Makoti Medical Scheme: options, hospital cover and who it suits

Makoti suits people on a low or moderate income who want registered medical scheme cover and are happy to use one chosen GP. On the Primary option that GP is your first stop for almost everything, and you get unlimited primary healthcare visits to that GP at the Makoti Scheme tariff.

It does not suit you if you want to be admitted to a private hospital on a budget option. The Primary option pays for hospital care only as PMBs, and only in state hospitals. It also does not suit people who want a big savings account or a wide choice of specialists without a referral, because on Comprehensive specialists are seen on a GP referral.

We found no current membership figure for Makoti, so we do not quote one. Ask the scheme for its size and solvency if that matters to you.

• Makoti Medical Scheme is a registered open medical scheme (CMS register as at 31 March 2025), administered by Universal Healthcare Administrators and managed clinically by Enablemed. (static.pmg.org.za)
• Makoti is on the CMS register of medical schemes (as at 31 March 2025) as an open scheme. (static.pmg.org.za)
• Makoti offers two options, Primary and Comprehensive, both with unlimited primary healthcare from a chosen GP in a network of more than 12 000 providers. (web.archive.org)
• Makoti says it imposes no co-payments on members on either option. (web.archive.org)
• Primary Option hospital cover is limited to Prescribed Minimum Benefits in state hospitals; private hospital cover is only on the Comprehensive Option (2025 benefits summary). (web.archive.org)
• Contributions are income-banded per option, with a separate principal, adult and child rate (2025 table: Primary from R406 for income R0 to R7 596; Comprehensive from R2 738 for income up to R10 586). The 2026 table could not be reached. (docs.mymembership.co.za)
• The chronic care benefit covers the 27 conditions on the Chronic Disease List, once registered through the chronic care programme by your GP (2025 guide). (docs.mymembership.co.za)
• Members must choose a general practitioner; changes of benefit option are only allowed once a year, effective 1 January (2025 guide). (docs.mymembership.co.za)

Makoti Medical Scheme publishes 2 benefit options for 2026. We could not confirm 2026 prices on Makoti's website on 29 September 2026, so the table lists the options only. Checked on 29 September 2026.

Sources: web.archive.org/.../makotihealth.co.za/benefits.

This table reflects Makoti's 2025 benefit summary, the latest official benefit material we could read. Both options use a network of more than 12 000 providers, and Makoti says it does not impose co-payments on either option. Because 2026 benefits could not be checked, treat this as a guide and confirm the current benefit guide with the scheme.

Contributions are income-banded for each option, with a separate rate for the principal member, an adult dependant and a child. Those are 2025 figures for orientation only and are not the 2026 rates.

Checked on 29 September 2026 against Makoti's official website. Numbers change, so confirm on the linked page before you call. A scheme will not ask you to pay into a new bank account over the phone: hang up and call the official number if anything feels off.

Sources: web.archive.org/...akotihealth.co.za/contact-us. All schemes' numbers are on our medical aid contact numbers page.

You must choose a general practitioner and use that GP as your gateway to care. Changing your option is allowed only once a year, effective 1 January of the following year, so pick carefully: if you start on Primary and need a private-hospital admission later in the year, you cannot simply move up mid-year.

On Comprehensive, private hospital admissions are subject to managed care protocols and pre-authorisation. Always get authorisation before a planned admission, and phone the scheme for emergencies as soon as you safely can. An emergency does not need to wait for authorisation, and the law says a scheme cannot stop a provider from starting emergency treatment. See the pre-authorisation guide.

The benefit summaries we read describe day-to-day cover through the chosen GP, the network and the formulary, and do not describe a personal medical savings account. You visit your GP and the scheme pays at its tariff. If you want your own pool of savings to spend on any provider, look at a saver plan on another scheme. Our medical savings account guide explains how these work, and the day-to-day benefits guide shows what to check on any plan.

Makoti's chronic care benefit covers the conditions on its Chronic Disease List, and Makoti's 2025 guide counts 27 conditions. CMS material varies between 26 and 27 conditions for the national list, so ask Makoti to confirm your condition is included. You must be registered on the chronic care programme, which your GP does, and medicine is paid per the formulary.

