Seniors can now enjoy medical gap cover benefits similar to younger medical aid members. Until recently, gap cover insurers had a maximum entry age of 65 years. This means that you could not qualify for medical gap cover after the age of 65 years. There was also an age limit on gap cover whereby the cover ended once a medical aid member passed the age of 65 years. Fortunately several gap cover insurers realised the shortsightedness of this policy and have lifted the age limit.
Senior Gap Cover Plans
The senior years are when you need quality medical care and most South Africans prefer private healthcare services. This can be expensive and medical aid is one of the only ways to fund it. However, medical aid is not enough these days. Many service providers, particularly medical specialists and surgeons, charge above medical aid tariffs. Without medical gap cover, you will have to fund shortfalls out of your own pocket as your medical aid will not pay rates higher than its tariffs.
Medical gap cover can pay up to 500% of the medical aid tariff and bridge the shortfall that remains. This means that you are protected against the financial shortfall. However, senior citizens were at a disadvantage. For a long time there were maximum age entry and age limits for gap cover. This has changed. Gap cover insurers now offer senior plans but the premiums are significantly higher. In fact it can be two to three times higher than a standard individual plan for younger adults.
Cheaper Pensioner Cover
Medical schemes have developed low cost medical aid plans for lower income earners. Often pensioners fall within this category and can enjoy medical aid at lower rates. Medical schemes cannot discriminate by age although late joiner penalties (LJP) and waiting periods may apply for senior members who start cover later in life. Although gap cover insurance is evolving and has now lifted the age limit, the premiums are not as yet discounted for pensioners.
It can be a predicament for seniors living on a pension. Your income is limited. It rarely grows with inflation and sometimes it is barely enough for your living expenses. Having to pay for expensive gap cover on top of your medical aid contributions can be financially difficult. However, if you are questioning the need for gap cover as a senior member then consider the financial implications of a medical aid shortfall. You could be out of pocket for thousands and even tens of thousands of rands in the event of a shortfall.
The reality is that your need for medical care increases as you get older. Medical aid becomes more of a necessity and topping up with gap cover adds to the overall protection. Whether you are a working senior citizen or a pensioner, gap cover can make the difference in the quality of healthcare that you can access despite being a medical aid member. Nevertheless it needs to be affordable and sustainable. Lapse in cover can compromise your healthcare and even land you in a financial dilemma.