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Business Day Insights MEDICAL COVER OPTIONS FOR 2027
Thursday 22 October 2026
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Medical schemes grapple with rising costs Contribution increases outpace inflation amid an ageing risk pool and surging claims, writes Lynette Dicey Medical schemes’ 2027 increases average between 7.35% and 8.9%, about double inflation. Regulation, an ageing risk pool and rising claims leave them little room to manoeuvre. Medical aid contribution increases have once again outpaced inflation. The Council for Medical Schemes (CMS) recommended that schemes anchor increases at 3.8% plus an allowance for higher utilisation. Consumer price inflation was 4.4% in August. However, the major open schemes that have announced their contribution increases for 2027 have set increases averaging between 7.35% and 8.9%. Bestmed has the lowest average increase of the group at 7.35%. CEO and principal officer Leo Dlamini says the scheme’s 2027 changes aim to deliver more value while protecting the scheme’s long-term sustainability. Medshield and Momentum Medical Scheme have each announced an average increase of 7.9%. Medshield has limited increases on its entry-level and mid-range options to between 6% and 7%, covering 125,603 lives. Momentum has paired its increase with a third GP benefit tier and higher specialist limits. Discovery Health Medical Scheme, which covers more than 2.7-million people, will raise contributions by between 7.4% and 8.9%, a weighted average of 8.2%. Two-thirds of its beneficiaries will see increases below 8%. Bonitas Medical Fund has set an average
increase of 8.7% across all plans. “Against a challenging economic backdrop, affordability remains a key priority,” says principal officer, Lee Callakoppen. “Strategic purchasing and provider negotiations continue to help maximise value for members, while supporting the long-term sustainability of the fund.” Among the other large open schemes to have announced their increases for 2027, Fedhealth has set an increase of 8.9% for 60% of its members and Medihelp an average of 7.5%. “This problem of medical inflation being significantly higher, almost double consumer price inflation, is not new,” says Kevin Aron, principal officer of Medshield. “It's been going on for
medical schemes for at least the past 15 years.” New medicines, treatments and technology push prices up. Schemes are also paying for more care as members age and chronic disease becomes more common. “Medical inflation is a challenge affecting health systems globally, not only medical schemes in South Africa,” says Dr Ron Whelan, CEO of Discovery Health. “What matters is how effectively a scheme manages those pressures.” Damian McHugh, chief marketing officer at Momentum Health, points out that hospitalisation remains the largest area of spending, which is why prevention and early intervention cannot be treated as optional extras. The risk pool is under strain too. Momentum’s data shows the open scheme market shrank by 3% between 2019 and 2024, while the average member’s age rose from 35 to 37. Schemes must hold reserves of at least 25% of annual contributions and fund a defined set of prescribed minimum benefits (PMBs) in full. They are also prevented from charging more based on age or health. “If you have four chronic conditions, you’re overweight and you don’t exercise, you pay the exact same on an option as someone who exercises, who is fit, who eats well and has no chronic conditions,” says Aron. Pricing too low only stores up trouble. “You could go lower, but that’s not going to result in a
sustainable medical scheme,” he says. Some schemes have used their reserves to cushion members. Medshield has brought its solvency down from 60% to 46%. Bestmed reports a solvency ratio of 37.3%. Discovery is the only open scheme with a AAA credit rating. Health insurance products face no such constraints. They are not required to cover PMBs and can price according to individual risk. “Health insurance plans, which are not subject to the same level of regulatory sort of challenges that medical schemes have, have boomed in recent years,” says Aron. Momentum, which offers both, says the health insurance market it competes in has grown from about 600,000 lives in 2022 to more than a million. Such products widen access, but are not designed to replace a medical scheme’s comprehensive protection. Many in the industry believe reform is overdue. The Competition Commission’s Health Market Inquiry recommended reforms, including a riskadjustment mechanism and a review of PMBs, that have yet to be implemented. Aron argues that the CMS “really needs to look at regulatory reform to help with the future sustainability of medical schemes”. Until then, members should look beyond the headline percentage. Lower co-payments, new benefits and preventative programmes can change the value of cover, even when the price goes up.
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Join Bestmed today. For a FREE quote, visit bestmed.co.za. *Best Bucks is not available on Beat1, Beat1 Network, Rhythm1 and Rhythm2. Product rules, limits, terms and conditions apply. Disclaimer: All information regarding the 2027 benefit options and accompanying services including information in respect of the terms and conditions or any other matters is subject to prior approval of the Council for Medical Schemes (CMS) and may change without notice having due regard to the CMS’s further advice. Please note that should a dispute arise, the registered Rules, as approved by the Registrar of Medical Schemes, shall prevail. Bestmed Medical Scheme is an Authorised Financial Services Provider (FSP no. 44058).
