Healthcare cover, no matter your age

Irrespective of whether you are studying, entering the job market, working or facing retirement, the challenge is finding the right medical aid plan to suit your healthcare needs and wallet.

Bonitas data reveals that members experience a 2% increase in health claims with each year they age. Lee Callakoppen, principal officer of Bonitas Medical Fund explains that as you age, you are more likely to experience conditions such as hearing loss, cataracts, back and neck pain, osteoarthritis, chronic obstructive pulmonary disease, diabetes and dementia.

“It’s therefore essential that, when doing financial planning for your future, you factor in the necessary medical aid and funds to access the level of care required,” he says.

He warns against downgrading to more affordable options as you get older. “The relief from higher monthly costs can be short-lived when unexpected medical events occur. Members need to understand what benefit limitations may exist on the option or plan they are considering downgrading to. These can include annual limits, co-payments and the use of network healthcare providers, so this needs to be considered and balanced against realistic healthcare needs.” 

Downgrading may lead to a medical aid plan with more exclusions, which is why it’s important to know what, if any, procedures or services are and aren’t covered, he adds. “This is particularly important as you get older. For example, knee and hip replacements become more likely: An MRI on your knee can cost around R15 000 and costs can increase rapidly when you factor in treatment, medication and procedures if you don’t have any healthcare cover.”

His advice to university-aged children is to join a medical aid as a main member as soon as they are able to so they can choose a plan to meet their specific needs. Joining earlier also means they have access to preventative care benefits and screenings. So, if a healthcare concern or non-communicable diseases — such as high cholesterol or diabetes — is detected early on, proper interventions can take place. 

“The earlier you join a medical scheme, the more likely you’ll avoid late joiner penalties, which will mean paying additional premiums,” he says.

Despite the fact that life is unpredictable and more people are feeling the pinch financially, cancelling medical aid should be a last resort, he advises. “If you resign from your medical aid to save money, you may incur additional expenses in the form of late-joiner penalties or face other underwriting consequences, such as waiting periods, should you decide to rejoin at some point in the future.”   

 The public healthcare system is already overburdened and despite the NHI Bill being signed, it’s a long way away from being implemented. “This means”, he says, “that access to the level of care required may not always be available. We advise members to rather consider a hospital plan to ensure they have cover for emergencies and chronic conditions should they be faced with financial pressures.” 

There are ways to manage your medical expenses and work smarter with your scheme’s benefits, reveals Callakoppen. This includes:

• using Designated Service Providers (DSPs) and hospital networks for more favourable tariffs;
• asking medical practitioners and hospitals for a quote before a procedure and negotiating an adjusted fee where necessary;
• using the free wellness screenings and tests offered by your medical aid;
• choosing generic medications where possible;
• using the chronic medication on your scheme’s formulary and obtaining this from a specified pharmacy;
• not consulting doctors or emergency rooms after hours unless absolutely necessary;
• ensuring you understand what is covered under Prescribed Minimum Benefits (PMBs); and finally,
• taking out gap cover to cover the difference — or part of the difference — between what the medical scheme pays and what you are charged for in-hospital procedures and treatments and specified outpatient procedures.

“The bottom line”, he says, “is that you cannot compromise on your health. The cost of private healthcare can be financially crippling, especially in the case of a severe illness or surgery. Medical aids allow access to quality healthcare when needed, which is vital in cases of an emergency.”