Medical-aid increases for 2027: the percentage is only part of the bill

Medical-aid members are being asked to make room for another substantial increase in their household budgets, with several schemes announcing contribution rises above 7% for 2027.

Discovery Health Medical Scheme has proposed increases ranging from 7.4% to 8.9%, with a weighted average of 8.2%. Its announcement says the changes are intended to take effect on 1 January 2027, subject to Council for Medical Schemes approval.

IOL reports announced average increases of 7.9% for Momentum and Medshield, 7.5% for Medihelp and 7.35% for Bestmed. These headline averages should not be treated as the final increase on every member’s particular option.

Why the 3.8% benchmark is not a price cap

The Council for Medical Schemes’ 3.8% benchmark has become a point of comparison in the debate. Reporting on its guidance says schemes seeking higher increases must justify their financial and actuarial assumptions, with expected healthcare use also relevant to pricing.

It would therefore be misleading to describe every increase above 3.8% as a breach of a legal ceiling. The question is whether the proposed contribution is justified, whether avoidable costs have been addressed and what the regulator ultimately approves.

Discovery attributes its proposed increases to medical inflation. A scheme’s explanation for its costs and a household’s ability to absorb those costs are separate questions. Even an increase supported by a sound financial case can be unaffordable to a member whose income has barely moved.

Calculate the rand difference on your own option

A weighted average reflects a scheme’s membership mix. It is not a personalised quotation. The relevant starting point is the approved contribution for your exact option and the combination of main member, adult dependants and children on your membership.

For illustration, an 8% increase on a R4,000 monthly contribution adds R320 a month, or R3,840 over a full year. That is an arithmetic example, not a quotation for a named scheme. An employer contribution may also affect how much of an increase reaches your payslip.

Compare that amount with the benefits available in the new year. A lower contribution can come with different provider networks, co-payments or day-to-day cover. The useful comparison is the expected total cost of using the plan, not only the debit order.

Check what changes before choosing cheaper cover

Members considering a different option should establish whether their usual hospital, doctors and medicines are covered on the same terms. They should also check how any medical savings component changes and what they may need to pay themselves after those funds run out.

Ask the scheme for the applicable option documents and its deadline for changes. If moving between schemes, obtain written clarity on any waiting periods or other conditions before ending existing membership. A general comparison cannot settle those member-specific terms.

The announcements give households an early warning. The decision should follow the approved figures and benefits for the actual membership. The most useful answer a scheme can provide is straightforward: what will this family pay next year, and what care will that payment buy?