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Thursday 22 October 2026
Business Day
Technology takes medical aid into new era Medical schemes harness artificial intelligence and digital care to improve health and contain costs Medical schemes are using data, artificial intelligence (AI) and virtual consultations to guide members earlier, and to reward the habits that keep claims down. For decades, medical aid has worked largely the same way for everyone: pay the contribution, claim when you’re ill. That model is shifting. Schemes are now using data and technology to tailor guidance to each member, nudge them towards healthier choices and give them quicker, cheaper ways to get care. Discovery Health Medical Scheme is taking Dr Ron Whelan. personalisation further in 2027. More than 750,000 adult members already use Personal Health Pathways, a Discovery Health patented AI-powered platform which recommends specific health actions based on each member’s profile. Together these individuals have completed more than 12-million health actions and unlocked more than R1bn in extra day-to-day benefits through the scheme’s Personal Health Fund. From January, the platform will be powered by Vitality AI and Discovery’s global partnership with Google. It will expand to provide individuals with more than 8,000 tailored and personalised clinically validated health actions and more than 41,000 personalised “next best actions”. Discovery Health CEO Dr Ron Whelan says personalisation has been central to Personal Health Pathways since its launch. “What changes in 2027 is the depth, precision and relevance of that personalisation.” Members will also gain access to Personal Health Insights, which brings their clinical history, claims, screening results and lifestyle data into one view. It’s designed to show how a member’s health is changing and to link any warning signs directly to help create the most appropriate next recommended actions. “Our experience shows that when guidance is personalised, timely and supported by meaningful context, members in partnership with their primary care doctors are more likely to take action and improve their health,” says Whelan. The scheme credits its wellness programmes, alongside managed care and other core risk
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strategies, with helping to limit its 2027 weighted average contribution increase to 8.2%, about 2.5 percentage points lower than would otherwise have been needed. These programmes also help attract younger, healthier members: more than 70% of members who joined in the past two years were under 40. Momentum Health is also seeing the results of rewarding healthy behaviour. Since January 2026, its Momentum Multiply programme has recorded a 25% increase in members achieving their physical activity goals and a 35% increase in those reaching their rest and recharge goals. The scheme’s data shows that engaged members generate 19% lower claims than other members. For 2027, Momentum is enhancing HealthReturns, which rewards these behaviours, and expanding rewards for employers so they can support employee wellbeing through HealthSaver contributions and other health initiatives. When health support is convenient, understandable and rewarding, people are more likely to build habits that last,” says Damian McHugh, chief marketing officer at Momentum Health. Digital access is changing how members first seek help. Momentum Health has seen consultations through Hello Doctor rise by 634% since 2021, as more members begin their healthcare journey online and get guidance earlier. “People should be empowered to take Damian McHugh. practical steps towards better health in ways that are accessible, relevant and meaningful to them,” says McHugh. Momentum has also replaced underused Covid-19 screening benefits with an over-thecounter pharmacy medicine benefit, a practical change that reflects how members actually use their cover. One of the biggest constraints facing medical schemes is that they cannot price for individual risk. Personalised guidance and well-designed rewards are among the few tools they have to reduce it. If members act earlier, chronic conditions are picked up sooner, avoidable hospital admissions fall and the cost pressure on everyone in the risk pool eases.
Medshield raises child dependant age to 24 on all options Young adults are studying longer and starting work later. For many families, the jump from a child to an adult contribution comes at exactly
Healthcare that works for you – In a time of rising costs and increasingly complex healthcare landscape, choosing the right medical aid has never been more important. Discovery Health Medical Scheme combines aordability, reliability, and access to quality care Ȃ helping you protect what matters most.
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the wrong time. A 21year-old may still be studying, looking for a first job or earning too little to contribute at home, yet on many medical aid options they start to cost their parents adult rates. Several schemes, including Discovery Kevin Aron. Health Medical Scheme and Bonitas, already charge child rates up to the age of 24. From 2027, Medshield Medical Scheme will do the same, raising its child dependant age from 21 to 24 on all of its options. Its students can already remain child dependants until 28. “We moved it out from 21 to 24 years to provide a couple of extra years of financial assistance to those families, so that their children don’t move into an adult dependent pricing category,” says Kevin Aron, principal officer of Medshield. The change comes at a cost to the scheme but is, says Aron, worth it. “Affordability is pushing members across the industry to buy down to cheaper options and new entrants to choose cover based on what they can afford.” Medshield has therefore held down increases on the options most likely to be chosen by younger members early in their careers. Its entrylevel MediCurve option will rise by 6% and MediCore by 7.5%, against a scheme-wide weighted average of 7.9%. In total, 125,603 lives will see increases of between 6% and 7%. “Our focus for 2027 ensures that members can afford to retain private healthcare in a challenging economic environment,” says Aron. The scheme has also reduced and removed selected co-payments, which Aron argues can lower a member’s total healthcare spend even when contributions rise.
