As a senior citizen, medical aid becomes more necessary than ever if you want to access private healthcare services. Unfortunately pensioners may find that medical aid is unaffordable. Medical schemes in South Africa cannot restrict membership by age. This means that any South African can join a medical aid and remain on medical aid cover irrespective of how old they are. However, there are distinct advantages of joining a medical aid as early in life as possible as starting on cover later in life is significantly more expensive.

Premium Penalty for Senior Citizens

Cost is always a factor and particularly for pensioners who may be living on a lower income during the retirement years. Any person who starts on medical aid cover after the age of 35 years is liable for a later joiner penalty that is added to the monthly medical aid contribution. This can significantly increase the monthly premiums and sometimes render medical aid cover unaffordable for seniors, especially pensioners.

The late joiner penalty is not a standard fee but is calculated according to the following factors, such as:

  • Current age of member applying for medical aid membership.
  • Previous years on medical aid cover that can be verified.

This simply means that the older you are, the more higher the late joiner penalty. It also means that if you have been on medical aid previously, then this may help to lower the current medical aid premium. A new late joiner penalty will not be levied on the medical aid premium if a pensioners are transferring from one medical scheme to another, provided that they were not already liable for a later joiner penalty with their previous cover.

Medical Cover for Pensioners

Most pensioners can find it difficult to fit in medical aid cover in their limited income. With less than 6% of South Africans able to retire comfortable in financial terms, medical aid premiums can sometimes be impossible to afford for pensioners. Fortunately there are some medical aid plans for pensioners. These options are not medical aid for pensioners specifically but plans that cater to lower income earners.

Medical schemes in South Africa understand that cover is inaccessible to most citizens. To cater for the growing demand for medical aid cover among low income earners, schemes have designated plans for people who are living on an income below a certain threshold. These plans are usually restricted to certain network providers. This means that a member of these plans can only see doctors or go to hospitals within the designated network.

Waiting Periods for Seniors

Another major factor that seniors have to bear in mind is that every medical scheme has waiting periods in place. This does not only apply to senior citizens. The general waiting period and pre-existing condition waiting period applies to any new member of a medical scheme, irrespective of age. However, it may be more of a concern for seniors whose need for medical care is often ongoing and cannot be delayed until a waiting period lapses.

The general waiting period is the first three months of cover during which no medical bills will be covered by the scheme. The pre-existing condition waiting period applies to the first twelve months of cover during which claims for the treatment or management of a pre-existing disease will not be covered by the scheme. Once these waiting periods are finished then members can lodge claims for essential medical care.

Can Pensioners Join a Medical Aid?

This is a common concern for many pensioners. The bottom line is that a pensioner is eligible for medical aid cover if he/she can afford the monthly medical aid premiums. As is the case with any financial service, the medical scheme or broker is required to do the necessary financial analysis of a pensioner’s ability to afford the premiums. The cost of a medical scheme should not impair a pensioner’s financial capacity to sustain themselves.

It is important to understand how a medical aid works. It is not a blanket cover that will fund all healthcare expenses in full. There are various factors to consider. Even with medical aid cover, pensioners may still have to pay for some healthcare costs out of their own pocket. This requires careful planning and saving, especially for pensioners with a limited income.