Medical Aid for Pensioners

Medical aid for pensionersMedical aid becomes increasingly necessary as people age and are more likely to suffer from chronic health conditions. Unfortunately, aging may also be associated with a drop in income, making it financially difficult or impossible to cover the high monthly premiums associated with comprehensive medical aid plans.

All South Africans, pensioners included, have access to government healthcare facilities. However, given the state of public healthcare in South Africa, it’s understandable why only those who absolutely can’t afford anything else resort to it.

If you’re approaching pensionable age or are already a pensioner and you’re considering joining a medical aid scheme, it’s important to weigh your options carefully and to be aware of all the relevant issues.

Planning Ahead

South African medical aid schemes are legally prevented from discriminating against applicants or members based on their age. They’re not allowed to refuse membership to people above a certain age, and basic monthly contributions are the same for all members in a specific plan, irrespective of age or any pre-existing conditions.

However, it’s important to note that medical aid schemes are entitled to charge anyone of 35 years or older who joins a scheme for the first time a “late joiner” fee. This fee is added to the member’s monthly contributions.

The late joiner fee doesn’t apply to medical aid members changing from one medical aid to another, if they have always had cover – only to those signing up for cover for the first time or to those that have had breaks in cover since age 35.

Waiting Periods

As a standard condition across all medical aid providers and plans, any new member of a medical aid plan is subject to a 3-month waiting period. During this period, you can’t claim for any expenses. A three-month waiting period applies even if you change from one medical aid to another but the criteria may change if the member has been on a previous Medical aid and the new scheme may have to cover certain conditions.

Note that if you join through IFC, we might be able to negotiate the 3 months, in certain cases!

Pre-existing Conditions

Typically once you join a medical aid scheme, there’s a 12 months period in which any pre-existing conditions won’t be covered. For this reason, it’s best not to wait until old age – when you’re at greater risk of a range of chronic health conditions – to join a medical aid scheme. If you can do so earlier, you’ll lessen the risk that you won’t be covered for pre-existing conditions.

Choosing the Right Plan

Typically the best plans for pensioners are those with lower monthly contributions but comprehensive cover for chronic conditions.

You may have to consider downgrading your medical aid plan as you move into retirement. Many consider changing to hospital plans because these offer good chronic cover, without the high monthly premiums associated with comprehensive plans. However, hospital plans don’t cover day-to-day medical expenses, such as consultations, acute medicines and tests.

Using IFC’s medical aid comparison tool, you can easily weigh up the options, comparing the looking at how their prescribed minimum benefits (PMBs), chronic cover, and day-to-day benefits offered by various medical aid plans in South Africa.

Alternatively, contact us for assistance in finding the medical plan that best suits your needs. 

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