Is Gap Cover Worth it and Do You Really Need It?

Is GAP cover worth it and do you really need it? is a great question.
No doubt you have heard of ‘gap cover’ when it comes to medical coverage, if only in passing as you researched something else, a new medical aid plan perhaps, so you may not fully understand just what it is. Even if you do if you are like thousands of other South Africans you are really in two minds over whether or not it’s yet another expense you really need to add to the monthly list.

Why Gap Cover Helps

Those who do know a little bit about gap cover often assume its usefulness is limited to helping meet the shortfalls that can occur between what a medical aid plan will cover for inpatient hospital expenses and what is actually charged, which can indeed sometimes be rather different (more about that in a moment) But the reality is that gap cover can also be useful in everyday life, helping to cover the more routine, but more expensive, medical procedures.

Gap Cover and Medical Aid

If you pay for a medical aid policy – and it’s fair to say such things are not cheap – then you expect that in the event of say, a catastrophic event like a car accident you’ll be covered for your treatment and you will be able to get on with the business of getting better free of that financial burden at least.

Just how true that can ever be depends on the level of medical aid coverage you pay for. As a rule the higher the ‘plan level’ the better coverage you’ll get. But even the very best coverage may not cover it all. For example, while many GPs are willing to accept the medical aid reimbursement rate as full payment, many specialists are not, which can lead to a big shortfall between what you are billed and what is covered by your medical aid scheme, a shortfall that could leave you in financial hot water you just did not expect.

To Gap Cover or Not to Gap Cover

So, with all of this in mind should you start shopping for a gap cover plan to supplement your medical aid? The answer is not a straight yes or no. To begin with, you need to go over the fine print of your medical aid policy, the sections you may have skipped over to this point. There you will find the nitty gritty of just what is covered and, perhaps even more importantly, at what rate.

If you suffer from a serious medical condition, or have a family history of such things, then gap cover may make a lot more sense for you than for the average, relatively healthy younger person. However if that younger person is also one who needs a lot of less serious, but basically essential, treatment – dental treatment is a good example – they may want to consider it too.

The one thing you should think about very carefully is lowering the level of your main medical aid plan to accommodate the cost of gap coverage. That is a route that some people do take, eliminating some of the ‘extras’ from their medical aid that they believe they can manage without. That may also be a big financial mistake too, so it’s not a decision to make lightly. To answer the question “Is GAP cover worth it and do you really need it?” it is best to speak to a Medical Aid Consultant, to gain a real understanding of your current shortfalls in your medical aid scheme.

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