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It's another Friday! We continue to explore how to get the most out of your medical aid plan, while paying the least for it.
Today we discuss:
- The never-ending cost increases for medical aids
- How to pay for day-to-day expenses
- How to reverse the age of your heart (by 20yrs+!)
Reminder: rehealth.co.za helps you get the most out of your medical aid. It's free, it's instant. No registration or pesky sales calls.
Please share!
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🖊️ Eve's notes...
Chances are you are somewhat aghast at your medical aid premium. Below and next week, I will help you decide if/how you can save on your cover, but before we get into that, I want to present you with another stark reality: your premiums will continue to escalate, way above the official CPI, forever. (Back of envelope estimates: if you are paying R5,000pm in 2026, assume you will pay about R13,000 in 2036, and probably for less benefits. If premium escalations followed the CPI, they would only rise to about R7,000!)
I can write a weekly newsletter about how to save on your medical aid until I am blue in the face, but the reality is: medical aid is becoming increasingly expensive. This is further compounded by the fact that the time when people earn less money (retirement) is exactly when their medical costs (and needs) escalate. My inbox is full of messages from 65yrs+ asking something to the tune of “...now that I am a pensioner, I can no longer afford this. What are my options?”.
There are 2 ways to approach this, both equally important. The first and most obvious one is to plan for it financially, as much as you can. Be prepared for the continuous high cost of medical aid, and do not rely on medical aid to pay all your medical bills in the future. Whether NHI happens or not, medical aid might change so much that it will no longer be able to cover all your claims/needs. Plus, you might need frail care which is mostly an out-of-pocket expense anyway. Careful financial planning might help cover these costs, and will help you not be a financial burden on your children.
The other way is just as important and much easier: look after your health today. Do the obvious: maintain a healthy weight, don’t smoke, eat well, exercise (strength and cardio). But also, go for your checkups. Things caught early are easier, quicker and cheaper to fix. Assume that unless you intervene, your health will decline with age, and your medical costs will rise. Be proactive.
(And yes, I have been thinking/researching a lot about how AI will affect future medical care, and at this point I think it will improve opportunity for care/treatment, but it will add massively to the cost. We can talk about that in some future newsletter).
Stay healthy! Stay wise and thanks for reading.
PS: Questions about your cover? I can't give individual advice, but I can probably point you in the right direction. Email me on eved@rehealth.co.za.
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🇿🇦 Medical Aid and other cover 101:
Useful and relevant information about medical aid, gap covers, hospital insurance and even pet cover. Goal: to help you know the rules, so you don't overpay.
How to evaluate your medical aid?
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When trying to determine whether you are on the right plan, it helps to think of benefits in three buckets:
1..Unexpected emergencies, when sh*t hits the fan. Think: car accident, cancer diagnosis, heart attack. Pretty much all medical aids have you covered comprehensively for the in-hospital part of these events, especially if you use network doctors (non network doctors can charge a huge excess, which is where gap cover helps). The PMB regulations ensure that you will get good care no matter what plan you are on, although obviously the higher plans do offer more.
2..Planned procedures, not totally unexpected. Think: joint replacements, maternity, wisdom tooth extraction. Once again, most plans have you covered here although it’s worth your while to look out for exclusions, co-payments, sublimits and required networks. (Gap cover can help here too).
3..Day to day expenses This is where the real difference in medical aids comes through. It’s all complicated (I explain more here), but my advice here is simple: there is no such thing as a free lunch. At the end of the day, one way or another, you will end up paying for this “out of pocket”, whether directly or through higher premiums. And you will have expenses that are not paid by your plan, no matter how "comprehensive" it is.
Given that in-hospital procedures are pretty much covered equally at PMB level, you need to spend your time thinking: a) whether you should have gap cover and b) how you want to fund your day to day expenses. The answer to those questions will help you figure out if you are on the right plan or not.
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You need to submit your changes
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If you think you want to change your medical aid plan (but stay on the same scheme), you need to decide in the next two weeks. (Schemes would like to know by Dec 1, but they’ll probably cut you some slack).
If you are confused as to what to do, let me give you a tip: it is much easier to downgrade a plan in the middle of the year than it is to upgrade. In other words, if you think you might need more cover than you have right now, definitely change plans if you are able to. I have more help here.
Note: some schemes (eg. Fedhealth and Bestmed) do let you upgrade in middle of year if you have a life changing diagnosis or event (cancer, pregnancy, divorce).
Lastly, if you are thinking of changing schemes, not just plans then you can change at any time in the year but January is a good time to do it to avoid pro-rated benefits.
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Day-to-day expenses: how to pay?
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There are about 6 ways to pay for out of hospital expenses. Determining which combination works best for you will help you decide what type of plan you should be on.
1..By scheme I do hope by now you are not surprised to learn that schemes pay for a lot of out of hospital expenses, even on “hospital” plans. Here are some examples of what schemes will pay:
- Treatment, management for 27 chronic conditions (asthma, epilepsy, hypertension)
- A lot of preventative benefits (mammograms, flu shots, wellness checks)
- Out of hospital treatment for cancer, dialysis etc
- Terminal care, home care
- All emergencies, even if they don’t require admission (deep cuts, head injury, broken legs, allergy attack, dental trauma, injury due to accident etc)
In addition, many schemes are now paying for some out of hospital claims via “funds” that activate once you fulfil certain health checks etc. This money can be substantial, (anywhere from R1,000-R10,000 per year).
