When it comes to choosing between a hospital plan and other plan types within a medical aid, understanding the key differences is essential. In this blog we will explore:
- What a hospital plan covers.
- What type of hospital plan is ideal for you.
- What hospital plan and other plan types within a medical aid will cover.
- What type of medical aid plan is ideal for you.
- The difference between other plans available and a hospital plan type within a medical aid.
- When to choose the right plan for your needs.
What is a hospital plan and what does a hospital plan cover?
A hospital plan is for “in-hospital” expenses incurred for things like surgery, emergencies, and being admitted to hospital following accidents or serious illnesses. It does not cover routine day-to-day benefits, such as visits to the GP, specialist consultations, or dental examinations.
What is medical aid and what does a medical aid cover?
A comprehensive medical aid at its core covers hospitalisation and, in some cases, everyday health care (depending on your plan). Prescribed visits to the doctor, medications, dentistry, and more, could also be included.
Types of medical aid options:
There are many medical aid options available, like traditional options, savings options, capitation options, and more:
- Comprehensive plans: As the name suggests, these plans are designed with comprehensive benefits and suit members with extensive medical needs. The in-hospital and day-to-day benefits are generous, and as a result these plans come at a higher premium.
- Traditional plans: This type of plan provides in-hospital and day-to-day benefits, but what defines this kind of plan is the fact that the extent to which a member can utilise the various day-to-day benefits is specified by the plan. For example, members might be allowed to get a new pair of glasses every two years, or they have 6 GP visits for the year, or they have a limit of R16 000 for radiology related claims. These plans often make use of designated service providers and members may expect certain co-payments.
- Hospital plan with savings: The foundation of these plans is the hospital benefits, but there is a percentage of the contribution that gets allocated to savings. The savings component will then apply to day-to-day benefits, where members can utilise their savings as they choose and according to the benefits they make use of. It’s important to note that members will typically have out-of-pocket expenses when the savings portion is depleted.
- Capitation-based plans: This plan type is designed for potential consumers who have a limited salary, so the plan is built with income-bands wherein the consumer pays a contribution based on the income they receive. These plans have set benefits, often including limited preventative care, maternity, and day-to-day benefits, along with the requirement of using designated service providers.
- Network plans: Within these plans, members receive care from a designated group of providers. The plan negotiates the rates with these providers, assisting in cost containment. Services of out-of-network providers are covered either at a lower rate or not at all.
Key differences between a hospital plan and medical aid
A hospital plan primarily covers treatment requiring admission to a hospital, such as emergencies, planned surgical procedures, and hospitalisation costs. It does not cover day-to-day medical expenses, such as visits to a general practitioner (GP), acute or over-the-counter medication, or consultations with specialists. In contrast, depending on the type of option, a more comprehensive medical aid plan type tends to offer additional benefits not provided for on a hospital plan. This includes certain expenses from hospital care to routine check-ups and more specialised in- and out-of-hospital treatment.
A more comprehensive medical aid plan type will be more costly, but this is because they offer wider cover and consequently there is less of a financial burden for ongoing medical care. Choosing between the two depends mainly on your health-related needs and budget. It also depends on whether you want a plan that covers a wider range of health-related needs or if you would rather pay for the day-to-day extras separately.
Who should choose a hospital plan?
- Young and healthy individuals who would like the assurance of hospital coverage, especially in the case of accidents or emergencies.
- Those who cannot afford a more comprehensive plan type but need in-hospital and emergency protection.
- People who have separate health insurance or savings for out-of-hospital costs.
Who should choose a more comprehensive medical aid plan?
- People who need on-going medical coverage, such as frequent doctor visits, specialist care, dentistry and optometry (this is applicable to certain medical aid types).
- Families with children or dependants who require comprehensive medical cover.
- Individuals who prefer to limit unexpected out-of-pocket medical expenses, but it’s important to note that out-of-pocket medical expenses cannot be completely avoided.
Considerations before choosing a plan
When deciding between a hospital plan and a more comprehensive medical aid plan type, consider the following:
- Budget – Are you able to afford the monthly premiums?
- Healthcare needs – Do you often consult with GPs or specialists, or require care for a diagnosed chronic condition?
- Risk tolerance – Are you comfortable with paying for your day-to-day medical expenses out of pocket?
- Network coverage – Check which hospitals and doctors will be covered under your plan.
Need help deciding? Let MedXpert guide you
MedXpert has been providing South Africans with more than 24 years of experience in comparing medical aid options. Speak with an expert today to ensure your healthcare cover is right for your needs.
Conclusion
The decision between a hospital plan and a more comprehensive medical aid plan type will depend on your personal healthcare needs as well as your budget. This understanding of the differences allows you to be proactive in making an informed decision. Contact MedXpert today for expert advice on finding the right fit for you.
Alternatively, you can call us on 0860 860 860 or email ask@MedXpert.co.za.
MedXpert, the medical experts on your side.