Bad news for medical aid members in 2025
Medical aid schemes in South Africa have announced significant price hikes for plans starting January 2025, averaging 10.7% across 12 of the biggest schemes – far higher than inflation, which is expected to average below 4%.
This means that medical aid prices will be shooting up by an average of 6.7% in real terms next year – while salary and wage increases are barely scraping by with a 1.5% to 2% hike.
Given the constraints on household finances, many will be left with no option but to either cut spending elsewhere to keep affording their plans – or downgrade to lower cover to ensure at least some coverage.
According to Jacqui Nel, business unit head of healthcare at Aon South Africa, the hefty price hikes have been largely driven by increased use of schemes, which have surpassed pre-Covid-19 levels.
At the same time, sharply rising living costs and heavily constrained household incomes are exerting untenable pressure, with many consumers struggling to keep pace with the soaring costs of retaining access to their private healthcare.
“While many South Africans are having to re-evaluate their healthcare funding plans, the continued strain on and poor quality of many public healthcare facilities means that retaining access to private healthcare remains a necessity,” Nel said.
This means that on top of all the other financial pressures households face, many will be forced to reprioritise their budgets to keep their plans.
If this proves too difficult on strained income, Nel said that households may have to consider downgrading their options.
“The most crucial aspect right now is to secure your healthcare cover which is fundamental to carrying you through a potential health crisis, ensuring that you get the best possible private medical care in your time of need,” she said.
Nel laid out key things to look at when considering medical aid coverage:
Medical aid changes
Medical schemes have released their increases and updated plan information for 2025. These updates include changes in contributions, co-payments and benefits.
Before renewing your plan, it’s crucial to evaluate the increases, most of which have been well above inflation.
Check for changes in benefits such as adjustments in coverage and limits, changes to hospital networks, limits on specialist visits or increased co-payments for certain procedures.
Some plans may restrict you to a network of hospitals, which could limit your access to healthcare providers.
Ensure that these hospitals are conveniently located and have a good reputation. Remember that a network is not an indication of inferior care, but rather the medical scheme’s ability to negotiate for better pricing and outcomes when using these networks in the interest of their members.
Flexibility
Check whether your benefit option provides the flexibility to upgrade due to life changing health events if needed – you may be healthy now, but no one knows what the future holds.
If you do face a life changing health event, check whether you are able to get access to upgraded cover when required, or if you would have to wait for the year-end renewal period to exercise this option.
Also, consider options that provide access to virtual doctor’s consultations as a means to provide access to more affordable, quality healthcare.
Over or under-insured
Assess your current day-to-day expenditure and whether your existing benefits provide sufficient cover and will not leave you out of pocket.
Similarly, check whether you are over-insured and paying for cover you do not need, which will allow you to buy down as an option to consider if you’re under financial pressure.
Downgrading
If you are downgrading cover to a lower benefit option it is important to understand that you will receive less cover and benefits.
Find out what those benefit reductions are, how your access to healthcare is affected and the implications for your pocket. If you are changing to another benefit option, move to another option within the same medical scheme to avoid any waiting periods.
Most schemes will allow a buy-down at any time during the year. If you do move to another medical scheme ensure you understand the underwriting that may be imposed such as waiting periods.
If you’re downgrading to a core benefit that only covers hospitalisation (ie, a hospital plan), understand that you will need to fully self-fund your day-to-day primary care like GP visits, dentistry, optometry, acute/chronic medication and preventative health check-ups.
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