Waiting too long to join a medical scheme could cost people dearly later in life, when late joiner penalties can significantly increase their monthly medical aid contributions, according to Michael Emery, marketing executive at Ambledown Financial Services. He advises that South Africans should ideally join a medical scheme as soon as they start working and before age 35.
Many young South Africans forego medical scheme membership because they are currently in good health or due to financial constraints. However, this decision often proves costly as they grow older and become more susceptible to illness.
“Starting early is an investment in the future of your health, and as important as retirement savings,” says Emery.
Ensuring access to quality healthcare should be a priority. As soon as individuals can afford it, they should invest in a plan that covers primary healthcare, diagnostics, and hospital treatment. Those who delay joining a medical scheme will eventually face significantly higher contributions because they pose a greater risk to the scheme.
Medical scheme late joiner fees and waiting periods are in place to prevent misuse of the system and to protect longstanding members who have consistently contributed to the healthcare fund.
“Late joiner fees and waiting periods could be seen as discriminatory in some way, but they’re not,” Emery explains. “They are designed to safeguard those who have been paying into the healthcare system for years from individuals who might try to enter and exit the system only when they require medical treatment. If people only join a scheme once they need care, it raises the scheme’s risk profile and artificially inflates premiums.”
Additionally, late joiners who have had no medical cover for many years are at greater risk of having undiagnosed or unmanaged health conditions, further complicating their ability to secure affordable care.
Medical schemes calculate late joiner penalties based on an individual’s age at the time of joining and the number of years they have not been a member. These penalties, often expressed as a percentage of the base contribution rate, can increase monthly premiums by as much as 75%.
While the high cost of medical aid contributions can deter many South Africans from securing cover, Emery highlights that various entry-level medical schemes and medical insurance products are available in the market.
“These options may not cover the full cost of certain treatments, but they can be supplemented with gap cover—an insurance product designed to cover shortfalls in medical scheme benefits,” he says.
Gap cover assists individuals in covering hospital expenses where medical costs exceed what their scheme will pay. It is not a substitute for medical aid but serves as a financial safety net for medical scheme members facing unexpected shortfalls.
Medical inflation continues to drive healthcare costs beyond the coverage limits of many medical schemes. In some instances, medical practitioners charge as much as 400% of the scheme rate or more. Gap cover plays a crucial role in helping people afford essential in-hospital and specific outpatient treatments, preventing undue financial hardship.
“Medical bills shouldn’t stand between you and quality care,” concludes Emery. “Having gap cover ensures that you receive the treatment you need—whether for cancer care, hospital procedures, or outpatient treatments—without financial stress.”
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