Healthcare costs can catch you off guard, even when you think you’re financially prepared. An accident, unexpected illness or hospital procedure can quickly result in medical bills and expenses you hadn’t planned for.
For South Africans, preparing for unexpected healthcare costs is an important part of protecting your finances. While medical aid can help cover many healthcare expenses, there may still be situations where you have to pay some costs out of your own pocket.
Understanding where these unexpected medical bills can come from can help you prepare for them.
Why Medical Bills Can Be Unexpected
Nobody plans to get sick, have an accident or suddenly need medical treatment.
When an emergency happens, your priority is naturally getting the care you need. But depending on the treatment required and the cover you have in place, you could discover that not every medical expense is covered in full, and it results in unexpected medical bills.
This is why it’s important to understand your healthcare cover before you need to use it.
Does Medical Aid Cover All Medical Expenses?
Having medical aid provides important financial protection, but it doesn’t necessarily mean every healthcare expense will be paid in full.
Medical schemes have different plans, benefits, limits, networks and rates at which they reimburse healthcare providers.
At the same time, doctors and specialists may charge fees that differ from the rate your medical scheme covers.
When there is a difference between an eligible amount charged by a healthcare provider and the amount covered by your medical scheme, you may be responsible for some of the remaining cost.
Discover why medical aids don’t always cover everything.
How Medical Expense Shortfalls Can Affect Your Budget
Unexpected medical bills can put pressure on your finances, particularly when it wasn’t included in your monthly budget.
For example, you may require an unplanned procedure involving a surgeon, anaesthetist or other specialist. Depending on your medical scheme and the fees charged, your scheme may not cover every eligible expense in full.
Even if you’ve carefully planned your finances, paying an unexpected medical expense out of pocket can affect your savings and other financial commitments.
That’s why preparing for healthcare expenses shouldn’t only be about planning for everyday doctor visits. It’s also worth considering how you would handle an unexpected shortfall.
How to Prepare for Unexpected Medical Bills
One of the best ways to protect yourself financially is to understand exactly what healthcare cover you already have.
Take the time to familiarise yourself with your medical scheme benefits, including applicable limits, network requirements and exclusions. Before a planned procedure, you can also ask your medical scheme what it will cover and ask your healthcare providers for an estimate of their fees.
Building an emergency fund can provide another financial safety net for expenses that aren’t covered.
You can also consider additional insurance products designed to complement your existing healthcare cover.
Where Does Gap Cover Fit In?
This is where Gap Cover can become relevant when it comes to unexpected medical bills.
If you are already a member of a registered medical scheme, Gap Cover can provide an additional layer of financial protection against certain qualifying medical expense shortfalls, subject to the benefits and limits of your policy.
Gap Cover doesn’t replace your medical aid. Instead, it is designed to work alongside it.
For example, if an eligible healthcare provider charges more than the amount your medical scheme pays for a qualifying event, Gap Cover may help cover some or all of that insured shortfall, depending on your policy.
This can help reduce the amount you may otherwise need to pay from your own pocket.
Understand what Gap Cover is.
Do You Need Gap Cover?
Whether Gap Cover is suitable for you depends on your circumstances, medical scheme and the level of financial protection you’re looking for.
Consider how comfortably you could manage an unexpected medical expense if your medical scheme didn’t cover the full eligible amount.
It’s also important to compare Gap Cover policies carefully. Look at the benefits, limits, exclusions, waiting periods and other policy terms so you understand exactly what is and isn’t covered.
Protect Yourself From Unexpected Healthcare Costs
You can’t always predict when you’ll need medical treatment, but you can take steps to prepare financially.
Understanding your medical scheme, planning for out-of-pocket healthcare expenses and having additional financial protection can help you feel better prepared when unexpected medical costs arise.
For medical scheme members looking for an extra layer of protection, Oneplan Gap Cover can help cover certain qualifying medical expense shortfalls.
Explore Oneplan Gap Cover today to find out how it can complement your existing medical scheme cover.
Your Gap Cover Family,