2..Out of pocket. Pretty self explanatory. You can also pay directly to provider (and maybe get a discount), and then claim the amount back from your scheme.
3. Medical Savings Account (MSA). This is a very specific arrangement. All the money that funds your MSA is paid directly by you, you do not get anything “extra”. The only benefit is that you get the full value of 12 month contribution available in January. My experience with MSAs is that they deplete funds unnecessarily quickly, because facilities are very quick to claim for anything they can and the scheme restricts you on how you can spend your MSA! (This doesn’t mean I don’t recommend savings plans. I do, but mostly because they open up gap cover benefits. More on that in near future.)
3.. Self Payment Gap, Above Threshold. On the “comprehensive plans”, you get your MSA, as above. When that is depleted, you need to pay out of pocket for a while, until you have spent the “Self Payment Gap” (SPG). Then, an Above Threshold Benefit (ATB) kicks in, which means that now the scheme starts paying for out of hospital expenses. The top plans have unlimited ATBs (but with sublimits for medicine, healthcare professionals, dental, hearing aids etc) or limited. NB: If you are on a comprehensive plan but did not make use of your ATB this year, you are probably on the wrong plan.
4.. Funds”
. Similar to MSAs, but this money is the scheme’s, not yours. What you don’t use does not roll over to next year, and there can be firm restrictions on how you use this money. It's often offered as a specific value (say R2,800 per person), and can then be used to pay for certain out of hospitals claims.
5.. Top up Wallets (Fedhealth and Momentum). Fedhealth allows you to not pay into a “savings account” until you need to. When the need arises, you activate the benefit, get an upfront lump sum, and start paying it off in equal instalments. It’s like activating a credit card, but without any interest due. Momentum also has a somewhat similar product, with HealthSaver.
6..Primary Health plans. These are separate insurance plans (just like gap cover) that cover you for primary health costs (mostly GPs, medicine, dentistry and optometry). The good plans start at about R400/m for main member and R200/child. I will have a full breakdown of available plans posted on rehealth.co.za in early 2026 but in meantime you can read about them here and download my FREE guide to them here.
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Other news:
✅ There are 33 plans that cost less than R2,000 per month. The cheapest costs just R589! (Yes, for medical aid, not insurance). The catch is you have to earn less than R1,500/m to qualify. The cheapest unrestricted income plan is from Discovery, at just R1,350 (I'm just as surprised as you 😆). Search for medical aid by price here.
✅ Looks like the medical aid credits are not going away. (This yo-yo'ing reaffirms what I have been saying for a while: it's fine to watch the NHI development from a distance, but no need to get worked up about it just yet)
✅ Don't forget, rehealth,co.za allows you to check all your plan benefits here, and you can also compare any two plans side by side.
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🇿🇦 Everyday health and wellness:
You might have 99 problems - until you have a health problem. Then you'll have just one problem. We help you look after yourself 😉
GBV
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I don't have to tell you about South Africa's shocking sexual violence statistics. Today, November 21, women across the country are gearing for a National shutdown, and are urging our President to declare GBV a national crisis.
The Council of Medical Schemes has issued a Script as to the level of care and treatment that PMB regulations provide for sexual violence incidents.
The treatment component is defined as medical management and psychotherapy, which means all diagnosis, treatment, and care costs related to sexual abuse must be covered in full by medical schemes. This includes:
- Medical consultations and investigations
- Pregnancy, drug, and infection testing (including HIV)
- HIV, Hepatitis B, and Tetanus vaccinations
- Post-Exposure Prophylaxis (PEP) for HIV
- Emergency contraception
- Treatment for injuries and infections
- Termination of pregnancy (TOP), if chosen
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Other news:
💔 End of year gets hectic and stressful. If you or someone you know needs mental health intervention, know that medical aid pays for up to 15 out of hospital consults with a psychologist, or up to 21 days in a mental health facility. By law. Even on hospital plans. More info here.
Know of a South African service / product / facility that I should feature here? Let me know by hitting reply to this email!
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🇿🇦 Weekend loading...
An important part of staying healthy is taking time out to relax, and smell the roses. Go hang out with a book, a podcast, your dog or your friends. Climb a mountain, eat a salad. Smile. This section is all about helping you get into that mood.
Read: A builder’s guide to living a long and healthy life
I'm not going to lie...this is a long, detailed read, but it is full of valuable insight into how to adjust your lifestyle to improve chances of a long and healthy life. Justin Mares breaks down everything, from what clothing to wear, what food to eat, what products to use etc. Very US centric, but the message is clear and applies to all of us. I've bookmarked it to reference over the next months. Find the full article here.
Watch: How to reverse heart aging
A quick video explaining how heart ageing can be reversed. (your heart grows smaller and stiffer as we age). In this case, the heart age of 50yrs+ sedentary individuals was reversed by 20 years just from doing regular, vigorous exercise. Lesson? It's never too late to start excersising.
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📆 Next week...
Thank you for reading! I appreciate your attention :-). Next week I am planning to tackle the following topics (but send me suggestions or questions!).
- When medical aids get sued...we discuss some recent cases
- Medical Aid for students and ageing parents: is there a best plan?
See you then!
PS. If you find value in this newsletter, please forward to a friend! I'll be so happy to see it spread through more medical aid members. Strength in numbers!
Important side note: I am not a broker or financial advisor, so cannot give individual advice. All info is my own interpretation of how the medical aid etc world works. Always speak to a broker or your insurer before making any decisions about your health cover
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