Hospital Plan vs Medical Aid: Which One Is Right For You?

Medical bills can be expensive. And unexpected, unbudgeted visits to the doctor certainly don’t work in your favour. 

There are more affordable options available, such as government hospitals. But in South Africa, these options aren’t known to rank very highly in terms of providing quality service. For this reason, many choose to opt for private cover from South African insurance companies instead. 

There are many important decisions one needs to make in life. And choosing between hospital plans and medical aid is certainly one of them. 

Both offer benefits that cater to your specific needs. But how do you know which one is right for you? Is there even a difference? And is it worth it?

In this article, we’ll be discussing the main differences between hospital plans and medical aid. We’ll also be giving a few helpful pointers to consider when deciding for yourself. 

A group of doctors and surgeons in surgery

What Is A Hospital Plan?

Before you make your decision on which is the right choice for you, you need to know what your options are. 

In most cases, a hospital plan is exactly that, it only covers your expenses if you were to be hospitalized. These plans also generally offer fewer allowances for everyday expenses compared to medical aid. 

A hospital plan is essentially a short-term health insurance plan that is more restrictive, as it covers only certain procedures, under certain conditions. They reimburse the individual or policyholder, but this payment is not always guaranteed. 

Hospital plans can refuse payment for certain treatment options or stop cover once you reach a certain age. They can even permanently exclude certain health conditions. 

Many people who are young and relatively healthy opt for this choice for a variety of reasons. Most hospital plan prices are more affordable, but only because they offer limited benefits and less coverage. 

Young people are generally less likely to develop health issues that require ongoing or regular treatment. In this case, a hospital plan seems to be the right choice. They don’t need frequent hospital or doctor visits, but would be covered in case of a medical emergency.  

What Is Medical Aid?

Medical aid is regulated by the Medical Schemes Council and pays the hospital or service provider directly. They cannot refuse to cover you, regardless of your health or age, and have to cover the cost of any life-threatening conditions. Any exclusions, exceptions or waiting periods are regulated.

While it may depend on your specific health requirements, most medical aid companies offer both hospital and medical aid plans. There are a variety of medical aid plans to choose from, all offering different benefits and levels of coverage. 

A comprehensive medical aid will cover both in-hospital expenses as well as everything in-between. This includes medical claims, surgery-related benefits, and your day-to-day expenses, such as medication and visits to the doctor or specialist. 

This option ensures peace of mind, but it doesn’t come cheap. 

5 Important Factors To Consider

In theory and on paper, a potential hospital or medical aid plan may look like a great deal. But there are advantages and disadvantages to both that you need to consider. 

These are mainly subjective and differ from person to person. That’s why it’s crucial to carefully weigh your options before making a decision between the two. Here are a number of key factors to consider when choosing between a hospital plan and medical aid:

1. Your General Health and Medical Requirements

Does your place of work pose any health or safety risks? Do you have a chronic disease?

Hypertension equipment and medicine

These are some of the things you should consider when taking into account your general and potential medical requirements. Some situations may be recurring for a long-term period. Others may call for a once-off accidental cover.

2. Your Age

It should go without saying that the older you are, the more at risk you become to certain health and medical conditions. This will likely play a significant role in your medical cover.

When signing up for medical aid over the age of 35, you could be liable to pay a Late Joiner Penalty. This does, however, depend on the number of years that you were not part of a medical scheme. 

3. Your Dependants

Prices may vary considerably depending on the number of people you intend to cover. Many times it’s cheaper to cover a couple or family on one plan than multiple separate plans. Whether it’s just yourself or a family of 5, it’s important to verify the cost depending on your family unit. 

4. Your Financial Situation

It’s natural to want the best package on offer, but you should be sure that it’s something you can afford. You want to avoid a situation where you require medical attention but can’t make a claim because you’re behind on payments. 

A large calculator sitting on top of a pile of money

If you’re unsure as to what you can expect to pay, consider getting a medical insurance quote.

5. The Pros And Cons Of Each Medical Plan

Whether it’s the exclusion of certain conditions or additional monthly perks and discounts, each medical scheme has pros and cons. It’s important to read the fine print and figure out what works best for you. 


Some may feel it’s a good idea to have a combination of medical aid and a hospital plan. But the decision is entirely dependent on your own personal needs, abilities and preferences.

From coming down with the common cold to accidental injuries at work, medical bills can be expensive. Regardless of your age, medical cover is definitely something you should consider. 

With a broad variety of medical plans to choose from, the decision could feel slightly overwhelming. These days you can even find pet insurance. But hopefully, this article has shed some light on how best to go about making your choice. 

If you have any further questions or concerns, it’s best to consult your doctor or hospital on the best option available for you. 

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