If you are asking the question “Should I belong to a Medical Aid?” because you simply cannot fit the premium into your budget, let me tell you a couple of real-life stories:

Story 1: A Tumble Down Some Stairs

Someone I know fell down a flight of stairs at her home a while back. She did not have a medical aid at the the time. The fall left her with scull fractures and compound fractures to both wrists.

Relatives stepped in and lent her the money needed.She ended up spending 3 days in hospital, of which 2 nights in high-care. She had emergency surgery on both her wrists, and needed various x-rays to determine the extent of her injuries, including two CAT scans to monitor her head injury. More than a R100 000 later, she is left with a large debt to the family member.

She is torn between paying back the money as fast as possible or signing up for a medical aid to cover future health risks. {personally, I would apply the four walls principle, and get the medical aid in place before starting to pay back the debt – since her risk ends up being her family member’s risk as well.}

Story 2: A Career-Altering Accident

I know of a photographer who had a motorcycle accident a few years ago. He did not have a medical aid, and his wife was pregnant with their first child.

He ended up in a state hospital which could only provide the most basic care. He needed a specialised shoulder surgery within a certain time window to save his ability to move his arm naturally. As a photographer you can imagine how important this function is for his lively-hood. The surgery was quoted at about R500 000 at the time. His family pulled out all the stops to fund-raise for him, but I’m not sure if they managed to raise the money in time.

This is an unfortunate example of how sub-standard medical care can impact on your future ability to earn an income for your family.

Story 3: An Unexpected Pregnancy

This is my own story. For a couple of years we did not have a medical aid because we simply could not afford it. We were very lucky to only have small medical emergencies during that time, that is, until I fell pregnant. This was unexpected since I have fertility issues. We went for a free scan at our local clinic, and all seemed well.

For the next five weeks I worried and worried about the pregnancy and delivery, since in South Africa, you will not be covered if you apply for a medical aid with a pre-existing condition such as pregnancy. I did a re-con visit to the local state hospital’s maternity ward and it honestly did not seem so bad. I had just started to make peace with my lot, when I woke in the middle of the night to find that I was having a miscarriage.

The day that followed was crazy, traumatic and emotionally draining. A grief fell on us that we still can’t put into words. We were ushered from doctor to doctor until the gynae told us that I had to have an emergency D&C that same day. Since we were private patients without medical aid, he could negotiate a big discount for us with the hospital, but we were so broke at that stage, that even the discounted amount was completely out of reach. I remember sitting in the parking lot of the hospital, frantically trying to apply for a personal loan to cover the costs. As is typical with credit providers, they are never there for you when you need them. I have never had borrowing issues before, and was able to borrow more than enough money just two days later, but on that day, no help was available to me. {This is why relying on credit for emergencies is very risky and unreliable. Rather build an emergency fund that you can access immediately when you need it.}

We then proceeded to start the admission process at the state hospital, my gynae was willing to perform the D&C there, although it was not his first choice. Because we both earn enough money, we still had to pay R700 upfront, with a second invoice due after the procedure. We live in a small town, and at least three people we know found me there in the reception area and I had to keep retelling the story. I was emotionally raw and very scared.

Nothing could prepare me for the chaos of the state hospital emergency ward. People lying on cots in the corridor, wild and frightened eyes all around, poverty, pain, nurses who did not have my details. Right there and then I had my big breakdown, I fled the ward and sat outside on the grass crying, refusing to be admitted.

My dad came through for us by lending us the R5000 deposit we needed for the private hospital. I cannot explain to you the contrast in experience… the calmness and compassion of the nurses, the clean sheets and the private room where my family could come and visit with me that night…

This got me thinking: What if I did not have a miscarriage, but ended up with a preemie or other birth complications? What if my baby needed NICU care but the state hospital could not provide it?

We realised that having medical aid cover or not is very often what stands between life and death in South Africa.

We signed up for medical aid cover the very next day, and have been cutting down in other areas of our lives but will never again not have a medical aid. The risks are too big, life is too fragile and we need to be able to work to earn an income. We also realised that we were debt-poor, people who earn a decent income on paper, but have no access to emergency funds because we are so indebted. Thankfully, we discovered Dave Ramsey’s pod-cast shortly after this, and we finally have a plan to get out of debt and get our lives back on track.

My Conclusion:

Should I belong to a Medical Aid? Yes!

My heart goes out to the masses of fellow South Africans who have no other option but to rely on state medical care. But for those of us who can make it work, we should try our utmost to have medical cover of some kind, even if it is just a hospital plan.

Most Affordable Medical Aid Options {2014}:

  1. Bonitas BonCap {Premium is based on income} – Starting at R615 pm / principal member.
  2. Genesis Private Choice – Starting at R855 pm / principal member, their cost for dependent children are quite low.
  3. Discovery Key Care {Premium based on income} – Starting at R490 pm / principal member.
  4. BestMed Pulse – Starting from R940 for the principal member
  5. Medihelp Necesse {Premium based on income} – Starting at R1002 pm / principal member.
  6. Liberty Hospital Select – Starting at R1143 / principal member.
  7. Medshield MediValue – Starting at R1158 / principal member.
  8. Momentum Incentive Option {state chronic providers} – Starting at R1288 / principal member.
  9. Sizwe Primary Care {Premium is based on income} – Starting at R1480 / principal member.

MoneySmart did a comparison of Hospital Plans, click here to take a look. Shop around and use a medical broker if you must, there are affordable medical aid options available with most medical aids, they are just not marketed as widely as the more expensive options.

If you can help it at all, don’t risk your life by going without a medical aid.

{The image used is from a MoneySmart piece called: Medical Aid for Single Mothers.}.