Medical aid contribution increases for 2026 are generally lower than the sharp hikes seen in 2025. This offers some relief to members after last year’s double-digit adjustments.
Among the top five open medical schemes, Momentum and Fedhealth reported the highest average increases at 9.9% and 9.6%. Bonitas followed at 8.88%, Medihelp at 8.46%, Discovery at 7.2% and Bestmed at 6.8%. Discovery’s increase is effective from 1 April 2026. This results in an effective annual increase of 5.4%, the lowest among the top five. Overall, this trend shows that 2026 medical aid contribution adjustments are stabilising after a period of volatility.
Sizwe Hosmed announced the highest average increase to date at 19.15%, effective 1 November 2025. This follows the placement of the scheme under curatorship in September 2025 after reserves dropped to 5.6% in June. This level is well below the required minimum of 25%. This situation highlights the importance of prudent management when determining the 2026 medical aid contribution structure across all schemes.
Unpacking the 2026 medical aid contribution increases
Contribution increases must reflect changes in the Consumer Price Index (CPI). Rising costs of healthcare services and products must be considered. In addition, schemes must include a margin for ageing and utilisation. This margin typically ranges between 2.0% and 4.0%. Adjustments may also be necessary for benefit changes and to maintain adequate reserves that protect schemes from unexpected events.
According to the August 2025 CPI published by Stats SA, the healthcare cost inflation component stands at 4.7%. This exceeds the overall CPI of 3.3%. Recent inflation and utilisation trends, combined with the need for stronger margins, have led to contribution increases that surpass the CPI rate. These pressures are reflected in the design of the 2026 medical aid contribution framework.
Each medical scheme has a unique risk pool. This results in variations in claims experience, ageing, utilisation and benefit design. As a result, both schemes and their individual options experience different contribution increases. At the scheme level, negotiated rates with providers such as hospitals may vary. These differences influence the overall cost of delivering benefits and the contributions required. This complexity creates a diverse landscape of 2026 medical aid contribution adjustments across the market.
Medical schemes must apply community rating as required by legislation. 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. It also creates a cross-subsidy from younger, healthier members to those with higher medical needs. However, younger and healthier individuals often view medical cover as a grudge purchase.
Many opt out of membership unless it is mandatory for employment. As a result, schemes age over time, and the cross-subsidy gradually declines. This demographic shift influences long-term 2026 medical aid contribution planning.
Why are average contribution increases lower in 2026?
In recent years, medical schemes implemented contribution increases that far exceeded inflation. These increases also surpassed the range recommended by the Council for Medical Schemes, which is CPI plus reasonable utilisation estimates. The adjustments were necessary to recover deferred contributions from the COVID-19 period and address deteriorating claims experience.
For 2026, however, increases are more moderate. This moderation is largely due to a notable drop in CPI in 2025 compared to previous years. CPI averaged 4.4% in 2024 and 6.0% in 2023. This provides slight relief after the steep double-digit increases seen previously. The higher increases from prior years helped ensure that benefits were more accurately priced. This reduced the need for further drastic adjustments.
The moderate increases are also supported by cost containment measures introduced by schemes. These include stricter controls on non-healthcare expenses and improved efficiency in benefit design. Although underlying cost drivers such as medical inflation, ageing membership and chronic disease prevalence continue, schemes have worked to balance sustainability with affordability by limiting contribution growth.
While lower increases in 2026 offer relief, schemes continue innovating through digital health, preventive care and smarter benefit design to ensure long-term affordability.
– Fazlin Swanepoel, Head of Health at Alexforbes
Preventive health and digital innovation
To manage long-term costs, medical schemes continue investing in preventive health initiatives and strategic partnerships. These include virtual care, wellness programmes and data-driven healthcare management. There is also a growing emphasis on the use of Artificial Intelligence (AI) and data analytics to predict and manage health risks more proactively.
For example, Discovery has introduced personal health pathways and a sleep programme to improve member outcomes. Medshield launched its “Hey Medshield” voice assistant to educate members about their health and benefits. These digital tools promote early intervention and healthier lifestyles. They also reduce future claims and support more predictable 2026 medical aid contribution levels.
Preventive screening remains a key priority across the industry. Schemes encourage members to undergo regular health assessments to detect and manage conditions early. Additional measures include affordable new options aimed at attracting younger members and easing the pressure of ageing membership. Examples include Discovery’s Active Smart Plan and Smart Saver Series and Bonitas’ BonCore. These strategies aim to reduce future claims risk and enhance member value.
Across the industry, many members have downgraded options due to affordability pressures. To promote sustainable growth, attracting younger and healthier members through affordable and relevant products has become essential.
Affordability, sustainability and the NHI effect
In setting contribution increases, schemes must maintain adequate reserves to ensure financial stability and protect members against adverse claims experience. This approach reinforces confidence in the industry’s commitment to providing secure and sustainable healthcare benefits.
Significant increases in healthcare costs are neither affordable nor sustainable over the long term. The growing need for equitable access to healthcare underscores the importance of introducing Low-Cost Benefit Options (LCBOs) and alternative insurance-based solutions.
Medical schemes have moved away from the sharp short-term increases seen in previous years. They now favour more moderate adjustments in 2026. This change reflects strengthened reserves and improved sustainability of previously loss-making options. It also reduces the need for further drastic hikes. Although cost pressures remain, it is expected that these lower increases will continue as schemes strive to balance affordability with long-term financial stability.
Under the current National Health Insurance (NHI) framework, medical schemes may only offer complementary coverage for services not included in the NHI. The scope of these complementary services will affect both member contributions and the tax rates required to fund the NHI. This dynamic will directly influence future 2026 medical aid contribution trends.
The industry remains on stable ground, supported by strong reserve levels. However, smaller schemes and those with ageing or high-risk member profiles remain vulnerable to adverse claims. Regulatory interventions that may enhance affordability and sustainability include introducing LCBOs, mandatory membership, price regulation and establishing a Risk Equalisation Fund.
For the NHI to be implemented effectively, collaboration between the public and private sectors will be essential. This cooperation will ensure equitable access to healthcare for all South Africans.
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| Paresh Prema | Branch Head | Technical & Actuarial Consulting Solutions | mail me | | Busisiwe Sibiya | Actuarial Analyst | mail me | |
| | Alexforbes | | |