Whatever the option, every registered scheme must pay PMB diagnosis, treatment and care in full, with no co-payment or deductible, when you use the scheme's designated service provider (DSP). If you have to use a non-DSP involuntarily, such as in an emergency or when no DSP is within reasonable reach, you also do not pay a penalty. See prescribed minimum benefits and chronic disease benefits.

Makoti's Comprehensive option covers maternity at cost, according to the 2025 benefit summary. The Primary option centres on primary care and state-hospital PMBs, so plan a birth carefully if you are on it. We could not verify 2026 maternity rules, so ask the scheme in writing what is covered, in which hospital, and whether a waiting period applies before you rely on it. Our medical aid for pregnancy guide lists the questions to ask.

We could not read Makoti's 2026 benefit guide, its 2026 contribution table or any announced 2026 or 2027 increase, so we do not report one. The industry context is this: the CMS recommended that 2027 increases be anchored at 3.8%, a benchmark and not a hard cap, and it acknowledges that private medical inflation typically runs 2 to 3 percentage points above CPI. Ask Makoti for your 2027 contribution, and see our 2027 increases page for what other schemes have announced.

• Medihelp: a not-for-profit open scheme whose network hospital plans include private hospitalisation, which is what the Makoti Primary option lacks. See Medihelp.
• Thebemed: an open scheme that says it serves low- and middle-income workers, mainly in mining, logistics and agriculture. It was under CMS curatorship from 2019 to 2022. See Thebemed.
• Sizwe Hosmed: an open scheme that has been under provisional curatorship since 4 September 2025. Ask about its status before you join. See Sizwe Hosmed.

The key question is what happens when you need a private hospital. If state hospitals are acceptable, Primary is a low-cost way to keep PMB protection and a regular GP. If not, compare Comprehensive with network plans elsewhere. Our low-income medical aid guide and cheapest medical aid page set out the wider field.

As an open scheme, Makoti has to enrol any person who applies and can pay, and it cannot refuse you on health or age. It can still apply waiting periods. The Medical Schemes Act sets the ceilings. If you have had no cover for 90 days or more, or have never had cover, a scheme may impose a general waiting period of up to three months and a condition-specific waiting period of up to 12 months. These are maximums, and a scheme may impose shorter periods or none. Switching within 90 days does not wipe waiting periods out: after up to 24 months of earlier cover the new scheme may still impose a condition-specific period of up to 12 months, and after more than 24 months it may still impose a general period of up to three months. Neither can be applied to treatment of Prescribed Minimum Benefits (PMBs). There is no waiting period when you move between options on the same scheme, or for a baby born while you are a member. Read more in waiting periods and exclusions.

Late-joiner penalties. A late joiner is someone aged 35 or older when they apply, without earlier cover. The loading is a percentage of that adult's own part of the contribution only, and the maximum depends on the years you were uncovered after 35, less any years of cover you can prove: 1 to 4 years is 5%, 5 to 14 years is 25%, 15 to 24 years is 50% and 25 years or more is 75%. Example: a 45-year-old with no proof of earlier cover has 10 years to count (45 minus 35), which falls in the 5 to 14 year band, so the maximum loading is 25%. A sworn affidavit can prove earlier cover if the documents are gone, and the penalty can follow you to another scheme. See the late joiner penalty guide.

Tax credit. For the 2026/27 tax year (1 March 2026 to 28 February 2027) the medical scheme fees tax credit is R376 a month for you, R752 a month for you and one dependant together, and R254 a month for each additional dependant. It only reduces the tax you owe and cannot be carried over. Details are in the medical aid tax credit guide.

Complaints. If something goes wrong, raise it with Makoti first and keep a written record. Makoti's membership queries go through Universal Healthcare Administrators, and pre-authorisation and chronic queries through Enablemed, using the numbers in the contact table. If you are not satisfied after using the scheme's own complaints process, you can complain to the Council for Medical Schemes (CMS), the regulator. Send a completed complaint form with proof that you took it up with the scheme to [email protected], or phone the CMS on 0861 123 267 (Monday to Friday, 08:00 to 16:30). The CMS acknowledges a complaint in writing within 6 working days, asks the scheme to comment, and aims to finish within 120 calendar days of receiving the scheme's response and documents. Clinically urgent complaints are handled urgently. Our CMS complaints guide explains each step.