Medical aid becomes more of an essential cover as you get older. The fact is that serious illnesses are more likely to arise in the elderly than in younger people. Given the cost of private healthcare in South Africa, trying to get good quality treatment without medical aid can be very costly. For the elderly on a tight budget, it is plain unaffordable without a medical aid. Fortunately medical aid is opened to any South African, irrespective of age.
Age Limit for the Elderly
Unlike other financial products, medical aid does not have restrictions when it comes to age of its members. You can join a scheme at any age and you can remain on your medical aid cover irrespective of how old you are. But as with other financial products, it is better to join a medical aid as early in your life as possible and stay with it.
The reason being that if you start too late, you may have to pay a higher monthly contribution for the rest of the time that you are on cover. Furthermore seniors are more likely to face waiting periods for chronic conditions like heart disease or diabetes and medical aid will apply up to 12 month pre-existing condition waiting period.
Premium Penalty for Seniors
Medical aids levy a fee on top of the monthly premiums if you start cover after the age of 35 years. This is known as the late joiner penalty and can vary from a small percentage of your monthly contribution to almost your entire medical aid premium.
In the worst case scenario, it can increase your medical aid premium by as much as 90%, depending on when you start cover. Obviously a person who starts medical aid at the age of 60 years will face a much larger penalty than a person who starts at 45 years.
Previous Medical Aid Cover
If you had been on a medical aid previously then you can minimise the impact of your late joiner penalty. You will need to prove to the medical scheme that you plan to join of your previous membership to a registered medical aid in South Africa. The duration of your previous cover and time period during which your were not covered will both impact on the final penalty added to your monthly premium.
However, if you have been off medical aid for less than 90 days or move from one scheme to another, then you will not be held liable for the late joiner penalty provided that you were not subject to it on your previous cover.
Like with any medical aid member, the elderly do not have to be concerned about their current health status or past medical history when joining a medical aid. A waiting period of 12 months applies to all pre-existing diseases. During this time you will still have to pay your monthly contributions but cannot claim for any consultations, tests or treatments related to the pre-existing condition. After this 12 month period, you can enjoy full cover for your ailments.
Waiting Periods for Pensioners
As mentioned above, there is a 12 month waiting period for pre-existing conditions. This applies to any new medical aid member of any age and not only to the elderly. The waiting period only applies if you were not on medical aid cover with any South African scheme in the past 90 days.
Then there is a 3 month general waiting period that is applicable to all claims. This means that you cannot expect your medical aid to cover you for any medical bills in the first 3 months of cover. Here again it is only applicable to new members who were not previously covered on medical aid in the past 90 days.
It does not matter whether you are a senior receiving a pension, living with your kids or working in your twilight years, there is no special pensioner discounts on medical aid rates. Currently there are some network plans which allows people of low income groups to join and pay a slightly discounted rated.
Ultimately you get what you pay for and these discounted plans are very restricted in which doctors you see, which hospitals you attend and other exclusions. If you are employed then it is always advisable to keep your company medical aid into your retirement years.
Rates and Prices for Pensioner Medical Aid
The rate you pay will determine on the level of medical aid cover. As a single pensioner, you can pay R700 for a cheap network medical aid plan with only hospital and chronic care benefits or you can opt for a mid-level cover around R1,500 to R2,500 where you can visit any private hospital of your choice, have full cover for out-of hospital treatment (up to a certain limit) and rest assured that your plan will cover tests, scans and scopes.
However, it is important to be aware that medical aid does not mean that you will not have to fork out cash for co-payments. Many specialists in South Africa now charge above medical aid rates. This means that there will be a short payment by the medical aid thereby requiring the patient to cover the difference. The loss can be mitigated to some extent by medical gap cover, but this type of insurance may have age limits unlike medical aid cover.
All medical schemes in South Africa charge around the same rates for plans with similar level of cover. Always ensure that the price of the cover you choose is affordable and sustainable over the long term. The benefits of the pensioner medical aid plan that you choose should also correlate with your level of healthcare needs. Cheaper plans may seem more attractive but may have restricted benefits and smaller limits.
- Choosing a medical scheme for your parents. Fin24.com