Gap Cover for seniors - what you need to know

By Janice Roberts

Tony Singleton, CEO, Turnberry

As we advance in years, we may gain invaluable wisdom, but for many of us the ageing process can also signal the onset of new health concerns.

In our late sixties many of us also begin our retirement phase, and with the increasing cost of living, it’s important to stretch our pensions as far as they can go.

“Increasing health risks combined with added financial pressure mean that seniors must have adequate support for their medical needs,” says Turnberry CEO Tony Singleton. “But in order to get the best care at lower costs, one should ideally settle on a Medical Aid and Gap Cover combination before they reach the age of 65.”

He advises that seniors carefully select the right products in consultation with their financial adviser. Based on their life-stage, their medical history, and the illnesses to which they’re predisposed.

By leaving it too late, and only taking out Gap Cover after 65, one incurs higher monthly premiums.

“After a lifetime of working, seniors deserve to kick-back and enjoy their retirement with great quality of life, without pain and without the stress of worrying about the costs of much-needed medical care,” he adds.

With the correct Medical Aid and Gap Cover in place, one can avoid having to dig into their pension to pay for major medical costs like hip replacements, MRI scans, cardiology procedures, or many of the other common needs among this age-range.

For example, Turnberry recently processed the following claims from clients over 65, which illustrates the importance of Gap Cover in saving clients from out-of-pocket expenses:

Claim 1 – Angiogram

Medical Practitioner Amount Charged Medical Aid Rate Amount Paid by Turnberry
Cardiologist R9 249.60 R3 082.42 R6 167.18
Anaesthetist R4 312.84 R1 110.93 R3 201.91

Claim 2 – Knee Replacement

Medical Practitioner Amount Charged Medical Aid Rate Amount Paid by Turnberry
Orthopeadic Surgeon R33 898.64 R20 130.25 R13 768.39
Anaesthetist R  8 568.31 R  3 001.89 R  5 566.42

Claim 3 – Knee Replacement

Medical Practitioner Amount Charged Medical Aid Rate Amount Paid by Turnberry
Orthopeadic Surgeon R21 573.36 R11 526.13 R10 047.23
Anaesthetist R13 260.00 R 4 578.10 R  8 681.90


“As we get older, not only do we tend to see the number of admissions rising, but clients often draw on more of their benefits. You may find that for a single medical event, a client incurs fees for specialist consultations, a co-payment on a procedure, a sub-limit restriction on the likes of internal prosthesis, and more.

“Gap Cover can go a long way to supporting those seniors for many of these costs.”

By assisting with the costs of things like MRI scans, senior and elderly Gap Cover clients are often able to address any emerging medical condition earlier – which gives them a greater chance of full recovery, and minimises the costs associated with procedures in the future.

“At this age, it’s important to know exactly what is one’s health status and likely health risks,” adds Singleton.

The introduction of last year’s Demarcation Regulations (which clarified the scope of Medical Aids, versus other medical insurance products) was positive news for those reaching their autumn years and considering Gap Cover.

“Across the industry, Gap Cover providers are no longer entitled to discriminate based on age, medical history or any other consideration,” Singleton explains. “While Gap Cover may be priced differently for over-65s (compared to younger clients), those prices must be carried through to all other over-65s that join a Gap Cover provider – to prevent discrimination against any particular individual or group.”

Many of the Gap Cover offerings targeted specifically for seniors – which offered reduced benefits – have also been largely phased out. Singleton says this means that seniors are now able to access comprehensive Gap Cover policies, which can be used alongside their Medical Aid to provide them with peace-of-mind.

“Advancing in age means paying much greater attention to one’s health. Wisely choosing the right Medical Aid and Gap Cover is a vital part of preventing medical issues and ensuring the very best possible quality of life.”

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