This is Part Five of our 2025 Gap Cover Guide.
How to use Gap Cover to save money
You can save money by choosing a “lower-level” (cheaper) medical aid plan with co-payments, sub-limits and network requirements, and pairing it with a good gap cover. Often, the right medical aid and gap pairing will give you better in-hospital benefits than a high priced medical aid plan on its own.
Example
A 2 adult and 2 children family on Discovery Classic Saver pays Rxxx/month.
Downgrading to Discovery Essential Delta Saver lowers that premium to Rxxx/month (but you lose some benefits).
You can counter that loss by choosing xxx Gap cover, for Rxxx/month.
Even with the new gap cover, you’d still save Rxxx/yr
AND you are covered for in-hospital co-payments, scheme rate shortfalls (paid at 500% rather than your previous 200%) and more.
On the downside, you are limited to only 1 non-network hospital admission without a penalty.
| Without gap cover | With gap cover | |
| Cost per month: | ||
| Scheme rate: | 200% | 500% |
| MRI co-payment: | R3500 | Covered |
| Dentistry co-payment: | 200% | Covered |
| Scope co-payment: | 200% | Covered |
| Oncology sub-limit: | ||
| Hospital choice: | Unlimited | 1 non-network admission |
| Hospital choice: | Unlimited | 1 non-network admission |
You have a choice:
- Keeping your medical aid plan, and finding a gap cover
- Change your medical aid plan and pair it with a gap cover
Let’s look at some concrete examples, where we just choose a network plan over a non-network plan. Assume a family of 2 adults and 2 young children.
Choosing a gap cover to match your current medical aid
Changing your medical aid, and pairing a gap cover
How to choose the right gap cover
Gap cover offers a combination of five benefits:
- scheme rate shortfalls,
- co-payments,
- sub-limits,
- network penalties and
- ER visits.
(There are many more possible benefits, but these are the main ones you should consider). You can read more about all this here.
Your job is to match the right combo of those five benefits against what your medical aid plan requires. For example:
- If you gap cover offers a scheme rate shortfall payments, your medical aid only needs to cover costs at 100% scheme rate (gap will cover the rest). There is no point in paying more for a medical aid that pays at 200% scheme rate (all other things being equal).
- If you have no significant co-payments on your medical aid plan, you don’t need to have this benefit in your gap cover.
- If you are not on a network plan (where you can only use certain hospitals) you don’t need the “network penalties” benefit from your gap cover.
On the other hand, you might want to adjust your medical aid plan to match your gap cover. For example, consider moving to a network plan (cheaper) and pairing it with a gap cover.
But, do be careful
- Gap cover helps with in-hospital expenses only.
- Gap cover has an annual limit per person per year, by law. In 2025, this is R220,000 (will be adjusted in April 2026).
- Gap covers also have rules, some of them quite sneaky! We outline some of those here.
- Gap cover applies to main member, spouse and children (usually under 21yrs). If you have other members on your medical aid (parents, students) you will need multiple gap covers
As always, we strongly suggest speaking to a broker when choosing a medical aid / gap cover pairing.
What next?
In Part Six we discuss common FAQs. Read that here.
