Last reviewed: July 2026. We review our guides regularly to keep them accurate.
If you belong to a registered medical scheme, SARS gives you two things on your tax return: the Medical Scheme Fees Tax Credit, a fixed monthly rebate for you and every dependant on your plan, and the Additional Medical Expenses Tax Credit, which can give back a portion of qualifying medical costs you paid from your own pocket. That is the full picture of how to claim medical expenses on your tax return in South Africa, and this guide walks through both, step by step, for the 2026 Filing Season.
By Hagop Jaghlassian, CEO of Curemed and a Certified Financial Planner. Reviewed by Roxanne Hurter-Ehlers, Director of People and Governance.
In short
- The return you file now covers the 2026 year of assessment, which ran from 1 March 2025 to 28 February 2026.
- The monthly medical tax credit for that year is R364 for the main member, R364 for the first dependant and R246 for each further dependant.
- Qualifying out of pocket medical costs may earn an extra credit through the Additional Medical Expenses Tax Credit.
- The eFiling codes that matter are 4020, 4034 and 4040, and they are not interchangeable.
- Gap Cover premiums are not tax deductible, and auto assessments can leave your medical credit out, so check yours before 23 October 2026.
What can you actually claim back?
Want a quick number first? Try our free medical aid tax credit calculator to estimate your credits for the 2026 or 2027 year, then come back for the detail.
South Africa does not let you deduct medical costs from your income the way some countries do. Instead, SARS works with two credits that reduce the tax you owe directly.
The first is the Medical Scheme Fees Tax Credit, usually shortened to MTC. You get it automatically for every month you and your dependants were on a registered medical scheme, no matter what you earn.
The second is the Additional Medical Expenses Tax Credit, or AMTC. This one looks at two amounts: medical scheme contributions that were unusually high relative to the MTC, and qualifying medical expenses you paid yourself that the scheme did not cover. Think co payments, self funded gap amounts, prescribed medicines and bills from registered practitioners.
One important point before the detail. A credit is not a deduction. It comes straight off your final tax bill, rand for rand, which is generally more valuable to lower earners than a deduction would be.
How the Medical Scheme Fees Tax Credit works
The MTC is a fixed monthly rebate per person on the scheme. It does not scale with your income or with what your plan costs, so a member on a hospital plan gets the same credit as a member on a comprehensive option. If you are weighing up plan levels, our guide on what medical aid costs in South Africa puts those price differences in context.
Here is the part that trips people up every year. The return you file in this 2026 Filing Season is for the 2026 year of assessment, meaning 1 March 2025 to 28 February 2026. For that year, the monthly amounts are:
| Who | Monthly credit (2026 year of assessment) |
|---|---|
| Main member | R364 |
| First dependant | R364 |
| Each additional dependant | R246 |
You may have seen newer figures of R376, R376 and R254 in the news. Those apply to the 2027 year of assessment, the one that started on 1 March 2026, and you will only use them when you file next year. For the return in front of you now, R364, R364 and R246 are the correct numbers. The official amounts for every year are on the SARS medical tax credit rates page.
A little background, offered with caution because the policy debate is not settled. In Budget 2026, National Treasury raised the MTC for the first time since 2023, and it declined a Department of Health proposal to phase out medical tax credits as a way of helping to fund National Health Insurance. The credits therefore remain in place for now, but the discussion continues.
The Additional Medical Expenses Tax Credit explained
The AMTC has two versions, and which one applies to you depends on age and disability status.
Under 65, no disability. Take your medical scheme contributions for the year and subtract four times your annual MTC. Add your qualifying out of pocket medical expenses to that result. If the combined figure is more than 7.5 percent of your taxable income, you get a credit of 25 percent of the excess.
65 and older, or where you, your spouse or your child has a SARS recognised disability. The formula is kinder. You get 33.3 percent of contributions above three times your annual MTC, plus 33.3 percent of all qualifying out of pocket expenses, with no income threshold at all.
A worked example
These are round example numbers, not a quote or a promise. Take a member under 65 with a spouse and one child, taxable income of R400,000 and medical scheme contributions of R5,000 per month, so R60,000 for the year. During the year the family also paid R20,000 in qualifying medical costs the scheme did not cover.
- Monthly MTC: R364 plus R364 plus R246, which is R974. Annual MTC: R11,688.
- Four times the annual MTC: R46,752. Contributions above that line: R60,000 minus R46,752, which is R13,248.
- Add the R20,000 paid out of pocket: R33,248.
- Threshold: 7.5 percent of R400,000, which is R30,000.
- Excess over the threshold: R3,248. The AMTC is 25 percent of that, which is R812.
