Navigating Your Options: A Guide to the Best Medical Aid Schemes in South Africa for 2026

Choosing a medical aid scheme in South Africa is one of the most important financial and healthcare decisions you will make. With over 70 medical schemes operating in the country, ranging from open schemes available to anyone to restricted schemes limited to specific industries, the landscape can feel overwhelming . To make matters more complex, just 16 of these are open schemes, and a few major players dominate the space—Discovery Health alone holds nearly 58% of the total market share . Yet within this concentrated market, each scheme offers distinct benefits, pricing structures, and philosophical approaches to healthcare. Understanding these differences is the key to finding the best fit for your unique circumstances.

The 2026 Pricing Landscape: What You Need to Know

After several years of steep double-digit increases, the 2026 contribution landscape offers some relief to South African households, though affordability remains a significant concern . Among the top five open medical schemes, Bestmed has announced the lowest average weighted increase at 6.8%, with some individual options rising by as little as 5.1% . This is followed by Discovery at 7.2%, though Discovery’s increase only takes effect from 1 April 2026, resulting in an effective annual rise of approximately 5.4%—the lowest effective increase among the major players . Medihelp follows at 8.46%, Bonitas at 8.88%, and Fedhealth at 9.6%, with Momentum recording the highest among the top five at 9.9% .

These increases must be understood against the backdrop of healthcare inflation, which stood at 4.7% in August 2025, well above the overall Consumer Price Index of 3.3% . The Council for Medical Schemes has recommended that increases be limited to 3.3% plus reasonable utilisation estimates, acknowledging that steep rises place significant financial burden on members already grappling with high electricity prices and food inflation . The outlier this year is Sizwe Hosmed, which announced a staggering 19.15% average increase following its placement under curatorship in September 2025 after reserves fell to just 5.6%, far below the required minimum of 25% . This serves as a stark reminder that financial stability matters when choosing a scheme.

Discovery Health Medical Scheme: The Market Leader

As the dominant force in South African medical aid, Discovery offers an extensive range of options designed to cater to different life stages and budgets. For 2026, the scheme has introduced innovative features including personal health pathways and a sleep programme aimed at improving member outcomes through preventive care . Two-thirds of Discovery members will see an increase of just 6.9%, while the new Active Smart plan will not increase at all, remaining at R1,350 per month—a strategic move to attract younger, healthier members . The high-end Executive and Comprehensive plans, along with Coastal variations and KeyCare entry-level options, will increase by 7.9% . Discovery’s Vitality wellness programme remains a standout feature, rewarding members for healthy behaviours with discounts on premiums, flights, and retail purchases, effectively reducing the net cost of cover for those who engage with the programme.

Bonitas Medical Fund: Value with Flexibility

Bonitas has announced a weighted average increase of 8.8% for 2026, with principal officer Lee Callakoppen emphasising that every benefit adjustment was guided by claims data and member health needs . The scheme is introducing two new options aimed at improving accessibility: Bon Core, priced at R1,275 per beneficiary, and Bon Prime, a restructured version of the Primary Select option . Bonitas has long been recognised for its balanced approach, offering solid coverage at competitive price points. Their range includes options for students, young professionals, and families, with particular strength in chronic disease management and oncology benefits. The scheme’s national network of healthcare providers ensures reasonable access across provinces, though members should always verify whether their preferred specialists are part of the network.

Bestmed: The Affordable Innovator

Bestmed has positioned itself as a leader in affordability with its 6.8% average weighted increase, the lowest among major schemes . Chief Executive Leo Dlamini acknowledges that healthcare inflation remains one of the biggest challenges facing households, stating that the scheme’s responsibility is to safeguard the depth of benefits while ensuring contributions remain competitive . For 2026, Bestmed is not only protecting current benefits but adding important new preventative care benefits, with enhancements in areas such as oncology and women’s health . The scheme has also invested in digital tools to improve member experience and access to care. Bestmed’s Pace+ and Beat options offer entry-level cover for those seeking basic hospitalisation and day-to-day benefits, while their Medical Savings Option provides greater flexibility for members who want control over their routine healthcare spending.

