Medical aid is often seen as the foundation of healthcare cover in South Africa, and it remains essential. However, it is no longer sufficient on its own to cover the full cost of treatment, leaving members exposed to co-payments and shortfalls. As healthcare costs continue to rise and funding pressures reshape medical scheme benefits, even comprehensive plans leave gaps that can result in significant out-of-pocket expenses. Alongside medical aid, gap cover plays an important role in addressing these shortfalls and forming part of a comprehensive approach to managing healthcare costs.
Why medical aid is no longer enough
Healthcare costs in South Africa are increasing much faster than general inflation. Advances in medical technology, rising hospital costs and increasing specialist fees continue to drive up the cost of treatment year after year. At the same time, medical schemes are limited by the Council for Medical Schemes in how much they can increase contributions, which means they cannot always keep pace with these rising costs.
To manage this pressure, medical schemes rely more heavily on co-payments and sub-limits and payclaims according to their own scheme rates. In many cases, specialists charge up to five times the scheme rate, and even the highest-tier medical aid plans will only cover a portion of those fees.
There is a growing gap between what medical aid funds and what treatment actually costs, and members are responsible for the difference. These shortfalls are not rare occurrences but are increasingly becoming a routine part of using private healthcare.
The impact on long-term financial planning
Medical expense shortfalls can have a direct impact on long-term financial plans. A single procedure can potentially result in a co-payment of tens of thousands of Rands, followed by additional shortfalls once treatment is complete. Over time, these costs can accumulate, placing strain on savings and reducing the ability to meet other financial goals.
For those approaching or in retirement, the risk is even greater. Healthcare needs become more frequent and more expensive with age, while income is often fixed. Without adequate protection, medical expenses can erode retirement savings far earlier than planned. Even for younger individuals, relying on medical aid alone can lead to unexpected financial pressure. Accidents, surgical procedures and specialist treatment can all result in costs that fall outside of what medical aid covers.
Medical expense shortfalls can affect anyone, regardless of age, and it is important to be adequately prepared. Over time, these costs can add up to substantial amounts. Recent Turnberry claims data shows that some clients have claimed between R406,000 and R678,000 in less than 10 years as a result of ongoing treatment, procedures and specialist care, rather than due to isolated incidents. Individual claims can also be significant, with recent claims including shortfalls of over R200,000 for conditions such as cancer, cardiac events and spinal problems.
Gap cover supports a sound financial strategy
Gap cover works alongside medical aid by covering the difference between scheme tariffs and the amounts charged by healthcare providers, as well as by assisting with co-payments and certain sub-limits. Without this additional cover, patients must pay these expenses out of pocket, which can place pressure on household finances, affect long-term financial goals, or deter people from seeking the treatment they need.
Even the highest-tier medical aid plans now include co-payments and sub-limits, and different options offer different levels of cover. Having gap cover in place from the start and aligning it with your needs and the cover offered by your medical aid, can protect you from the financial impact of unexpected medical expenses.
Building a more complete healthcare strategy
Medical aid remains a critical component of healthcare planning, but it is no longer a complete solution on its own, and additional protection is needed to avoid unnecessary financial strain. Gap cover strengthens medical aid by addressing the costs that schemes do not fully cover. It helps protect savings, supports long-term financial goals and reduces the impact of unexpected medical expenses. For a more complete and resilient healthcare strategy, it is important to look beyond medical aid alone. Speak to your financial advisor about how gap cover can complement your medical aid and protect you from the rising cost of healthcare.
Brian Harris, GM Operations at Turnberry Management Risk Solutions
Business of Money – 28th April 2026
Medical aid alone is not enough for long-term healthcare planning – The Business of Money
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