So in this example the family receives the full annual MTC of R11,688 plus an extra R812. The AMTC often works out smaller than people expect for taxpayers under 65, because of that 7.5 percent threshold. For members over 65 or families dealing with disability, the numbers can be much more meaningful.
Which SARS codes go where?
Three source codes do the work on the ITR12, and mixing them up is the most common filing mistake we see.
- 4020 is for out of pocket qualifying medical expenses that appear on the tax certificate from your medical scheme, usually shown as claims not recovered from the scheme. SARS normally populates this automatically from the data the scheme submits.
- 4034 is for additional qualifying medical expenses you paid that are not on any certificate. Cash paid to a registered practitioner, prescribed medicine bought over the counter, that sort of thing. You enter this manually and you must keep the receipts.
- 4040 is for medical scheme contributions you paid privately, for example by debit order rather than through your employer. Enter it manually if the contributions are not already on your IRP5 under codes 4005 or 4474.
Keep 4040 and 4034 firmly apart. Code 4040 is contributions to the scheme. Code 4034 is medical expenses. Putting contributions under 4034, or expenses under 4040, will distort the calculation and can trigger a verification request from SARS.
Is Gap Cover tax deductible?
No. Gap Cover is short term insurance, not a contribution to a registered medical scheme, so the premiums do not qualify for the MTC and cannot be claimed as a medical expense. The same applies to hospital cash plans and similar insurance products.
That does not make Gap Cover less worth having. It exists to cover the difference between what specialists charge and what your scheme pays, which is exactly the kind of shortfall that otherwise lands in your out of pocket column. If you want to understand how it fits alongside your medical aid, our complete guide to Gap Cover in South Africa covers it in plain language.
What if your auto assessment is wrong?
SARS issues auto assessments from 1 to 12 July 2026, built from data supplied by employers, banks, insurers and medical schemes. Most are accurate. Some are not, and the medical tax credit is a frequent gap.
Two situations come up. If your medical scheme submitted incorrect or incomplete data, you cannot fix the certificate yourself. The scheme must correct the record and resubmit it to SARS, so your first call is to the scheme. If instead you have qualifying out of pocket expenses SARS never knew about, you do not have to accept the auto assessment. Open your ITR12 on eFiling, edit it, add the amounts under the right codes and submit before 23 October 2026.
Either way, do not simply assume the pre filled numbers are right. Compare the assessment line by line against the tax certificate from your medical scheme before you accept anything.
When does the 2026 Filing Season close?
The dates for this season are set out on the SARS Filing Season page. Auto assessments run from 1 to 12 July 2026. Taxpayers who are not provisional taxpayers can file from 13 July to 23 October 2026. Provisional taxpayers have until 22 January 2027.
Paying a lot out of pocket? That is worth a conversation
Large amounts under codes 4020 and 4034 are useful at tax time, but they are also a signal. They often mean the plan no longer matches how your family actually uses healthcare. A Curemed Advisor can review your current option against your claims pattern, at no cost and with no obligation, and tell you honestly whether a change makes sense or whether you should stay put. Our article on how to choose medical aid in South Africa is a good starting point, and an Advisor can take it from there. Curemed has been doing this since 1992, across all nine provinces, as an FSCA licensed brokerage (FSP 44098).
Frequently asked questions
Is Gap Cover tax deductible?
No. Gap Cover is short term insurance rather than a contribution to a registered medical scheme, so the premiums do not qualify for the Medical Scheme Fees Tax Credit and cannot be claimed as a medical expense.
How much is the medical tax credit for the 2026 tax year?
For the 2026 year of assessment, 1 March 2025 to 28 February 2026, the credit is R364 per month for the main member, R364 for the first dependant and R246 for each additional dependant. The higher R376 and R254 amounts only apply to the 2027 year.
Can I claim medical expenses I paid myself?
Yes, if they qualify. Expenses on your medical scheme certificate usually appear automatically under code 4020. Qualifying expenses not on any certificate go under code 4034, entered manually, and you must keep proof. They feed into the Additional Medical Expenses Tax Credit calculation.
Why is my medical credit missing from my auto assessment?
Usually because the medical scheme data did not reach SARS correctly. Ask your scheme to correct and resubmit the information. If you also have expenses SARS did not know about, edit and submit your own ITR12 on eFiling before 23 October 2026.
Do I need to submit my medical aid tax certificate?
Not with your return, because the scheme sends the data to SARS directly. Keep the certificate safe, though. You need it to check your pre filled return, and SARS may ask for it if your return is selected for verification.
This article is general information, not tax advice. SARS rules and your personal circumstances apply. Speak to a registered tax practitioner about your own return.
