20 Mar What is a medical aid shortfall? How to protect yourself from unexpected hospital costs

Many South Africans think that when a person has a medical aid, it covers all his hospital medical fees, but most times this is not true. Medical aid shortfalls can leave you responsible for large, unexpected costs.

So, what is a medical aid shortfall? It’s the difference between what your medical scheme pays and the actual charges from healthcare providers. This is where gap cover for medical shortfalls becomes essential, offering financial protection and peace of mind.

What causes a medical aid shortfall?

A shortfall may happen for several reasons, and some of these are:

1. Medical scheme tariff shortfall

Medical schemes have set tariffs for procedures and treatments. However, many specialists and private hospitals charge more than these tariffs, leaving you with a medical scheme tariff shortfall.

2. Co-payment health insurance gaps

Certain medical aid schemes require patients to co-pay for certain tests and procedures and specialist consultations. These out-of-pocket costs can be quite surprising and high.

3. Medical insurance shortfall due to sub-limits

Your medical aid may come with limits on certain benefits, like MRI scans or hospital stays or treatment by a specialist. Once the amounts exceed such limits, then the difference must be paid by you.

4. Emergency medical aid shortfall

Medical emergencies are unpredictable. If you require urgent medical care or hospitalisation, you may incur additional expenses, which are not fully covered by your medical aid.

How does gap cover help with medical aid shortfalls?

The importance of gap cover in the management of unforeseen expenses cannot be overemphasised. Here’s how gap cover works:

• Hospital shortfall cover allows you to avoid out-of-pocket expenses related to in-hospital treatments and procedures.
• Medical aid gap cover makes up the difference between what your medical scheme pays and what is actually charged by providers.
• GapCover® covers shortfalls and co-payments in order to give you financial stability against any high medical bills.

What to do if your medical aid doesn’t cover the full bill?

If you find yourself facing a medical aid shortfall, here are some steps you can take:

• Review your medical scheme’s cover to understand its limits and potential shortfalls.
• Ask your doctor about their rates and whether they charge above the medical scheme tariff.
• Consider medical aid shortfall cover to protect yourself from unexpected costs and financial strain.

Conclusion

Many people ask, why does medical aid not cover full hospital costs? The simple answer is that medical scheme tariffs are often lower than private rates, leading to shortfalls.

How to protect yourself from medical aid shortfalls? The best solution is investing in gap cover for medical shortfalls, ensuring you’re not left with hefty medical bills.

Want peace of mind? Speak to a consultant today and secure your hospital shortfall cover to safeguard your finances against unexpected medical expenses!

For more details or to sign up, visit GapCover.co.za.