16 March 2022

As the health care costs continue to rise…

It is essential to learn how to manage healthcare costs more effectively. Learn how to stretch your medical aid benefits and still receive the care you need.

Healthcare costs shown with a piggy bank.Understanding your benefits

Identify the benefits on your medical aid plan. This way you will know which benefits and services are available to you and the requirement to activate additional benefits your plan might offer.

Use your benefits

Most schemes offer a comprehensive preventative and early detection programme to all their members. Your medical aid pays for this programme and does not diminish your allocated day-to-day benefits.

Therefore, make it a priority to go for your routine health screenings. Health problems detected at an early stage might be more easily treatable.

Use your General Practitioner (GP) as your gatekeeper

Instead of consulting directly with a specialist regarding a health concern, rather visit your GP first. You may not know this, but your GP is qualified to conduct a detailed examination for most health conditions. Some conditions could be easily remedied by prescribing effective treatment. Also by making sure that you receive a referral to see the most appropriate specialist.

Not only could this save you time and keep you healthcare costs low, but it also enhances your health journey and continuity of care as your GP builds your health history.

Save money on medicines

If you or your dependents need to use medication daily that does not qualify for chronic cover, ask your doctor if you can switch to generic medicines. These cost less than brand name drugs, but still contain the same active ingredients.

Should you or any of your dependents suffer from one of the 26 chronic conditions that are Prescribed Minimum Benefits make sure that these conditions are registered with your medical aid and that the medication prescribed does fall under the list of approved drugs. This is a ‘formulary’, to avoid co-payments and therefore, decrease your healthcare costs.

Try to use a GP that has a dispensing practice. This way, the medication prescribed for the illness will form part of your consultation cost and not an extra expense at a pharmacy.

Use your medical savings account (MSA) wisely

Most of the medical aid options available offer a savings component for your day-to-day medical needs. This is a compulsory savings component, which is a certain percentage of your monthly contribution. This percentage varies from medical aid to medical aid and also differs per plan type. The maximum savings percentage allowed by schemes is 25% of your monthly contribution.

The available funds in your MSA are for the exclusive use of day-to-day medical needs and co-payments. You can avoid having the co-payments being funded from your MSA by paying this upfront on the day of the procedure. Also by instructing your scheme prior to the claim being submitted not to process it from your MSA.

The total MSA amount availability is at the beginning of the benefit year, which is January till December. This means that you will have access to 12 months’ worth of savings in January. If you join the medical aid later in the year, your savings are available pro-rata based on the remaining months of the year.

Being on a savings option places the responsibility with the member to manage the utilisation of the funds, therefore you need to use this wisely as most of your day-to-day medical expenses will be paid from your available MSA. You do not want to realise mid-year that there are no more funds available in your MSA when you need to go for dental treatment, as this will mean that you must pay for it out of your pocket.

Any savings left at the end of the benefit year should be available during next benefit year.

Utilise the designated service providers (DSP’s) and networks

All medical aids have implemented networks and have identified DSP’s to be used for specific benefits. These providers could include doctors, pharmacies, optometrists, hospitals and many other healthcare providers and facilities.

This is not to disadvantage the members or force them to change their lifelong healthcare providers, but merely a measure to make the services more cost effective by negotiating the best possible rates for healthcare services, which in turn will ensure your claims are paid in full by your medical aid.

Minimise shortfalls

When you have a planned medical procedure or require specialised treatment you can request the service provider to supply you with a quotation before the planned admission / treatment date. This will enable you to get a cost estimate from your medical aid to identify possible shortfalls and engage with your doctor to negotiate a better rate.

If you need to go for a specific procedure or surgery that has a procedural co-payment, ask your doctor whether there is an out-patient facility instead as this could result in a lower co-payment.

Why does the cost of medical aids increase annually?

Medical aid increases are based on a combination of the expected and the unexpected.

The sustainability of medical aids is also largely dependent on healthy growth, with young and healthy lives.

Medical aids not only pay out medical claims for their members, but they also must provide for their running costs and legislated requirements. Healthcare cost inflation, which is usually significantly higher than CPI has a direct impact when it comes to annual medical aid increases. Medical aid increases are also driven by the increased charges from healthcare providers, how the members use these healthcare services, the demand for healthcare and the increase in members needing chronic medicines.

Using benefits wisely and by making smart choices in managing healthcare expenses by all medical aid members could play an import role in containing the ever-increasing healthcare expenditure.

Contact HealthMax Medical Aid Services to assist you with all your medical aid enquiries.

The information contained in this communication, including attachments, is not to be construed as advice in terms of the Financial Advisory and Intermediary Services Act of 2002 (“FAIS”) as the writer is neither an appointed representative of Zestlife, nor a licensed financial services provider as contemplated in FAIS. Please consult your Financial Adviser or Zestlife should you require advice of a financial nature and/or intermediary services.