What should you do if your medical aid hikes up premiums?

Last month, Momentum, one of the country’s leading medical aid providers, announced that their premiums will be increasing by a whopping 6.4% increase from April 2023.

The rise, which is significantly above the providers previous 2% increase for 2021, will cause understandable concern for many households, especially if other providers follow in a similar vein. Already besieged with higher than normal inflation and an escalating cost of living crisis, forking out more for your health is an unlikely option for many but what are the alternatives and how can you determine what it is you need?

Assess your needs

‘Looking at your family size, the age of any child dependants, your life stage or healthcare needs are just some of the things to consider before  you make any decisions on changing options, switching medical schemes or joining a scheme,” warns Madelein Barkhuizen, sales and marketing executive at Bestmed Medical Scheme.

If, for example, you are planning on starting a family, you should ideally be on a medical aid before falling pregnant for the scheme to cover your pregnancy and delivery. Similarly, if you have advanced healthcare needs that require elective procedures like a hip or knee replacement or ongoing chronic medication, then you will want to check if the scheme covers the costs of these.

‘There are varying levels of cover across most healthcare plans and while the Medical Schemes Act (MSA) obligates schemes to cover certain conditions called Prescribed Minimum Benefits (PMBs), there is other add-on cover provided on the different options that will cover the rest of the non-PMB care,’ explains Barkhuizen

Get a healthcare advisor

With so many medical aid options on the market, choosing the right one can be tricky.  As Barkhuizen explains, every person and household have different needs and levels of affordability. Having a healthcare advisor who can complete a needs analysis and explain competing options is a good way to identify the correct option for your needs and your pocket.

‘A healthcare advisor will review your chronic conditions, current and future healthcare needs as well as your budget, to propose the right option for you,’ she says.

Change your habits

Being financially savvy is vital when it comes to the healthcare choices you make. Medical aid doesn’t have to feel like a grudge purchase and there are several ways to avoid unnecessary costs and even save money. For instance, you can ask your doctor or pharmacist for the generic versions of medications, which often cost less.

Using healthcare providers who are part of your medical scheme’s designated service provider (DSP) network is also a good idea, as it ensures you don’t have to a minimum co-payment.

‘Although the norm is for children to pay child dependant rates until the age of 21, there are schemes that cover children at child dependant rates until 24 years of age.  This can help parents realise significant savings,’ says Barkhuizen.

Consider downgrading – not cancelling

Those who have decided to change their plans to suit their pockets tend to opt out of comprehensive plans in favour of more affordable options. These range from entry-level plans that mainly cover hospitalisation, to plans with additional ‘savings’ and/or out-of-hospital benefits and comprehensive plans that provide extensive healthcare cover.

‘While downgrading is always preferred over cancelling, it is important to ensure that your new plan provides sufficient cover, as this will affect your future claims and potential out-of-pocket costs. It is essential that you choose a scheme that provides important benefits such as maternity and preventative care as well as managed care programmes that provide for the likes of oncology care, HIV/AIDS, and diabetes care,’ adds Barkhuizen.

Make use of other benefits

Most medical schemes offer preventative care benefits to empower members to take a proactive approach to manage their health sustainably with measurable results. During an economically challenging time in South Africa, taking advantage of these will help reduce your healthcare expenditure from medical aid savings accounts or on co-payments.

Barkhuizen advises that if your medical aid is offering screenings, preventative tests, and vaccines, then make use of them as they are often paid from scheme risk. ‘More critically, these benefits assist with the early detection of various diseases, thus increasing chances of successful treatment and recovery,’ she says.