How to Choose a Medical Aid in South Africa (2027 Guide)

Last reviewed: November 2026. How we work: our editorial standards, corrections policy and how Curemed is paid. General information, not advice. A personalised recommendation follows a written needs analysis under the FAIS Act.

By Hagop Jaghlassian, CEO at Curemed. Reviewed by Roxanne Hurter-Ehlers, Director of People and Governance.

What changed, 13 November 2026: updated for the 2027 benefit year. Added the CMS 3.8% guidance for 2027, the 2027 contribution increases stated by five schemes, the difference between an option change and a move to a new scheme, the late joiner penalty bands, the 2027 tax year medical credit and who may claim it, and corrected the PMB count to the 271 diagnosis and treatment pairs stated by the CMS.

What should you decide before you compare plans?

Start with your needs, not with a brochure. List who must be covered, how often each person saw a GP or specialist in the past year, which medicines are taken every month and whether a pregnancy, an operation or orthodontic work is planned for 2027.

Then note which doctors and hospitals you want to keep. A plan that looks affordable on paper can cost more in practice if your usual hospital or specialist falls outside its network.

With that list in hand, the comparison becomes simple: which option pays for the care you expect, and what will you pay from your own pocket for the rest?

Which types of medical aid plan can you choose from?

Schemes use different names, but their options fall into a handful of types. The table shows what each type covers and the trade-off that comes with it.

What are Prescribed Minimum Benefits and why do they matter?

Prescribed Minimum Benefits (PMBs) are the floor of cover that every registered option must provide. The Council for Medical Schemes PMB page lists 271 diagnosis and treatment pairs plus 26 Chronic Disease List conditions.

A hospital plan and a comprehensive plan therefore share the same PMB floor. The cover is subject to scheme protocols and designated service providers, so how and where you receive treatment still matters.

How much day-to-day cover do you need?

Day-to-day cover pays for GP visits, acute medicine, dentistry, optometry and similar out-of-hospital costs. Add up what your household spent on these in the past 12 months and compare that total with the extra contribution a richer option would cost over the year.

If the extra contribution is higher than your likely claims, a leaner option plus your own emergency fund may serve you better. If you claim often, paying for the benefit in advance tends to be easier on cash flow.

Why do networks and designated service providers matter?

A network is the list of hospitals, doctors and pharmacies an option has contracted with. A designated service provider (DSP) is the provider the scheme has chosen for a specific benefit, such as chronic medicine or PMB treatment.

Using a provider outside the network or DSP by choice can lead to a co-payment. Before you commit, confirm that a network hospital is within reach of your home and that your GP and pharmacy are on the 2027 list, because networks can change from one year to the next.

How should a chronic condition shape the choice?

The 26 Chronic Disease List conditions are covered on every option, but the way they are covered differs. Check the medicine formulary, the DSP pharmacy and whether the option pays anything towards chronic conditions outside the list.

A change of option or scheme can also mean a new chronic application, a different formulary and fresh authorisations. Plan that paperwork before 1 January 2027 so that a script is not interrupted.

How do waiting periods work when you join a new scheme?

When you join a new scheme, section 29A of the Medical Schemes Act 131 of 1998 allows a general waiting period of up to three months and condition-specific waiting periods of up to 12 months, depending on your prior cover. A gap of 90 days or more without cover allows the scheme to apply the full waiting periods.

PMBs may be excluded during a waiting period for an applicant who had no cover in the preceding 90 days. Do not assume that PMB cover starts on day one if you are joining after a long break.

Is an option change treated differently from a move to a new scheme?

Yes. An option change inside the same scheme carries no new waiting periods under section 29A(4) of the Act.

Take the Naidoo family, who are on a comprehensive option and want a lower contribution for 2027. If they move to a network option in the same scheme from 1 January 2027, no new waiting periods apply. If they resign and join a different scheme, that scheme may apply waiting periods depending on their prior cover, and a gap of 90 days or more between the two would allow the full waiting periods.

Who pays a late joiner penalty?

Regulation 11 of the General Regulations defines a late joiner as an applicant aged 35 or older without enough prior cover. Regulation 13 sets the penalty bands, based on years without cover after age 35: 5 to 9 years is 5%, 10 to 19 years is 25%, 20 to 29 years is 50% and 30 or more years is 75% of the contribution.