Medihelp: Member-Driven Flexibility

Medihelp’s 8.46% average increase for 2026 reflects what principal officer Varsha Vala describes as a focus on affordability through actuarial oversight . The scheme is introducing an innovative savings plan feature that allows members to adjust whether co-payments are paid from their medical savings account at any time during the year. “This elevates Medihelp from simply allocating savings to actively empowering members to manage and grow their benefits. It’s flexible, member-driven, and unique in the South African market,” Vala explains . Additionally, from 2026, only the highest procedure-specific co-payment per admission will apply, reducing members’ out-of-pocket costs during hospitalisation. Medihelp’s range includes options tailored for different life stages, with particular strength in benefits for pensioners and older members.

Fedhealth: The Built Different Partnership

Fedhealth’s partnership with Sanlam represents one of the most significant developments in the 2026 medical aid landscape . Together, they have launched a reimagined scheme under the theme “Built Different,” designed to address common consumer frustrations with medical aid: that it is too expensive, too rigid, too complicated, or not inclusive enough . Principal Officer Jeremy Yatt explains that the scheme embodies five core values: affordability, customisation, inclusivity, simplicity and trust, which shape everything from pricing strategies to benefit enhancements . For corporate clients particularly, the partnership offers easier access for employees to a suite of physical and financial wellness products, including Sanlam Gap Cover, Sanlam Primary Care, oncology solutions, funeral insurance, and even discounted car and home insurance through Santam . With 32 on-site clinics nationwide staffed by occupational and primary health nurses, the scheme brings care directly into the workplace, managing risks, monitoring chronic conditions and supporting absenteeism management . This integrated approach, combined with a 9.6% contribution increase, positions Fedhealth as an attractive option for both individuals and employers seeking holistic healthcare solutions.

KeyHealth: Comprehensive Cover with Transparency

While smaller than the top five, KeyHealth deserves attention for its straightforward approach to medical aid. Their Gold option, priced at R8,675 per month for a principal member, offers unlimited hospital cover at designated service provider hospitals including Life Healthcare and Netcare facilities nationally, along with selected Mediclinic hospitals . The Gold option includes a medical savings account component, with R9,156 per annum for the principal member, plus additional day-to-day benefits once savings are exhausted . For those seeking a mid-tier option, the Silver plan at R5,857 per month provides unlimited hospital cover, enhanced day-to-day benefits, and cover for 29 chronic conditions, including four non-PMB conditions such as ADHD for children and major depression . KeyHealth’s transparent benefit design and inclusion of unlimited dental treatment across all plans make them a compelling choice for families who prioritise predictable coverage.

Understanding the Forces Shaping Medical Aid

Several underlying dynamics affect what you pay and what you receive from your medical scheme. Medical schemes in South Africa are required by law to apply community rating, meaning contributions may only vary based on benefit option, family size, and income . This prevents schemes from charging higher rates to older members or those with greater medical needs, but it relies on a cross-subsidy from younger, healthier members to older members or those with higher medical needs . As younger and healthier individuals increasingly view medical cover as a grudge purchase and opt out unless it is a mandatory condition of employment, schemes tend to age over time, and the cross-subsidy gradually declines . This demographic pressure, combined with rising healthcare costs and increased utilisation of services, pushes contributions upward .

To address these challenges, schemes are investing in preventive health initiatives and digital innovation. Discovery has introduced personal health pathways and sleep programmes, while Medshield has launched its ‘Hey Medshield’ voice assistant to educate members about their health and benefits . These digital tools support early intervention and promote healthier lifestyles, which can reduce future claims . Schemes are also introducing new, affordable options designed specifically to attract younger members, such as Discovery’s Active Smart Plan and Smart Saver Series, and Bonitas’ BonCore . These strategies aim to reduce future claims risk and enhance member value while ensuring the long-term sustainability of medical schemes.