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of medical schemes. Personal Health Pathways is enabled by the combination of Discovery Health’s healthcare capabilities and Vitality’s behaviour change expertise.
He urges members to look at the full picture: “Members need to read their brochures. They need to understand their medical aid. They need to see what value they’re really getting.” A new distribution agreement with Sanlam will also give Medshield members progressive access to gap cover, financial planning and other financial wellbeing products. For families weighing up whether they can afford to keep their cover, three extra years on child rates may make the difference.
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Schemes bet on prevention to curb costs Unable to price for individual risk, medical schemes are working to reduce it, with more screenings, quicker follow-up care and rewards for members who take part. Medical schemes cannot charge a member more for being unhealthy. What they can do is help members catch health problems before they become serious, and expensive to treat. For 2027, prevention has moved from the edges of benefit design towards its centre. “Healthcare in South Africa is evolving rapidly, and members need more than traditional medical aid cover,” says Lee Callakoppen, principal officer of Bonitas Medical Fund. “They need proactive support, personalised health journeys and meaningful value at every stage of life.” Bonitas has made preventive healthcare Lee Callakoppen. a strategic priority for 2027, starting with access. Members can now have basic wellness screenings at more than 1,245 pharmacies, after the scheme added Clicks, Dis-Chem and Medirite to its provider network. About 95% of Bonitas members live within 10km of a health risk assessment provider. Demand is already rising. Health and wellness assessments increased by 138.6% in 2025 compared with the year before. Screening only helps if members act on the results. Bonitas is therefore introducing a GP Confirmation Benefit: when a screening flags a potential health risk, eligible members can see a GP within 14 days, funded from the scheme’s risk pool. “It’s important that members are both enabled and encouraged to identify potential health risks earlier through preventive assessments and screenings,” says Callakoppen. The scheme is also expanding its Benefit Booster by 140%, giving families up to R12,000 in additional value and making it available on the income-based BonCap plan for the first time. Its B-Value platform, which offers guidance, tools and rewards across fitness, nutrition, financial health
and stress management, adds Takealot and Checkers as partners. Care programmes such as Live Lean, the Ocular Health Programme and a new back, neck, shoulder and knee rehabilitation programme round out its support. Leo Dlamini, CEO and principal officer of Bestmed, says the scheme believes that better health starts with understanding your health risks early and taking action before concerns become more serious. To encourage this proactive approach, qualifying members who complete their annual Tempo Lifestyle Screening will receive access to Best Bucks, a new benefit that provides R1,000 per family towards eligible day-to-day healthcare services, helping members access the care they need when they need it most. Best Bucks brings together two aspects that are important to Bestmed — encouraging members to take a proactive approach to their health and giving them additional value when they do,” says Dlamini. Bestmed continues to evolve its benefits around what matters most to members, balancing clinical evidence, affordability and long-term sustainability. This has resulted in enhanced preventive care benefits, including expanded cancer screening and HIV rapid testing, making it easier for members to access early detection services. Preventive benefits are paid from the scheme's risk pool rather than from members’ savings or day-to-day allocations, subject to the rules of each option. Both schemes are Leo Dlamini. betting that money spent on early detection will save far more later. For members, the message is simple: the benefits are there, but they only pay off if you use them. A screening that picks up raised blood pressure, high cholesterol or early signs of diabetes gives a member time to act while treatment is simpler and cheaper. Across a whole membership, those early interventions help keep claims and future contribution increases in check.
Why Momentum is good for your health and your pocket Momentum Medical Scheme, awarded the Scheme of the Year in the News24 Business Awards 2025 and 2026, is the third largest open medical scheme with the ā ċ ā Č Ā ā
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Momentum Health complements your medical aid cover with
HealthSaver, so you can invest in healthcare savings
Multiply, a wellness programme to maximise your rewards
HealthReturns, the reward for taking ownership of your health
gap GapCover, for co-payments, out-of-benefit expenses and more
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Health4Me, affordable healthcare insurance