Pain for medical aid members in South Africa – with one scheme hiking fees by almost 20%
Although most medical aid schemes have managed to keep their annual increases for 2026 below double-digits, one has hiked its premium by almost 20%.
According to new data from Alexforbes, most medical aid schemes have managed to keep their annual increases for 2026 below double digits, offering some respite after steep hikes in 2025.
However, even the smaller increases are proving unaffordable for many households, who are cutting back on cover or downgrading their plans in the face of mounting financial pressure.
Among South Africa’s top five open medical schemes, Momentum and Fedhealth recorded the highest average contribution increases for 2026, at 9.9% and 9.6% respectively.
They were followed by Bonitas (8.88%), Medihelp (8.46%), Discovery (7.2%), and Bestmed (6.8%).
Discovery’s increase only takes effect from 1 April 2026, meaning its effective annual rise is about 5.4%—the lowest among the leading schemes.
The outlier is Sizwe Hosmed, which announced a staggering 19.15% average increase effective from 1 November 2025.
The scheme was placed under curatorship in September after its reserves dropped to just 5.6% in June—far below the regulatory minimum of 25%.
Sizwe Hosmed said the sharp increase was essential to stabilise its finances and “correct the historical underpricing of benefits.”
The scheme added that it was focused on restoring financial health through cost containment and operational improvements, while ensuring that members continue to receive affordable care.
Medical aid pricing, Alexforbes explained, is influenced by a range of factors, including inflation, ageing membership profiles, and rising utilisation of healthcare services.
The firm noted that contribution increases typically include allowances for changes in the Consumer Price Index (CPI), the rising cost of medical services, and reserve requirements to cushion against unexpected claims.
Stats SA’s latest figures show that healthcare inflation stood at 4.7% in August 2025, well above the overall CPI of 3.3%.
These cost pressures, combined with a shrinking pool of younger and healthier members, are pushing medical aid prices upward.
South African households can’t keep up
Because South Africa’s medical schemes are required to use community rating, they cannot charge different premiums based on age or health status.
Instead, younger, healthier members subsidise older or sicker ones. As more young people opt out of medical aid, this balance weakens—forcing schemes to raise contributions further to remain solvent.
“As an industry, we have seen many members buying down options due to affordability pressures,” said Fazlin Swanepoel, Head of Health at Alexforbes.
“To ensure the sustainability of medical schemes, attracting younger, healthier members through affordable and relevant options that ensure access to care has never been more important.”
Swanepoel added that more South Africans are turning to alternatives such as gap cover and low-cost primary care options, which have seen dramatic growth.
These products provide limited private healthcare access and have also helped ease pressure on the public health system. However, they are not a replacement for full medical scheme coverage.
Alexforbes warned that the current pace of medical aid inflation is neither affordable nor sustainable.
The financial squeeze on households is already evident in recent consumer research conducted by infoQuest and Decapod Customer Experience in August 2025.
The survey found that 41% of households have cut back on medical aid, insurance, and savings to make ends meet.
The data paints a grim picture of daily financial life. Nine in ten consumers are actively hunting for bargains, 85% are spending less on luxuries, and 83% have reduced socialising and eating out.
More than two-thirds have cancelled or reduced streaming subscriptions, while 65% are switching to local rather than imported goods.
Consumers are also changing how they live: 62% have switched grocery stores for cheaper options, 56% have abandoned hobbies, and 51% are carpooling or using public transport.
Nearly half have cancelled gym memberships, and four in ten have downsized their homes.
Some households are under such financial strainthat 37% have paused education, 29% have sold or pawned possessions, and 27% have borrowed money from family or friends to stay afloat.
Informal borrowing now exceeds formal bank loans, with 24% taking personal loans, 22% withdrawing from home loans, and 20% increasing credit card limits. More than half say they are struggling to keep up with credit repayments.
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