Why your “why” matters when choosing a medical aid
Kevin Aron, Principal Officer at Medshield Medical Scheme
7 October 2025
JOHANNESBURG - Healthcare is one of the most important long-term investments you will ever make. Yet for many South Africans, selecting a medical aid can feel overwhelming – with too many plans, too much jargon, and too little time. As a result, people often end up either over-insured, paying for benefits they never use, or under-insured, left exposed when they need care most.
The best way to cut through this noise is to start with a simple but powerful question: Why? Why do you need medical aid? Why these particular benefits? Why this type of cover? If you cannot answer these questions, there is a risk of buying the wrong cover. Defining your 'why' ensures your scheme’s benefit aligns with your genuine needs. Without it, you leave advisors to guess on your behalf, which can lead to mismatched cover.
Choosing the right fit for you
Much of the confusion stems from a lack of understanding about how plans differ. Let's simplify:
- Hospital plans: As the name suggests, they cover you for in-hospital incidents. If you are involved in an accident and require surgery, your hospital plan covers those costs. However, these plans typically do not cover GP visits, dental work, or spectacles.
- Traditional plans: These give you a "basket" of defined benefits across categories like GP visits, hospital cover, dental, and optical. They are predictable, but unused benefits expire at year-end.
- Savings plans: In this case, a portion of your contribution is deposited into a savings account that you control. One year, you may use it for dentistry; the next, for spectacles. Unused balances roll over, and in some cases, can be transferred if you move schemes.
The medical aid industry is notorious for acronyms – PMBs, DSPs, co-payments – but jargon should never be a barrier to understanding your healthcare. Members have a responsibility to engage - read scheme communications, ask questions, and demand clarity. After all, your contributions are an investment in your health. If you don’t understand a term, ask. At Medshield Medical Scheme, we are committed to simplifying language and offering plain, accessible explanations. And remember, you are not alone. Brokers are available to unpack the fine print and guide you through your options.
The role of brokers
Too many people don’t realise they have the right to a broker. Brokers – formally known as independent financial advisors – are licensed to represent multiple schemes. They are legally obligated to match your needs with the most suitable plan, not simply to sell one product.
A good broker listens to your why, presents alternatives, and recommends the closest fit. Their services come at no cost to you, yet their value is immense. Just as you may have a trusted advisor for retirement planning, you can also have one for healthcare. In fact, some families have had the same broker for decades, guiding them through every stage of life.
If your current broker doesn't offer all the benefits you need, including medical aid, retirement, or short-term insurance, you are entitled to switch to one that does.
Do not forget the networks
Even with the right plan, where you go for care matters. Visiting out-of-network providers can result in unexpected bills. Medshield negotiates rates with in-network doctors, specialists, and hospitals – ensuring lower costs, smoother administration, and consistent standards of care. To help, we provide online tools and an app to search for in-network providers by location or speciality. Medshield’s digital benefits available on all options, gives you access to telemedicine so you can consult virtually or telephonically with your General Practitioner before deciding on in-person care.
Switching schemes
Sometimes your needs change, and so must your scheme. But switching requires caution:
- Waiting periods: A 3-month general waiting period may apply, or a 12-month exclusion for pre-existing conditions. If you move directly between schemes with no break in cover, these cannot be applied.
- Late-joiner penalties: If you join a scheme for the first time after 35, you may face penalties of 5% to 75% of your premium, depending on the years you were not covered.
- Gap cover: Schemes do not always pay specialists' full rates. Gap cover can bridge the shortfall and prevent financial shocks.
At Medshield, members can switch between options once a year, during December, with the change taking effect from January. This flexibility ensures your cover keeps pace with your life.
Value and partnership
Healthcare costs in South Africa rise faster than consumer inflation, driven by increasing pharmaceutical drug prices, technological advancements, and an ageing population. For households, this means that healthcare is consuming a growing share of income.
Schemes must provide clarity and value, but members must also take responsibility. Healthcare isn't "set and forget". Your needs evolve – marriage, children, chronic conditions, retirement – and your cover should evolve too. Regular reviews and engagement with your broker ensure you remain adequately protected.
Healthcare is not just about claims. It is about confidence, stability, and well-being. At Medshield, we are committed to walking with you at every stage of life. We simplify choices, broaden access, and help you stay financially secure while protecting your health. When you choose Medshield, you choose more than a scheme. You select a Partner for Life.
FIN
(856 words)
