Seven ways to review your medical aid cover
The medical aid review window is closing. Here's how you can check for shortfalls or overspending in your healthcare protection.
Choosing the right medical cover for you and your family is one of the most critical decisions you will make.
Scores of medical aid members currently have the option to change their covers as part of an annual review window.
Studies have found that more than 80% of South Africans lack sufficient funds for emergency expenses.
A recent study conducted by JustMoney found that only 16% of respondents would be able to cover a R10,000 emergency.
The Money & Me survey further found that just 27% were insured for medical costs. JustMoney's Sarah Nicholson says it’s crucial to ensure your healthcare package strikes a balance between sufficient protection and affordability.
“Start gathering information now so you can make an informed, confident decision about whether your current medical aid plan meets your needs and budget."
Nicholson urges people not to leave the decision until the last minute.
"The larger medical schemes have announced premium increases of up to 10% for 2026. Households that are already under pressure from rising food, electricity, and fuel prices will find this premium jump to be a strain on their monthly budgets," she says.
“A different network plan or a slightly cheaper option could meet your essential healthcare needs without compromising financial stability, but this requires thorough research,” Nicholson says.
Knowing your options is the first step to making the right decision.
Most medical schemes adjust contributions, savings allocations, and hospital benefits each year. Some introduce new plans and amend rules for chronic medicines. They communicate these changes to their members via member portals, emails, and benefit guides.
Plan upgrades are generally only allowed during an annual window, typically from November to mid-December. Downgrading may be possible during the year, subject to specific timing and scheme rules.
READ: Report finds racial bias by medical aid schemes
JustMoney offers the following seven tips to check for shortfalls or overspending in healthcare protection.
1. Note what’s changing in your current plan. Read your benefit update correspondence carefully and compare the 2025 and 2026 documents. Even small changes can affect day-to-day expenses.
2. Assess your current needs. Consider your typical medical expenses over the past 12 months, and whether your requirements have changed. Perhaps you’re planning a pregnancy, you’ve developed a chronic condition, or you need specialist visits.
3. Weigh up plans within your scheme. You may be paying for benefits you no longer need. Assess whether a different plan within your current scheme could better suit your budget.
4. Compare medical aid schemes. Use comparison tools such as MedAidQuote and Hippo, or consult a professional healthcare broker, to evaluate packages from multiple providers. Review offerings such as maternity benefits, hospital cover, day-to-day allowances, co-payments, oncology limits, network requirements, and whether your chosen providers are covered.
5. Watch out for hidden costs and co-payments. Some plans have strict rules about hospital networks, and/or require pre-authorisation for routine procedures. Co-payments for scopes, specialist consultations, certain medicines, and out-of-network providers can also add up. A plan that appears cheaper upfront may cost more overall, once co-payments and exclusions are factored in.
6. Consider taking out gap cover. Many doctors charge above medical scheme rates, leaving a shortfall that you must cover. Gap cover is a low-cost add-on that can protect you from unexpected costs.
7. Get advice before making changes. Switching plans is a big decision. Some plans have waiting periods, late-joiner penalties, or restrictions for pre-existing conditions. Financial advisers or accredited medical scheme consultants can help you compare options accurately and understand the long-term implications of changing plans.
Nicholson says insurance should also be chosen with full awareness of its limitations, and ideally used as a stepping stone to a comprehensive medical aid plan, when finances allow.
“Healthcare is one of the most crucial pillars of financial well-being. By taking a few hours to review your medical cover and understand what’s changing in 2026, and explore alternatives, you can ensure that you and your family are protected while getting the best value for your hard-earned money.”
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