Your mammogram: which medical aid plans offer it for free?

Mammogram

October is breast cancer aware month, which is as good a time as any to schedule a mammogram. If you’re lucky, your medical aid will cover the cost of the mammogram as part of your monthly premium. To see if your plan offers this as a benefit, find your scheme and plan below, and note any special rules such as how often you can have one.

Note that all the schemes below , with the exception of Keyhealth,  offer a mammogram once every 2 years (sometimes only in the second year of membership). (Please note that we only list open medical schemes ie schemes that are “open” to the public and not tied to specific employment group).

What about PMBs?
If you have a PMB condition that requires a mammogram as part of its treatment, and this protocol is recognised by your medical aid scheme, then the mammogram will always be paid by the scheme. To learn more about PMBs click here or speak to us if you have a specific question.

Tip! How do I save money on my mammogram?
Just because the medical aid is paying for your mammogram does not mean that you will definately not be out of pocket. Here are some steps you can take to save your cash:

  • When you make your appointment, ask if they radiology department charges your scheme’s rates. If they do, great. If they don’t…call your medical aid and ask them to tell you who does charge scheme rates.
  • While you are on the phone with your medical aid, ask them what steps you need to take to make sure that they pay for the mammogram. They might insist you go to a specific provider, or that you are referred by a doctor, or that you get pre-authorisation.

So which plans pay for a mammogram? All benefits below apply to 2020. 

Bestmed

Bonitas

Cape Medical

  • Covered on all plans, with a co-payment of R300 for women 49yrs+, once every 2 years, and limited to R1,470

Compcare

  • All plans, for women 35yrs+, every second year

Discovery

Fedhealth

Genesis

  • No plans offer the mammogram as paid-for benefit

Hosmed

  • Every plan for women 40yrs+, every 2 years

Keyhealth

  • Every plan for women 40yrs+, every year

Medimed

  • Alpha, Medisave Max, MediSave Standard offer some cover for a mammogram. The monetary allocation is shared with other benefits.

Medihelp

Medshield

Momentum

Profmed

  • All plans, for women 40yrs+

Sizwe

  • All plans except Gomomo plans, for women 40yrs+, every 2 years

Suremed

  • All plans except Explorer offer some cover for a mammogram. The monetary allocation is shared with other benefits.