Is gap cover worth it?
Is gap cover worth it in South Africa?
For most medical aid members, gap cover is worth considering, because in-hospital specialist shortfalls can be large and unpredictable, while the premium is small by comparison. If you are on a medical aid and would struggle to pay a big shortfall out of pocket, gap cover buys peace of mind cheaply. Whether it suits you depends on your scheme, health and budget.
Key takeaways
- In-hospital shortfalls can be large and hard to predict.
- Gap cover premiums are small relative to the bills they can cover.
- It suits medical aid members who could not easily absorb a big shortfall.
- It cannot replace a medical aid, only top it up.
- Whether it is worth it depends on your scheme, health and budget.
The case for gap cover
The value of gap cover comes from the mismatch between its cost and the risk it covers. In-hospital specialist charges can run to many times the scheme rate, leaving shortfalls that are hard to budget for. Gap cover pays those shortfalls for a small monthly premium, so it turns an unpredictable, potentially large bill into a modest fixed cost. For many members that trade-off is clearly worthwhile.
Who benefits most
Gap cover is most valuable if you are on a medical aid and would struggle to pay a large shortfall out of pocket, or if your family is likely to need hospital treatment. Younger, healthy single people on a strong plan may see less immediate need, though accidents happen to anyone. See family gap cover for why households in particular tend to value it.
When it may matter less
Gap cover matters less if you could comfortably absorb a shortfall from savings, or if your scheme already pays specialists at a rate that leaves little gap. Even then, the low premium means many still take it for peace of mind. What it never does is replace a medical aid, so it is an add-on to weigh, not a core purchase. See gap cover versus medical aid.
Making the decision
Weigh the premium against the shortfall you could face and whether you could pay it yourself, and check that a policy's benefits and limits match your scheme. Because gap cover is affordable and the downside it covers is large, many members conclude it is worth it, but the choice is yours. Compare quotes. This is general information, not financial or medical advice.