{"id":8413,"date":"2026-08-17T13:46:11","date_gmt":"2026-08-17T13:46:11","guid":{"rendered":"https:\/\/turnberry.co.za\/?p=8413"},"modified":"2026-08-17T13:46:11","modified_gmt":"2026-08-17T13:46:11","slug":"medical-aid-cover-is-changing-are-south-africans-prepared-for-the-gaps","status":"publish","type":"post","link":"https:\/\/turnberry.co.za\/2027\/medical-aid-cover-is-changing-are-south-africans-prepared-for-the-gaps\/","title":{"rendered":"Medical aid cover is changing \u2013 are South Africans prepared for the gaps?"},"content":{"rendered":"

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Medical aid cover is changing \u2013 are South Africans prepared for the gaps?<\/strong><\/p>\n

FA News \u2013 11th<\/sup> August 2026<\/p>\n

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Medical aid remains essential for accessing private healthcare in South Africa, but it is no longer safe to assume it will cover the full cost of treatment.<\/p>\n

In 2026, industry regulators recommended that scheme contribution increases be capped at around 6-7% (CPI plus 3%), roughly in line with inflation, yet several major schemes have raised contributions well beyond that, with healthcare cost inflation broadly running at\u00a09 – 11%<\/strong><\/a>\u00a0against consumer inflation of about 3%. Medical aid options have also introduced growing numbers of co-payments, sub-limits, penalties and benefit restrictions. As a result, the role of gap cover has changed. What was once seen as an optional extra has become a critical safeguard against medical expense shortfalls, and it is now imperative that advisers and clients understand where medical aid cover may fall short and how those risks can be managed.<\/p>\n

Healthcare cover is not what it used to be<\/strong>
\nThe biggest change over the past decade is that medical aid has become far more complex. In the past, it was fairly simple to understand, and many routine healthcare costs were covered. Today, most day-to-day expenses are paid from medical savings or out of a client\u2019s own pocket, and members must weigh up co-payments, sub-limits, designated service providers, network restrictions and benefit limits, all of which affect what a scheme will ultimately pay. At the same time, healthcare costs have continued to climb, and specialists often charge well above scheme rates. This means that having medical aid and being fully financially protected are no longer the same thing.<\/p>\n

Every registered medical scheme is still required to cover Prescribed Minimum Benefits (PMBs) in full, a defined list of around 270 conditions, the Chronic Disease List, and emergency care, regardless of a member’s savings or threshold status. But PMBs are a floor, not a ceiling: outside of them, members are far more exposed than many realise.<\/p>\n

Despite this, many people still believe they are adequately protected, without fully understanding the limitations of their medical aid. The reality often only becomes apparent when they need treatment. A claim subject to a co-payment, a specialist charging above the scheme rate, or a treatment subject to benefit limits can result in significant and unanticipated out-of-pocket costs.<\/p>\n

Advice needs to evolve with the healthcare system<\/strong>
\nAs the healthcare landscape has changed, the role of the adviser has changed with it. Recommending a medical aid option is no longer enough. Advisers also need to help clients understand how that option works, what it covers, where medical expense shortfalls may still arise, and how concepts such as co-payments, penalties, and designated service providers could affect them.<\/p>\n

Advice also needs to be more personalised than in the past. Medical scheme options differ significantly, and the right level of cover depends on a client\u2019s healthcare needs, affordability and family circumstances. A younger family with children, for example, may require very different cover from someone approaching retirement, even if both belong to the same medical scheme.<\/p>\n

It\u2019s also worth noting that gap cover itself isn\u2019t unlimited. Under the Demarcation Regulations, gap cover claims are capped at an aggregate annual limit per beneficiary, a figure adjusted each year for inflation. Most claims fall comfortably within it, but very large shortfalls can still exceed the cap, which is one more reason the underlying medical aid plan needs to be right in the first place, not just the gap cover sitting on top of it.<\/p>\n

This advice is no longer a once-off conversation either. Medical scheme benefits change, family circumstances shift over time, and healthcare needs evolve. Regular reviews help ensure that both medical aid and gap cover continue to provide the level of protection clients need.<\/p>\n

A critical part of healthcare planning<\/strong>
\nThe healthcare system has changed significantly over the past decade, and the way advisers approach healthcare cover needs to change with it. Medical aid remains essential, but it no longer provides the level of protection many people still expect. As a result, gap cover has evolved from an optional extra to a core part of protecting against medical expense shortfalls. Helping clients understand how their medical aid works, where shortfalls may arise, and how gap cover can address them has become an important part of modern healthcare advice.<\/p>\n

As medical aid benefits, healthcare costs, and client needs continue to change, regular reviews are essential. By ensuring cover continues to reflect a client\u2019s circumstances, and by explaining potential shortfalls before they arise, advisers can help clients make informed decisions and avoid unexpected medical expenses. Clients should speak to their broker or financial adviser regularly, to make sure their medical aid and gap cover continue to meet their healthcare needs.<\/p>\n

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Client Testimonials<\/strong><\/p>\n

Turnberry have been absolutely amazing. Mitze was the consultant on our claim and she went above and beyond to assist us. The first claim was submitted online, thereafter when I tried to submit the form for another claim, the online form was not available. However, all claims were emailed to Mitze who ensured they were processed.\u00a0 \u00a0If you want exceptional service and a hassel free claim process, use Turnberry.<\/strong><\/p>\n

Seamless and extremely efficient.\u00a0 Would highly recommend \u00a0it. In fact I have already referred a friend to my broker and suggested she opt for Turnberry.\u00a0\u00a0Cheryl Beer<\/strong><\/p>\n

BEST INSURANCE PRODUCT I HAVE EVER PURCHASED<\/strong>.\u00a0 Have claimed numerous times and always been paid in full in a short space of time. No drama or fuss of insurer looking for reasons not to pay.\u00a0 I have already recommended Turnberry Gap Cover to my family, friends and colleagues, and will continue to do so.\u00a0\u00a0Happy to have my name used for a product that I highly recommend.<\/strong>\u00a0\u00a0Fran Davidson<\/strong><\/p>\n

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