Calculators & guides
How to compare medical aid plans: a checklist
By Naledi Mokoena · 7 min read · Updated 24 June 2026
To compare medical aid plans fairly, line them up on the same six points: monthly contribution, hospital cover and rate, day-to-day and savings benefits, network rules, co-payments, and chronic cover. Price alone is misleading because a cheaper plan often shifts more cost onto you when you claim.
Use the checklist and comparison table below. Fill in two or three plans you are considering and compare like for like.
The right plan is the one that covers what you actually use, at a contribution you can keep paying every month.
The six things that matter
- Monthly contribution, including the cost for each dependant.
- Hospital cover and the rate it pays at (100%, 200%, 300% of scheme rate).
- Day-to-day cover: savings, an above-threshold benefit, or none.
- Network rules: which hospitals, doctors and pharmacies you must use.
- Co-payments and deductibles on procedures, scopes and scans.
- Chronic and PMB cover, including the formulary.
Side-by-side comparison table
Copy this and fill it in for each plan:
| Feature | Plan A | Plan B | Plan C |
|---|---|---|---|
| Monthly contribution (main) | R | R | R |
| Cost per child | R | R | R |
| Hospital rate paid | % | % | % |
| Day-to-day / savings | |||
| GP visits covered | |||
| Specialist cover | |||
| Hospital network | |||
| Co-payment on scopes | R | R | R |
| Chronic cover | |||
| Annual overall limit |
Match the plan to your life
- Young and healthy, rarely sick: a hospital plan plus cash for day-to-day may be enough.
- A family with kids: weigh day-to-day or savings benefits for GP visits and medicine.
- A chronic condition: check the chronic list, formulary and DSP carefully.
- Planning a pregnancy: look at maternity benefits and any waiting periods now, not later.
Buy for how you actually use healthcare, not for the longest benefit list.
Watch the hidden costs
Two plans at the same price can leave you thousands apart when you claim. The usual culprits are:
- A low hospital rate (100%) when specialists charge 300%, leaving a shortfall.
- Co-payments on scopes, scans and joint procedures.
- Network penalties for using a non-network hospital.
- Day-to-day benefits that run out by mid-year.
Gap cover can bridge the rate shortfalls, but it is a separate product.
Use a broker or compare yourself
An accredited broker is paid by the scheme, not by you, and can compare plans across schemes. That is useful, but ask the broker to show you the trade-offs, not just the cheapest option. If you compare yourself, get each scheme's benefit brochure and put the numbers into the table above. Either way, decide on cover first and price second.
Frequently asked questions
How do I compare medical aid plans in South Africa?
Compare them on six points: monthly contribution, hospital rate, day-to-day benefits, network rules, co-payments and chronic cover. Use a side-by-side table so you compare like for like, rather than choosing on price alone.
Is the cheapest medical aid plan the best value?
Not usually. A cheaper plan often pays at a lower rate, has more co-payments, or runs out of day-to-day benefits early. The best value is the plan that covers what you actually claim for at a contribution you can sustain.
What does hospital rate mean when comparing plans?
It is the percentage of the scheme rate the plan pays in hospital. A plan paying 100% can leave a shortfall when a specialist charges 200% or 300%. Higher cover rates cost more but reduce the gap you pay yourself.
Should I use a broker to compare plans?
A broker can compare across schemes and is paid by the scheme, not by you. Ask them to explain the trade-offs and show more than the cheapest option. You can also compare yourself using each scheme's benefit brochure.
What is the difference between savings and day-to-day cover?
A medical savings account is your own money set aside for day-to-day claims; once it runs out, you pay cash unless the plan has an above-threshold benefit. Some hospital plans have no day-to-day cover at all.
How often should I review my plan?
Review at least once a year, before the scheme's annual benefit changes take effect. Your health, family and budget change, and so do plan rules and prices. An annual check stops you overpaying for cover you no longer use.