Proof of earlier membership reduces the years counted, so gather old membership certificates before you apply. Our guide to the late joiner penalty on a medical aid shows how the years are worked out.

How do the 2027 contribution increases affect your budget?

Budget on the 2027 contribution, because that is what leaves your account from January. In Circular 20 of 2026 the Council for Medical Schemes guided schemes towards 3.8% for 2027, anchored to projected CPI. That figure is a starting point, not a cap, and the averages the schemes below have stated all sit well above it.

An average hides the spread between options, so ask for the 2027 rand amount on your own option. For every scheme, see our page on the 2027 medical aid increases by scheme.

Who claims the medical scheme fees tax credit?

For the 2027 tax year, which runs from 1 March 2026 to 28 February 2027, SARS sets the credit at R376 a month for the first person, R376 for the first dependant and R254 for each additional dependant. The credit belongs to the taxpayer who paid the contributions, not automatically to the person named as the member.

Say Thandi pays the monthly contribution for her son Sipho, 24, who is the principal member on his own option. Thandi claims the credit, provided Sipho is her dependant for tax purposes, and the same contributions cannot be claimed by two taxpayers. The tax certificate is issued in the name of Sipho, so SARS may ask Thandi for an affidavit on audit.

Use the medical aid tax credit calculator to see the monthly effect on your household.

What steps should you follow to choose for 2027?

1. List every person to be covered, their regular medicines and any treatment planned for 2027.
2. Write down the hospitals, doctors and pharmacy you want to keep using.
3. Pick the plan type that fits how you claim: hospital only, savings, network or comprehensive.
4. Get the 2027 contribution for each shortlisted option and subtract the tax credit of the person who pays.
5. Check the network, the chronic formulary and the co-payments on each option against your list.
6. Decide whether an option change in your current scheme solves the problem before you consider a new scheme and its waiting periods.
7. Submit the form before the scheme deadline and register chronic medicine on the new option straight away.

Why use an independent broker?

A scheme call centre can only describe its own options. An independent broker compares options across schemes and can tell you when staying where you are is the sensible answer.

Curemed is an FSCA-licensed brokerage (FSP 44098) with Council for Medical Schemes accreditation ORG 163, and has advised members since 1992. An Advisor works from your needs list, sets out the trade-offs in writing and leaves the decision with you.

Which other questions come up when choosing?

Who does a hospital plan suit?

A hospital plan tends to suit a healthy person or household that can pay for GP visits, dentistry and optometry from their own pocket and wants cover for large, unplanned costs. It is a weaker fit where someone needs frequent consultations, because the option pays little or nothing towards those costs.

Can an adult child stay on the medical aid of a parent?

That depends on the rules of the scheme. Each scheme sets who qualifies as a dependant and at which age a child starts paying the adult rate, so ask for the rule in writing before you plan the 2027 budget around it.

Does Gap Cover replace a medical aid?

No. Gap Cover is short-term insurance, regulated as an accident and health policy under the Demarcation Regulations and supervised by the FSCA, and it is not a medical scheme. Benefits are subject to an annual limit of R226,881.03 per insured person a year, effective 1 April 2026. Insurers require medical scheme membership as a condition in their policy wordings, so Gap Cover works alongside a medical aid. Our complete guide to Gap Cover explains how in-hospital shortfalls arise.

Does it cost more to join through a broker?

No. Medical schemes pay broker commission out of contributions under Regulation 28, and the amount is capped by law. Your contribution is the same whether you join through a broker or directly. Read how Curemed is paid for the detail.

Is there a deadline to change your option for 2027?

Yes, and each scheme sets its own. Verified dates from scheme forms include Fedhealth on 30 November 2026, Profmed on 15 December 2026 and Medshield on 31 December 2026 with a contribution collection cut-off of 15 December 2026, while Discovery had not published a 2027 plan change deadline as at 13 November 2026. See the 2027 option change deadlines by scheme for the full list.

General information, not advice. Curemed is an authorised financial services provider (FSP 44098), and a recommendation under the FAIS Act requires an analysis of your own needs by an Advisor.

Hagop Jaghlassian

CEO and Certified Financial Planner | Curemed Health and Wealth Consultants

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