Medical aid members in South Africa are about to get a nasty surprise
With medical aid contributions increasing by around 8% in 2027, members could see close to half their salary increases for the year eaten up in an instant.
Calculations done by Efficient Wealth show that anyone receiving an inflation-based salary increase in 2027 will have a huge chunk of that swept away by medical aid hikes.
The group used the example of a household earning R30,000 in take-home income per month and paying a medical scheme contribution of R6,000.
With a 4.1% salary hike for 2027—in line with average CPI—this household would take home an extra R1,230 a month.
However, an 8% increase in medical aid contributions would cost R6,480 per month—an increase of R480.
This would wipe out 40% of the higher take-home pay, leaving just R750 to cover other rising bills, such as higher electricity prices, rent, etc.
While the example used by Efficient Wealth is not comprehensive, it illustrates the widening gap between income and the cost of living in South Africa, as well as the growing unaffordability of private healthcare.
The picture changes depending on which medical aid scheme a household is part of and which plan they are on.
In October, South Africa’s largest medical aid schemes announced average contribution increases ranging from 7.35% to 8.7%.
- Discovery Health Medical Scheme: 8.2%
- Bonitas Medical Fund: 8.7%
- Momentum Medical Scheme: 7.9%
- Medihelp: 7.5%
- Bestmed: 7.35%
“Some medical scheme increases for 2027 look gentler against recent history,” Efficient Wealth said.
Discovery Health Medical Scheme announced a weighted average increase of 8.2%, compared with 9.3% for 2025. Bestmed announced 7.35%, against 12.75% in 2025.
However, while these are smaller percentage increases, they are being applied to already higher bills.
“A lower headline number can, therefore, offer little relief when income is struggling to keep pace,” the wealth managers said.
Salaries are shrinking in real terms
The other side of the equation—salary increases—is also not guaranteed.
While a higher-than-inflation salary increase for 2027 could mitigate the steeper climb in medical aid prices, this is not guaranteed.
Efficient Wealth added that a bonus or commission windfall could also help, but medical aid contributions must be paid monthly and shouldn’t be budgeted for money “hoped for”.
Worse still, salary data for South Africa shows that pay is declining in real terms.
According to the latest PayInc Net Salary Index (September 2026), the average nominal net salary in South Africa is currently at R21,689 per month.
This is up 0.3% from August and up 1.8% from September 2025.
In real terms—taking inflation into account—salaries are at R20,178. This is 0.1% higher than in August but still 2.6% lower than in 2025, reflecting the erosion of purchasing power among salary earners.
“Year-to-date statistics suggest that, on average, net salaries are down by 2.2% in real terms, limiting consumers’ spending power and weighing on discretionary expenditure and confidence,” PayInc said.
The destruction of purchasing power in 2026 has largely been driven by higher fuel costs, which are not expected to last forever.
But higher medical aid costs, higher electricity costs—with Eskom implementing another 9% hike in 2027—and food price pressures from events like El Niño could see households buckle once again under the rising cost of living.
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