Last reviewed: July 2026. We review our guides regularly to keep them accurate.
Yes, you can usually change your medical aid plan mid-year in South Africa, but mostly in one direction. Many schemes, including Discovery Health Medical Scheme, allow a downgrade to a cheaper option during the year, while upgrades generally wait until 1 January. Switching to a different scheme is allowed at any time of year, but the new scheme may apply waiting periods and your medical savings account balance follows strict rules.
By Martin Janse van Rensburg, Sales Manager and Financial Advisor at Curemed. Reviewed by Roxanne Hurter-Ehlers, Director of People and Governance.
In short
- Most schemes allow option changes once a year, effective 1 January, but downgrades are often possible mid-year.
- Discovery Health Medical Scheme allows downgrades at any time, effective the first of the next month.
- Upgrades mid-year are generally not allowed, although some schemes make exceptions after a life-changing event.
- You can switch to a different open scheme at any time of year, but waiting periods of up to 3 months general and 12 months condition-specific may apply.
- A positive medical savings balance moves with you. If you overspent your savings, you must repay the difference.
- Always tell your Gap Cover insurer when you change plan or scheme. Staying with the same provider triggers no new waiting periods.
July is when these questions arrive at our desks. Medical savings accounts often run dry around the middle of the year, and the 2026 contribution increases have bitten: Discovery members absorbed a deferred 7.2 percent weighted increase on 1 April 2026, Momentum increased by 9.9 percent, Fedhealth by 9.6 percent, Bonitas by 8.88 percent, Medihelp by 8.46 percent and Bestmed by 6.8 percent. Add SARS filing season, which opened for manual filing on 13 July 2026, and many households are reviewing every debit order.
Can you downgrade your medical aid plan in the middle of the year?
Often, yes. The general rule across the industry is that option changes happen once a year with effect from 1 January, but several schemes make room for members who need to reduce contributions sooner.
Discovery Health Medical Scheme is a clear example. It allows a downgrade to a cheaper plan at any time during the year, effective from the first day of the next month. One caution: Discovery may block a downgrade if you are planning a procedure that attracts an upfront payment.
Broker guidance indicates that several other schemes, including Bonitas and Medihelp, allow a mid-year option change within 30 days of a life-changing event such as a serious diagnosis or a divorce. The rules differ from scheme to scheme, so confirm the position with your scheme or with an Advisor before you act.
Can you upgrade your plan mid-year?
Generally not. Upgrades open a door to anti-selection, where members move to richer benefits only once they know a big claim is coming, so schemes restrict upgrades to 1 January.
There are narrow exceptions. Discovery permits certain mid-year upgrades, for example when a member moves more than 50km from a network hospital, or for certain newborn registrations. Fedhealth markets upgrades at any time after a life-changing event such as pregnancy or a dread disease diagnosis.
Because every scheme writes its own rules, treat these as general guidance and ask your scheme or an Advisor to confirm what applies to you.
Can you switch to a different medical aid scheme mid-year?
Yes, at any time of year. Under the Medical Schemes Act 131 of 1998, open schemes must accept applicants year-round, and the Council for Medical Schemes regulates how they do it.
The catch is underwriting. Section 29A allows the new scheme to impose a general waiting period of up to 3 months and a condition-specific waiting period of up to 12 months. If you had at least 24 months of continuous previous membership and you join the new scheme within 90 days of leaving the old one, typically only a 3 month general waiting period with prescribed minimum benefit cover may apply. Our guide to medical aid waiting periods unpacks the detail.
Two more points matter. First, Regulation 13 allows late-joiner penalties from age 35 if you had a break in cover of more than 3 months, with loadings of 5 to 75 percent depending on the years without cover. Our late-joiner penalties guide explains how these are calculated. Second, switching mid-year resets your accumulated limits and threshold progress, and annual limits at the new scheme apply pro rata for the remainder of the year.
What happens to your medical savings account when you change plans?
Under Regulation 10, the full annual savings amount is advanced to you upfront in January, even though you pay it off month by month. That creates two possible outcomes when you change plans mid-year.
If your balance is positive, it transfers to the new option or the new scheme. If the new plan has no savings account, the balance is paid out to you, and that payout can be taxed.
If you spent more than you contributed by the time you downgrade or leave, you must repay the overspent portion. Ask for a savings statement before you make any decision, so the repayment does not arrive as a surprise.
What happens to your Gap Cover when you change medical aid?