The Growing Affordability Crisis

Despite these efforts, affordability remains a pressing concern. Research conducted by infoQuest and Decapod Customer Experience in August 2025 found that 41% of households have cut back on medical aid, insurance, and savings to make ends meet . 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, and 65% are switching to local rather than imported goods . Some households are under such financial strain that 37% have paused education, 29% have sold or pawned possessions, and 27% have borrowed money from family or friends . Fazlin Swanepoel, Head of Health at Alexforbes, notes that the industry has seen many members buying down options due to affordability pressures, and that attracting younger, healthier members through affordable, relevant options has never been more important .

Practical Steps for Choosing Your Scheme

With this complex landscape in mind, how do you choose the best medical aid for your needs? Start by assessing your healthcare usage patterns. If you rarely visit the doctor and are primarily concerned about catastrophic events like hospitalisation, a hospital plan with a lower premium may suffice. If you have young children or chronic conditions requiring regular GP visits and medication, a plan with day-to-day benefits and chronic coverage will provide better value. Consider the network of hospitals and specialists available under each option—choosing a scheme with strong networks in your area can significantly reduce out-of-pocket costs.

Pay attention to chronic disease benefits. All schemes must cover the 26 Prescribed Minimum Benefit conditions, but some, like KeyHealth, offer cover for additional conditions beyond this list . If you or your family members have specific health needs, verify that these are adequately covered. Look at benefit limits for important categories like oncology, MRI and CT scans, and mental health support. The KeyHealth Gold option, for example, offers R527,000 per family per annum for oncology, while the Silver option provides R230,500—a significant difference that could matter profoundly if cancer strikes .

Consider the role of medical savings accounts. Some plans include a savings component that you can use for day-to-day expenses, with unused funds rolling over to the next year. Others operate on a “traditional” model where you pay for routine expenses until you reach a threshold, after which the scheme covers costs partially or fully . There is no universally superior approach; the best choice depends on your ability to manage cash flow and your comfort with risk.

Finally, work with an independent financial adviser who specialises in medical aid. As Alexforbes notes, independent advisors play a crucial role in demystifying complex benefits and guiding consumers toward cover that fits their lifestyle, their pockets, and their financial goals . An advisor can help you compare options across multiple schemes, explain the fine print, and assist with applications and underwriting.

Looking Ahead: The NHI and the Future of Medical Aid

The National Health Insurance Act casts a long shadow over the future of private medical aid in South Africa. Under the current NHI framework, medical schemes will only be permitted to offer complementary coverage for services not included in the NHI . The government has also begun engagements to commence the phasing out of medical aid tax credits, currently valued at approximately R34 billion annually, which are projected to be redirected to support the NHI . As these credits are gradually removed, the cost of maintaining private medical cover will rise, particularly for middle- and lower-income earners .

However, the NHI Act is currently being challenged by various stakeholders seeking clarity on its provisions, with numerous interest groups launching legal challenges arguing that the Act is unaffordable, irrational, and unconstitutional . The Constitutional Court will ultimately determine the outcome, and until then, medical schemes are expected to continue operating in their current form . Fazlin Swanepoel observes that as NHI developments unfold, collaboration between public and private sectors remains essential in promoting equitable access for all, and that Alexforbes is positioned to help members navigate uncertainty as policy changes unfold .

A Final Word

The best medical aid scheme in South Africa is not necessarily the one with the lowest premium or the most extensive benefits. It is the one that aligns with your health needs, your financial situation, and your peace of mind. Whether you choose the market-leading innovation of Discovery, the value-focused flexibility of Bonitas, the affordability of Bestmed, the member-driven approach of Medihelp, the integrated wellness ecosystem of Fedhealth and Sanlam, or the transparent coverage of KeyHealth, the most important step is to make an informed choice. Review the 2026 increases, understand the benefits, and consider how each option supports your long-term health and financial wellbeing. In a landscape of rising costs and evolving regulation, proactive engagement with your medical aid choice is not just prudent—it is essential.