Medical Aid if you’re Over 60

Medical aid over 60

As we age, our medical expenses tend to skyrocket. Wear and tear on joints and organs, an increasing incidence of chronic conditions and general illnesses associated with aging may all require specialist interventions from medical practitioners.

The need for comprehensive medical aid is more critical than ever before, and at a stage of life when you're probably heading for retirement and the associated budgetary constraints.

Adjust your risk profile frequently

If you're a signed up member of a medical aid scheme in South Africa, it's a good idea to re-adjust your risk profile on an annual basis. This is to ensure that as you age, your cover remains appropriate, given your likely needs.

Among the medical aid components you should consider when assessing your current medical aid benefit structure are the following:

  • chronic illness benefit – is it sufficient, what non-PMB conditions and chronic medications are covered, and at what rate?
  • disease management program – does your medical aid offer a management program for your condition, and are you a registered member?
  • emergency and casualty benefit – is there blanket cover for emergency evacuations, how are the costs of casualty visits covered, and do you have to use network facilities, or any hospital or clinic?
  • external medical appliances – are wheelchairs, walkers, breathing devices, hearing aids and insulin pumps paid for in full by your medical aid?   
  • prosthetic devices – does your medical aid provider limit the benefits associated with knee, hip and shoulder prostheses, pacemakers and other internal devices, and do you have to use a preferred supplier?
  • home nursing benefit – is your care at home covered, and for how long after an event or surgery?

Are there medical aid related pensioner discounts or special rates?

Unlike many other industries, the medical aid industry does not offer beneficial rates, or pensioner discounts, to senior citizens.

However, people older than 60 typically claim more frequently and for more expensive treatments and procedures than younger individuals, but they pay the same monthly contributions, which are standard across a particular medical aid plan or package.

Late joiner fees

If you are over 60 and intend joining a medical aid scheme for the first time, or have been without medical aid cover for three months or more, you will be slapped with a late joiner fee.

This penalty applies to all adults of 35 years and older, and increases exponentially according to the period of time that you have been without cover.

A late joiner fee is not a one-off payment. It is integrated into your monthly contribution for as long as you remain a member of a particular scheme.

If you have belonged to a scheme before, this may minimise the penalty. You will be expected to prove prior membership at a registered medical aid in South Africa. Cash-back hospital plans and other short-term medical insurance products do not qualify, however.

Medical aid beneficiaries who switch medical aid providers within 90 days won't be required to pay late joiner fees if they have always had cover or are below age 35.

Waiting periods if you have had breaks of longer than 90 days:

In addition to a late joiner fee, defined waiting periods apply. Generally, you won't be able to claim any benefits at all during your first three months with a particular medical aid provider.

Furthermore, expenses relating to the treatment and care of a pre-existing condition will not be covered for the first year of membership. 

Consult an independent medical aid broker

For expert advice about the best medical aid if you're over 60, consider using the services of an IFC independent financial broker.

Our brokers are experts at evaluating risk, have in-depth knowledge of the medical aid industry and its products and services, and can point you in the right direction, recommending a medical aid plan and option that suits your budget, age and current healthcare needs.