if co-payments are required and if you are restricted to only going to certain hospitals. 

So, What About a Hospital Plan?

A hospital plan will require you to pay a monthly fee, but you are only covered for admittances to a private hospital. You are only covered for inpatient hospital procedures and treatments excluding visits to a trauma unit and hospital based clinic. Any day to day, out of hospital costs like a GP appointment or prescription will need to be paid for from your own pocket. 

A hospital plan provider will need to be notified before you are admitted to hospital and you will need to get approval. On approval the provider will send the hospital a payment guarantee so you can access healthcare. In the event of an emergency, admittance is arranged between the hospital and your provider. 

A hospital plan is able to give lower income individuals access to private healthcare. It is able to bridge the gap between what medical aid covers and what it doesn’t. You are able to get hospital cover as part of your medical aid. There are hospital plans that will allow you to go to the hospital of choice, but is dependent on provider approval. 

If you need various day to day benefits, then a hospital plan might not be the best option for you. A hospital plan works best in the event of a large procedure, but it’s still wise to have the cash benefits of a medical aid available for other medical expenses, especially if you have dependents. 

A hospital plan then offers fewer benefits when compared to a medical aid. A hospital plan will only pay for medical expenses that you incur in hospital. All other medical expenses will need to be paid by you. 

With a medical aid you are covered for a set of prescribed minimum benefits and with a comprehensive plan, you will also be covered for a number of other treatments and procedures. 

Regardless of your lifestyle you or your family can become ill and a medical aid and hospital plan makers it easier for you to receive the healthcare you and your family need.