This is Part Five of our 2025 Health Insurance Guide.
It helps to think of healthcare costs in three categories:
1. Primary care (GP visits, x-rays, dentistry, optometry, acute medication) (Medical Aid, Primary Care Insurance)
2. Specialist care (cardiologist, endoscopy, specialised dentistry) (Medical Aid, and occasional Gap Cover)
3. In-hospital procedures (surgery, childbirth, organ transplant) (Medical aid and Gap Cover)
As we will see, it’s possible, and often cost efficient, to use medical aid for Specialist and In-hospital care, and pay for primary care out of pocket, or via Primary Care insurance.
Primary Care insurance, and medical aid
Health insurance can help you save money on your medical costs. It can also help you choose a cheaper medical aid plan (similar to how a gap cover does). If you already have medical aid, you probably only need Primary Care cover from a hospital insurance policy.
Primary Care cover will pay for some of your out of hospital claims, possibly including GP visits, x-rays, blood work, medication and ER visits. You can see a comprehensive list of possible benefits here.
In theory, then, you can choose a medical aid plan without a medical savings account. Instead, you can rely on a health insurance plan to cover your GP costs, medication and x-rays. You will still receive cover from your medical scheme for any PMB related out-of-hospital claims, and – depending on your health insurance plan – might enjoy unlimited GP consults.
Of course, not all your claims are guaranteed to be covered by the insurance policy: for example, you might have to pay out of pocket for specialist consults. You can still opt to use a medical savings account to cover these claims, if you have one, or pay out-of-pocket.
If you can only afford a “hospital only” medical aid, Primary Care health insurance might be a clever way to bridge the gap of unpaid claims, especially for GP and medication costs.
What next?
In Part Six we discuss the difference between Insurance and Medical Aid in more detail. Read it here.
