South Africa continues to grapple with economic pressures because of rising living costs, high unemployment rates, and an uncertain global financial outlook – all of which impact households.
Under these circumstances, individuals have no choice but to review their budgets, and insurance and long-term cover are sometimes the first things to be cut. However, one of the biggest mistakes you can make is to cancel your medical scheme membership, particularly considering that healthcare costs continue to rise.
The rising cost of quality healthcare has been largely driven by medical inflation outperforming the Consumer Price Index, an increase in healthcare claims due to post-Covid consequences, higher cancer and chronic condition prevalence, and the increasing demand for mental health services. Fraud, waste, and abuse add to the escalating costs.
Furthermore, the demand for increased benefits such as improved prosthesis options, broader preventative care, and modified diagnostic imaging structures, have raised overall expenses. Despite increasing costs, ensuring that your and your family’s health risks are covered is crucial.
Consider downgrading – not cancelling
Many South Africans have decided to change their medical scheme benefit options to suit their pockets, opting out of comprehensive options in favour of more cost-effective options. These range from entry-level options to options with “savings” or out-of-hospital benefits that are provided for from a portion of their contributions.
Hospital plans remain the most popular and attractive option for people whose day-to-day medical needs are less than those living with chronic illnesses and diseases.
Customise for your needs
While loyalty and rewards-based programmes offer some attractive benefits, such as free or discounted gym memberships or cashback on fuel spend, many people do not use these programmes enough to justify the monthly cost of their memberships.
If you aren’t meeting the daily step or fitness goals to rack up rewards points, cancelling the extra expenses that these programmes bring can save you money. You can always sign up again in the future if you wish, or do your homework and take advantage of value-adding free wellness programmes and inclusive benefits available on your existing benefit option.
Prioritise preventative care
One of the most cost-effective strategies for healthcare is prevention. Most medical schemes offer preventative healthcare benefits such as annual health check-ups, vaccinations, and screenings. Not only do these benefits empower members to identify and address potential health concerns early, but they also cut down the cost of future treatments, which can be avoided via early detection and prevention.
Furthermore, look for a medical scheme that offers benefits that go beyond just covering medical expenses and include preventative care programmes, chronic disease management, and mental health support, which are all essential and ensure good value for your money.
The National Institute of Health reports that South Africa has a high prevalence of chronic diseases such as HIV, hypertension (high blood pressure), and diabetes. If left untreated, these conditions can result in serious complications, which can result in increased medical expenses. Having cover and dedicated programmes, which help to manage these conditions effectively, can go a long way to alleviating additional financial stress.
Mind the gap
No matter how comprehensive your benefit option, it’s a good idea to have gap cover to take care of any payment shortfalls. For those with medical scheme cover, there are other considerations to keep in mind, such as the cost of MRIs and CT scans, which can cost well over your allowed annual limit.
Gap cover can minimise co-payments, particularly when it comes to footing the bill once your medical savings or day-to-day benefits have run out. If you’ve opted for a simpler benefit option, gap cover can help to ensure you don’t end up with unplanned costs once the bill arrives.
In recent years, the cost of healthcare has risen, and most medical schemes have adapted to this reality and offer benefit options tailored to different budgets and diverse healthcare needs. It can be tempting to view medical scheme cover as an optional or discretionary expense but not having this cover can be very costly when the unexpected happens – serious illness, a serious accident, or pregnancy. The cost of these can far exceed monthly contributions.
Madelein O’Connell is an executive: marketing, sales and corporate relations at Bestmed Medical Scheme.
Disclaimer: The views expressed in this article are those of the writer and are not necessarily shared by Moonstone Information Refinery or its sister companies.
