A breast cancer diagnosis can turn your world upside down.
Suddenly, there are doctor’s appointments to schedule, tests to undergo, treatment options to understand and some pretty big decisions to make.
The last thing anyone wants to worry about during this time is money.
But here’s something many people don’t realise. Even if you have medical aid, you could still face unexpected medical expenses during cancer treatment.
And when you’re already dealing with the emotional and physical impact of a diagnosis, receiving an unexpected medical bill is the last thing you need.
So, in recognition of Breast Cancer Awareness Month, let’s talk about some of the costs that can come with a breast cancer diagnosis, why medical aid doesn’t always cover everything and where Gap Cover fits in.
1. Breast cancer treatment isn’t always one appointment
When we think about breast cancer treatment, chemotherapy or surgery might be the first things that come to mind.
But the reality is that treatment often involves several stages, depending on the diagnosis and the recommended care.
These could include:
- Diagnostic tests: Mammograms, ultrasounds, biopsies and other tests to confirm a diagnosis.
- Specialist consultations: Appointments with oncologists, surgeons and other healthcare professionals.
- Surgery: Procedures such as a lumpectomy or mastectomy, depending on the treatment plan.
- Cancer treatment: Chemotherapy, radiation therapy, hormone therapy or other prescribed treatments.
- Follow-up care: Ongoing appointments and tests to monitor recovery and check for recurrence.
Not everyone will need all these treatments, and the costs will differ depending on the care required.
But even when your medical aid contributes towards treatment, there may still be expenses that aren’t covered in full.
And that’s where things can become financially stressful.
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2. Medical aid doesn’t always mean everything is paid for
Here’s something worth knowing before you’re faced with a medical bill.
Having medical aid doesn’t automatically mean every healthcare provider will charge within your scheme’s rates.
For example, your medical aid might pay a specialist according to its medical scheme tariff, but the specialist could charge more than that amount.
The difference between what the specialist charges and what your medical aid pays could become your responsibility.
And when you’re dealing with multiple consultations or medical procedures, those shortfalls can add up.
It’s also important to understand that medical schemes have different benefits, rules and payment arrangements for cancer treatment.
Certain cancer-related treatments may qualify for Prescribed Minimum Benefits (PMBs), subject to the applicable requirements and scheme rules. However, this doesn’t mean every treatment or provider charge will automatically be covered in full.
That’s why it’s important to understand what your medical aid covers before treatment begins, wherever possible.
Discover our self-examination guide to breast cancer.
3. The hidden costs of cancer treatment
When someone receives a breast cancer diagnosis, the focus is understandably on getting the right treatment.
But there are also other expenses that can come with the journey.
Think about things like travelling to appointments, taking time off work, arranging childcare or paying for additional support at home.
Then there are potential medical expenses, such as specialist fees or certain hospital-related charges, that your medical aid might not settle in full.
These costs can put pressure on your finances at a time when you need to focus on your health.
While Gap Cover won’t pay for every expense associated with cancer treatment, it can help with certain eligible medical aid shortfalls, depending on your policy.
The important thing is knowing which expenses are covered and which ones you’ll need to plan for yourself.
4. Where does Gap Cover come in?
You’ve probably heard of Gap Cover, but do you know what it actually does?
Let’s break it down.
Your medical aid pays towards eligible medical expenses according to your scheme’s rules and benefits.
But sometimes, the amount charged by a healthcare provider is higher than what your medical aid pays.
That difference is commonly referred to as a medical expense shortfall.
Gap Cover is designed to help cover certain qualifying shortfalls, subject to the policy’s terms, limits and exclusions.
For someone undergoing breast cancer treatment, this could be particularly relevant when eligible specialist or in-hospital charges exceed the amount paid by their medical aid.
However, Gap Cover isn’t a replacement for medical aid, and it doesn’t automatically cover every cancer-related expense.
The benefits available will depend on your chosen Gap Cover policy and the circumstances of the claim.
5. Why understanding your cover matters
Nobody wants to spend hours reading policy documents, especially when there are already so many other things to think about.
But understanding your medical aid and Gap Cover benefits can help you avoid unnecessary surprises.
If you or someone you love is preparing for cancer treatment, here are a few questions worth asking:
- What will my medical aid cover? Check which treatments, specialists and facilities are included in your benefits.
- Do I need pre-authorisation? Certain procedures and treatments may need approval before they take place.
- Could there be a medical expense shortfall? Ask for cost estimates and check what your medical aid is expected to pay.
- What does my Gap Cover policy include? Understand which shortfalls qualify, along with any limits, waiting periods and exclusions.
- What expenses will I need to cover myself? Plan for costs that fall outside your medical aid and Gap Cover benefits.
Having these conversations early can help you make more informed decisions about your healthcare and finances.
And if something in your policy doesn’t make sense, ask your provider to explain it.
Early detection still matters
While understanding the financial side of breast cancer is important, looking after your health should always come first.
Breast cancer can affect people of different ages, and although it’s much more common in women, men can develop it too.
That’s why being aware of changes in your body matters.
Some warning signs to look out for include:
- A new lump in the breast or underarm.
- Changes in breast size or shape.
- Unusual nipple discharge.
- Changes to the skin, such as dimpling or redness.
- A nipple that suddenly turns inward.
These symptoms don’t necessarily mean breast cancer, but they should be checked by a healthcare professional.
Regular screening, when recommended for your age and risk, can also help detect breast cancer before symptoms appear.
And remember, early detection can make a real difference to treatment outcomes.
Your health comes first. Your finances matter too.
A breast cancer diagnosis comes with enough challenges. Understanding your medical expenses shouldn’t have to be another one.
While you can’t predict every healthcare expense, you can take steps to understand your medical aid benefits, ask questions about treatment costs and prepare for potential shortfalls.
That’s where having the right Gap Cover can make a difference.
With Oneplan Gap Cover, you can explore additional financial protection against certain qualifying medical aid shortfalls, so you’re better prepared when eligible healthcare costs aren’t covered in full.
Because when your health needs your attention, the last thing you want is an unexpected medical bill.
Explore Oneplan Gap Cover and see how it could complement your existing medical aid.
Oneplan Gap Cover is a separate insurance product that supplements medical aid. It is not a medical scheme and does not replace medical aid. All benefits are subject to policy terms, limits, waiting periods and exclusions. Cover for cancer-related medical expenses is not automatic and depends on the applicable policy benefits.
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