Gap Cover only works while you have active medical scheme membership, so whenever you change your plan or your scheme, you must tell your Gap Cover insurer.
If you stay with the same Gap Cover provider, no new waiting periods apply. If you switch Gap Cover providers with unbroken cover, the new insurer may impose waiting periods only on benefits you did not previously have.
Keep the annual limit in mind too. The Demarcation Regulations cap Gap Cover payouts at R223,000 per insured person for the period 1 April 2026 to 31 March 2027, up from R219,845 before, with the cap adjusted for CPI each April.
Downgrade within your scheme or switch to another scheme?
| Downgrade within your scheme | Switch to another scheme | |
|---|---|---|
| Timing | Often possible mid-year, for example Discovery from the first of the next month. Other schemes may require a life-changing event. | Any time of year. Open schemes must accept applicants year-round. |
| Waiting periods | None. You remain a member of the same scheme. | Up to 3 months general and up to 12 months condition-specific may apply under section 29A. |
| Medical savings account | A positive balance moves to the new option. An overspent balance must be repaid. | A positive balance transfers or is paid out, and the payout can be taxed. An overspent balance must be repaid. Limits reset and apply pro rata. |
| Gap Cover impact | Notify your insurer. Same provider means no new waiting periods. | Notify your insurer. A new Gap Cover provider may apply waiting periods only to benefits you did not previously have. |
Should you downgrade or add Gap Cover instead?
Sometimes the answer is neither a downgrade nor a switch. A common alternative is to move to a network or hospital-focused option and pair it with Gap Cover, which covers in-hospital shortfalls when specialists charge more than the scheme rate.
Gap Cover is not a substitute for day-to-day benefits, though. If your family relies heavily on GP visits, acute medication and dentistry, a stripped-down plan plus Gap Cover can leave real holes in your cover. This is exactly the kind of trade-off an Advisor can model for your specific claims pattern.
What should you check before changing your plan?
Before you sign anything, work through this list:
- Hospital network restrictions: is your preferred hospital on the new network?
- Upfront co-payments on planned procedures, especially if surgery is already scheduled.
- Chronic medication formularies and designated service providers: will your current medicine still be covered at your current pharmacy?
- Reduced day-to-day benefits and a smaller or absent savings account.
One thing that does not change with your plan choice is the medical scheme fees tax credit. For the 2026 tax year it is R364 per month for the main member, R364 for the first dependant and R246 for each additional dependant, whichever option you belong to. You can confirm the figures on the SARS medical tax credit rates page, which is worth a look now that filing season is open.
If you are weighing up a downgrade, a switch or a Gap Cover top-up, you do not have to work it out alone. Curemed has advised South African families since 1992, our advice is free, and we compare options across all the major schemes. Speak to a Curemed Advisor for a free, no-pressure comparison, or start with our medical aid comparison page.
Frequently Asked Questions
Can I change my medical aid plan in the middle of the year?
Usually only downwards. Most schemes allow option changes once a year effective 1 January, but Discovery Health Medical Scheme allows downgrades at any time, effective the first of the next month. Some schemes, including Bonitas and Medihelp per broker guidance, allow a change within 30 days of a life-changing event.
Do waiting periods apply if I switch medical aid schemes mid-year?
They can. The new scheme may impose a general waiting period of up to 3 months and a condition-specific waiting period of up to 12 months. If you had at least 24 months of continuous membership and join within 90 days of leaving, typically only a 3 month general waiting period with prescribed minimum benefit cover may apply.
What happens to my medical savings account if I downgrade mid-year?
The annual savings amount is advanced upfront, so the outcome depends on your balance. A positive balance transfers to the new option or scheme, or is paid out if there is no savings account, and a payout can be taxed. If you spent more than you contributed, you must repay the overspent portion.
Will my Gap Cover still pay if I change my medical aid plan?
Yes, as long as you keep active medical scheme membership and tell your Gap Cover insurer about the change. Staying with the same provider triggers no new waiting periods. If you switch Gap Cover providers with unbroken cover, waiting periods may apply only to benefits you did not previously have.
Can I upgrade my medical aid plan mid-year after a diagnosis or pregnancy?
In limited cases. Upgrades are generally only allowed on 1 January, but Fedhealth markets upgrades at any time after a life-changing event such as pregnancy or a dread disease diagnosis, and Discovery allows narrow exceptions. Confirm the rules with your scheme or an Advisor before relying on this.
Martin Janse van Rensburg
Sales Manager and Financial Advisor | Curemed Health and Wealth Consultants
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