Is a hospital plan enough?
Finding the right medical aid scheme is on the priority list of many adult individuals and their families. There’s so much to look out for with regards to medical aid, including affordability, coverage, company, necessity, lifestyle, and the list goes on.
So, for some people, a hospital plan is enough. But, for others, they may require a more comprehensive medical aid scheme. By looking into a hospital plan we will be exploring the difference between hospital cover versus medical aid, by which you should be able to decide as to whether a hospital plan, alone, is enough.
What is hospital cover?
Hospital cover is a medical scheme that covers you for, well, hospital-related incidents. No-one plans to end up in hospital but, unfortunately, it’s something that happens beyond our control. And it’s definitely no secret that hospital expenses can be crazy expensive.
Hospital cover can help you out financially when there are in-hospital visits, treatments and procedures necessary (the extent of which depends on your medical scheme company). As for the everyday doctor appointments, prescription medication and out-of-hospital expenses, those will have to come out of your own pocket.
That’s the first difference between hospital cover and medical aid because medical aid plans tend to cover an individual for more medical-related activities including both in and out of hospital expenses (also subject to the terms of the medical aid plan).
In both cases, you will be paying a monthly fee for funding for your chosen coverage option.
How does it work?
Okay, so you know you’re paying a monthly fee, you know you can be admitted into the hospital without stressing about paying medical bills out of your ears, but do you know how the benefits work?
Your hospital plan will cover the cost of your private hospital visit and will, usually, provide a list of approved hospitals that you can go to. These will be the hospitals with which your medical scheme company has an agreement with regarding the different rates. In these cases, your hospital bills are likely to be paid completely through your hospital cover.
But, even so, there are certain aspects of hospital charges that are charged above what your hospital plan will pay. The total amount may be less, but co-payments can still be expensive. In these cases, you need to make sure you’re aware of the additional costs and try beforehand to reduce the costs where possible.
What you need to be sure of
When it comes to reading all the plan details and terms and conditions, medical aid and hospital plans don’t differ too much. You always need to be sure of exactly what you are and aren't covered for and whether there will be any surprises waiting for you when the time comes to be admitted into hospital or claim from the medical aid company.
- Restrictions: We’ve mentioned that hospital plans only cover in-hospital expenses. And while there are different medical schemes out there that can offer hospital cover for a variety of things, there generally are restrictions in most hospital plans. It’s not to say that you won’t find a hospital plan with a few of these added benefits, but you also need to read the fine print and make sure you are still able to be covered for all the care you need.
- Unlimited cover: Many hospital and medical aid plans talk about “unlimited cover” and that, obviously, gets people excited. But there can be restrictions here too that you need to be aware of. Usually, there is a specific amount of money that your medical scheme is able or willing to pay for the year (or specific time period) which is normally enough to cover the average individual. The problem comes in when there are unforeseen circumstances that require more-than-usual visits or procedures and the budgeted cover has been used. Yes, it can even happen with an unlimited cover plan.
Why do people favour hospital cover?
When it comes down to deciding between hospital cover and medical aid, there are a few reasons why people tend to go for a hospital plan. Sometimes it’s just for the peace of mind of being covered should anything have to happen, unexpectedly.
- Affordability: Hospital plans tend to be more affordable than medical aid schemes and, therefore, offer affordable cover for individuals.
- Demographics: Many young, newly employed and lower-income people opt for hospital cover as a starting out point because it is affordable and offers just enough cover for their lifestyles.
- Medical history: It’s easier and more affordable to find a hospital plan when you know you and your family have a “healthy” medical history where the full benefits of medical aid aren’t required.
- Lifestyle: People who live healthier lives, exercise, eat correctly and take care of their immune systems don’t spend a lot of time at the doctor’s office and a hospital plan is merely there in the case of an emergency.
