Medical aid survey lists perks and perils of popular plans

Broker advises which health schemes offer more bang for your buck

Jill Larkan
Jill Larkan

The cheapest medical aid for low earners is CompCare Networx‚ giving consumers the best bang for their buck.

But for those who want a more expensive medical aid described as offering “comprehensive” cover‚ Fedhealth Maxima plans are the cheapest.

This is according to the GTC Annual Medical Aid Survey 2018.

GTC Healthcare broker Jill Larkan compares and analyses 272 medical aid plans from 21 open schemes that are available for anyone to join‚ as well as Profmed‚ which is only for people with degrees.

After her analysis‚ Larkan said she always felt Fedhealth was good value for money.

The data Larkan uses for her survey comes from the medical aid regulator‚ the Council for Medical Schemes, and website Hello Peter‚ where consumers can complain about various products and services‚ including medical aids.

The medical aid survey also shows which medical aids force members to use a state hospital for hospital care and only provide private doctors for out-of-hospital care.

These are Discovery’s Keycare Access‚ Makoti Primary Plan and the Momentum Ingwe state hospital medical plan.

“People join Keycare Access as it is cheapest [and cheaper than Keycare Plus] and don’t realise they have to use to a state hospital,” Larkan said.

Larkan tells people to use her survey with their medical aid broker to help them understand which procedures their medical aid won’t pay for‚ often referred to as “exclusions”.

For example‚ medical aid plan Discovery Keycare Plus does not pay for hip replacements or back operations – and Larkan said medical aid members do not always know what their plans exclude.

The report looks at two elements – the macro-elements and the micro-elements.

Macro-elements measure a scheme’s long-term sustainability. To do this, Larkan analyses the level of reserves – or savings – it has‚ if it has members who are ageing or if it has enough young, healthy members.

The macro-elements might not matter to consumers‚ but they did show if the scheme was likely to be around in five years’ time‚ Larkan said.

If the medical aid is unsustainable with ageing‚ sicker members‚ then there will be more and more health bills – translating into higher annual premiums, making it unaffordable five years from now.

Then Larkan looks at the micro-elements of a scheme‚ which is the price of the plan and if it offers value for money.

The combination survey results combine a medical aid’s long-term sustainability with its current cost.

In these combination results‚ Bonitas BonCap‚ Discovery Keycare Plus‚ Momentum Ingwe Network Hospital and CompCare Networx‚ and Fedhealth Blue Door Plus plans perform well in terms of price and long-term sustainability.

Any of these options were usually a safe bet‚ she said.

Many Discovery plans do well when she takes long-term prospects and current affordability into account.

But Larkan’s survey includes one assumption – that every person must have gap cover.

This is an insurance policy usually costing between R100 to R200 and it ensures any doctors’ bills in hospital that are not covered by a medical aid will be paid for.

Medical schemes offer to pay 100% or 200% or 300% of doctors’ bills in hospital.

This was confusing for consumers as 100% did not mean the bill was covered entirely‚ but people thought it was‚ Larkan said.

Gap cover always covers the shortfall for doctors used in hospital and means consumers can choose cheaper medical aids with the 100% option.

The medical aids to avoid as they had the lowest macro scores – meaning they were likely to become way more expensive each year – were Resolution Health, Medshield and Medihelp, Larkan said.