Rising healthcare costs, including hospital bills that can run into hundreds of thousands and more, have made medical aid cover essential for most working people.

While most medical expenses are covered by a good medical aid, there are usually extra payments (called co-payments) that you may have to make when you visit your doctor and dentist or are admitted to hospital.

Nobody likes unexpected expenses, and luckily there’s a way to cover yourself against them – but is gap insurance really worth it? Let’s take a closer look.

Protection against rising medical costs

Most medical aid schemes provide a fair amount of cover for everyday doctor’s visits and mild illnesses, but if you end up visiting medical specialists you may be in for an expensive surprise.

Some top specialists in South Africa are known to charge up to 500% of the maximum fee covered by most medical aids – and that could lead to co-payments that run into thousands of Rands for each visit.

You may not see a specialist every month – or even every year – but if you’re unlucky enough to have an illness that requires specialised treatment one day, gap cover could save you a lot of money.

Gap cover pays you back for all those extra fees

Gap cover is a type of insurance that pays out when you make co-payments. It covers the gap between what your medical aid covers and what your healthcare provider actually charges.

For example, if your doctor’s office asks you to pay a top-up fee of R85 after every visit, it probably means that his or her consultation fee is R85 higher than the highest fee your medical aid is willing to pay for.

Gap insurance will refund you these amounts that you have to pay out of your own pocket for In-Hospital, Out-of-Hospital and Benefit Extender – to a maximum of R150 000 per year. Since most medical aid customers claim between R8 000 to R10 000 a year from their gap cover, this figure should see to all your extra cash payments.

Is it worth paying for gap cover?                                           

Having insurance that covers your medical co-payments is great – but you also have to consider the additional monthly costs for gap cover. Some medical aid customers – especially those who are in good health and seldom go to the doctor – may choose not to take out gap cover and save their cash.

  • If you have a chronic medical condition, or are over 50, you may find yourself visiting the doctor more often than you’d like to – and those co-payments may start to add up.
  • Gap cover will save you money in the long term, especially as you get older, and you can add it to your insurance options at any time.

Can you add gap cover to your medical aid?

In the past, gap cover was provided by insurance companies, not medical aids – but this has started to change. Several medical aid providers now offer gap cover as a monthly option and simply add the costs to your premium.

If you feel that you’d benefit from the extra financial security that gap cover offers, your medical aid provider will be able to give you the information you need.