South Africans Feel the Pinch as Medical Aid Costs Climb Sharply for 2026

Medical aid members in South Africa are facing renewed financial strain, with one prominent scheme implementing an almost 20% increase in fees for 2026. While most medical aid providers have managed to keep their annual contribution adjustments below double digits, the overall trend remains concerning for consumers already grappling with high living costs.

Key Takeaways

• Rising Medical Aid Costs: Most South African medical schemes have kept their 2026 premium increases below double digits, but affordability remains a growing issue for many households.
• Sizwe Hosmed’s Steep Hike: Sizwe Hosmed stands out with a massive 19.15% increase, introduced to stabilise its finances after falling below regulatory reserve requirements.
• Household Financial Strain: With healthcare inflation outpacing general inflation, many South Africans are downgrading plans or turning to cheaper alternatives like gap cover to cope with rising costs.

Most Medical Aid Schemes Keep Increases Below Double Digits, but Affordability Remains a Major Concern

According to fresh figures released by Alexforbes, the majority of the country’s medical schemes have contained their 2026 premium hikes within single digits. This moderation follows the steep contribution surges of 2025 and was initially seen as a sign of relief for households. However, despite the relatively lower increases, many families continue to find these premiums increasingly unaffordable. Consequently, a growing number of South Africans are either scaling down their coverage or downgrading their plans in an attempt to reduce expenses. Industry analysts note that the average South African household spends around 9% of its income on healthcare-related expenses, making it one of the highest proportions in the developing world.

Momentum and Fedhealth Among the Highest Increases

Within South Africa’s five leading open medical schemes, Momentum Health and Fedhealth have recorded the most substantial average premium increases for 2026, at 9.9% and 9.6% respectively. Bonitas followed closely behind, implementing an 8.88% increase, while Medihelp adjusted its premiums by 8.46%. Discovery Health opted for a more conservative increase of 7.2%, and Bestmed registered the lowest rise among the top players, at 6.8%. To put this in perspective, these increases outpace the country’s inflation rate, meaning consumers are effectively losing purchasing power year after year just to maintain their medical aid coverage.

Discovery’s contribution adjustment will only take effect from 1 April 2026, which effectively reduces its annualised increase to approximately 5.4%. This figure positions it as the most restrained among the leading medical aid providers in the country. Discovery’s approach of staggering its increase is often viewed as a strategic move to retain members and maintain affordability, especially among younger professionals who are increasingly price-sensitive.

Sizwe Hosmed’s Massive 19% Increase Raises Concern

The clear outlier among the schemes is Sizwe Hosmed, which has introduced a staggering average premium hike of 19.15% effective from 1 November 2025. This follows a turbulent period for the medical aid provider, which was placed under curatorship in September after its reserve levels plunged to just 5.6% in June, far below the minimum regulatory requirement of 25%.

The steep increase was described as a necessary step to restore the scheme’s financial stability and to address long-term underpricing of benefits. Sizwe Hosmed has indicated that its immediate focus lies in rebuilding its financial health through strict cost control measures and enhanced operational efficiency, while continuing to ensure that members retain access to quality healthcare at a manageable cost.

Households Struggling to Keep Up

South Africa’s regulatory framework requires all medical aid schemes to use a community rating model, meaning they cannot vary premiums based on an individual’s age or state of health. Under this model, younger and healthier members effectively subsidise older or more vulnerable ones. However, as increasing numbers of young adults withdraw from medical aid due to affordability issues, this balance becomes progressively weaker, leading to further price increases to keep schemes financially viable.

Industry experts have noted a clear trend of members opting for lower-tier medical aid plans to cut costs. According to Alexforbes, the sustainability of the medical scheme environment now depends heavily on attracting and retaining younger, healthier members through affordable and well-structured options that guarantee adequate access to healthcare. Financial planners often advise consumers to keep at least a hospital plan if they can’t afford full medical aid coverage, as hospital expenses are the most financially devastating.

Rise of Alternative Health Solutions

In response to rising premiums, a growing number of South Africans have started exploring alternative products such as gap cover and low-cost primary healthcare options. These alternatives have seen rapid expansion in recent years. Although these products provide limited access to private healthcare services and offer short-term relief, they cannot serve as complete replacements for comprehensive medical aid coverage. Nonetheless, they have contributed to easing some of the strain on the overburdened public healthcare sector. Gap cover typically costs between R300 and R700 per month and covers the difference between what doctors charge and what medical aids pay, providing a major safety net for those who rely on private hospitals.

Alexforbes has cautioned that the pace at which medical aid contributions are rising is both financially unsustainable and socially concerning. If the current trend continues, more households will be priced out of private healthcare entirely, widening the gap between insured and uninsured citizens. Some experts predict that by 2030, fewer than 10% of South Africans will be able to afford full medical scheme coverage if current inflation trends persist.

Households Under Intense Financial Pressure

Evidence of the growing financial distress among South African households has emerged from a survey conducted by infoQuest and Decapod Customer Experience in August 2025. The research revealed that 41% of households have been forced to scale back on medical aid, insurance, or savings in order to manage day-to-day living expenses. This statistic reflects a broader economic reality: more South Africans are now prioritising immediate needs such as food and housing over long-term financial protection.

The survey paints a sobering picture of modern South African life. Nine out of ten respondents are actively searching for discounts and promotional offers to stretch their income. A total of 85% reported cutting back on luxury purchases, while 83% have curtailed social outings and dining experiences.

More than two-thirds of households have either cancelled or downgraded streaming subscriptions, and around 65% have shifted their purchasing preferences towards locally produced goods instead of imports. Additionally, 62% have switched to more affordable grocery stores, 56% have abandoned hobbies, and just over half now carpool or use public transport to save on fuel costs.

Nearly 50% of respondents admitted to cancelling gym memberships, while four in ten said they have downsized their homes to reduce living expenses. The data also highlights that 37% of households have temporarily paused education-related spending, 29% have sold or pawned personal belongings, and 27% have borrowed money from relatives or friends to stay financially afloat. Economists warn that this level of household cutback has long-term consequences, potentially stalling economic recovery as consumer spending, a key growth driver, declines sharply.

Informal lending networks now appear to have overtaken traditional bank loans in popularity. Around 24% of households have taken out personal loans, 22% have withdrawn funds from home loans, and 20% have extended their credit card limits. Alarmingly, more than half of those surveyed reported difficulty in keeping up with their monthly debt repayments, underscoring the depth of the financial challenges confronting South Africans today.

Trivia: South Africa has one of the highest household debt-to-income ratios in the world, hovering around 62%, which makes families especially vulnerable to interest rate fluctuations.

Conclusion

The escalating cost of medical aid in South Africa underscores the growing pressure on both healthcare providers and consumers, revealing a widening gap between affordability and access to quality care. As schemes struggle to balance rising healthcare costs, ageing membership bases, and regulatory requirements, many households are being forced to make difficult financial decisions that compromise their medical security. Without structural reforms or innovative solutions to contain medical inflation, the strain on South Africans’ pockets is likely to intensify, potentially leaving millions without adequate healthcare coverage in the years to come.