In short
- Every registered scheme must cover the Prescribed Minimum Benefits (PMBs) by law.
- Match the plan to your needs: a hospital plan for big risks, a savings or comprehensive plan for day to day and chronic cover.
- Check the hospital and provider network before you buy.
- Join before age 35 to avoid a permanent late joiner penalty.
- An accredited broker is free and gives independent, written advice after a needs analysis under the FAIS Act.
Last reviewed: July 2026. We review our guides regularly to keep them accurate.
By Hagop Jaghlassian, CEO · Reviewed by Roxanne Hurter-Ehlers
Choosing a medical aid is one of the bigger financial decisions a South African household makes, and the cheapest option is rarely the right one. The plan that fits you depends on how you use healthcare, who is on the plan, and what you can afford every month, not on the headline price. This guide walks through how to choose a medical scheme step by step, written by an FSCA-registered broker (FSP 44098).
Start with your needs, not the premium
Before comparing prices, get clear on what you actually need cover for. Map out who is on the plan and their ages, any chronic conditions or regular medication, how often you see a GP, dentist or optometrist, whether anyone is planning a procedure or a baby, and which hospitals and specialists you want access to. A young single person who rarely visits a doctor has very different needs to a family with small children or a member managing diabetes. The right plan is the one that covers your likely healthcare use without paying for benefits you will never claim.
The main types of medical aid plan
Most South African schemes structure their plans into a few broad types. Understanding these makes comparison far easier.
| Plan type | Who it suits |
|---|---|
| Hospital plan | Covers in-hospital treatment and Prescribed Minimum Benefits, with little or no day-to-day cover. Suits healthy members who mainly want protection against a big hospital bill. |
| Network or efficiency plan | A lower-cost plan that asks you to use a set network of hospitals, doctors and pharmacies. Suits budget-conscious members who are comfortable using designated providers. |
| Savings plan | Adds a medical savings account for day-to-day costs such as GP visits and dentistry, on top of hospital cover. Suits members who want some everyday cover with flexibility. |
| Comprehensive plan | The most extensive cover, with strong hospital benefits, day-to-day cover and chronic benefits. Suits families and members who use healthcare often or manage ongoing conditions. |
Plan names and structures differ between schemes. Compare what each plan actually pays, not just its category. See our medical aid comparison hub.
What every medical scheme must cover
By law, every registered medical scheme in South Africa must cover the Prescribed Minimum Benefits (PMBs) on every plan, including the cheapest hospital plan. PMBs are a defined list of around 270 conditions plus a set of chronic conditions that schemes must pay for in full when treated correctly, under the Medical Schemes Act 131 of 1998 and the Council for Medical Schemes. This is your safety net, so a low premium does not mean you have no cover for serious illness. Read our explainer on Prescribed Minimum Benefits for the detail.
Day-to-day cover and medical savings
Hospital plans generally do not pay for routine GP visits, dentistry, optometry or over-the-counter medicine. If you want help with those, you need a plan with a medical savings account or defined day-to-day benefits. Be realistic here. If your day-to-day spend is low, a hospital plan plus paying small bills yourself is often cheaper than a comprehensive plan. If you have a family that sees doctors regularly, day-to-day cover usually earns its keep.
Networks and designated service providers
Many affordable plans lower their cost by using networks. You agree to use a designated service provider, such as a specific hospital group or pharmacy, and the scheme covers you in full there. Use a provider outside the network and you may face a co-payment. Before choosing a network plan, check that your preferred hospital and doctors are in the network and that there is a network facility near your home and work. Our guide to medical aid network plans explains how this works.
Chronic conditions and major illness
If you or a dependant has a chronic condition, this should drive your choice. Check how each plan covers your specific medication, whether you must use a particular pharmacy or formulary, and how oncology and other major benefits work. The Chronic Disease List conditions are covered as part of PMBs, but the way schemes manage them, and what they pay above the minimum, varies a great deal between plans.
Waiting periods and the late-joiner penalty
When you join a scheme, it may apply a general waiting period of up to three months and a condition-specific waiting period of up to twelve months for pre-existing conditions. If you join a medical scheme for the first time later in life, or after a long break in cover, a late-joiner penalty can be added to your contribution for years. These rules matter when timing a switch, so read our guides on waiting periods and late-joiner penalties before you move.
Matching cover to your budget
Decide what you can comfortably pay every month, then find the best cover within that figure rather than stretching for a plan you cannot sustain. Contributions rise each year, so a plan that is a stretch today may be unaffordable in two years, and dropping cover when you are older or ill is the worst time to do it. A sensible approach for many families is a strong hospital plan as the base, day-to-day cover only where it pays for itself, and gap cover to protect against in-hospital specialist shortfalls.
Why it helps to use an independent broker
There are many schemes and hundreds of plans, and they change every year. An independent, FSCA-registered broker compares options across schemes, not just one, and is paid the same regulated commission whichever plan you choose, so the advice is not tied to a single product. A broker also helps with the parts people get wrong, such as waiting periods, networks and chronic registration, and supports you at claim time. Our advice always follows a written needs analysis under the FAIS Act, and broker support does not add to your contribution. For more on this, see should I use a medical aid broker?
Frequently asked questions
What is the most important thing when choosing a medical aid?
Match the plan to how you actually use healthcare and what you can afford long term, not the lowest premium. Start with your needs, who is covered, any chronic conditions and your preferred hospitals, then compare what each plan pays for those.
Is a hospital plan enough?
For a healthy member who rarely needs day-to-day care, a hospital plan plus gap cover is often a sensible, affordable base, because every plan must still cover Prescribed Minimum Benefits. Families that see doctors often usually need some day-to-day cover too.
Does it cost more to use a broker?
No. Broker commission is set by regulation and is the same whether you use a broker or sign up directly, so professional advice does not add to your monthly contribution.
When can I join or switch medical aid?
You can join most open schemes at any time, though waiting periods and, for first-time or lapsed members, a late-joiner penalty may apply. Many members review and switch plans at year-end when schemes announce new contributions and benefits.
Not sure which plan fits your family and budget?
Get free advice from an independent brokerGeneral information, not advice. Medical scheme plans, contributions and benefits change each year. A personalised recommendation follows a written needs analysis under the FAIS Act.
Hagop Jaghlassian
CEO, Curemed Health and Wealth Consultants | Certified Financial Planner (CFP), FAIS Key Individual
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