Medical aid for pensioners and SASSA pensioners in South Africa (2026)

The Medical Schemes Act stops a scheme from unfairly discriminating on grounds that include age and state of health. It also says contributions may be based on income, the number of dependants, or both, and on no other ground, including age or health. That is community rating.

The Council for Medical Schemes says registered open schemes must enrol any person who applies and can pay. They can still apply waiting periods and, from age 35, a late-joiner penalty.

Restricted schemes are for the employees of a particular employer, industry, profession or union, and some also admit retirees. Anglo Medical Scheme, for example, admits retirees and continuation members of its participating employers, and had a pensioner ratio of 24.1% in 2024 against an industry average of 9.97%. If you retired from an employer with its own scheme, ask whether you can stay on it and whether the employer pays a post-retirement subsidy.

A late joiner is anyone aged 35 or older when they apply for membership. The scheme works out the penalty band from your age and your years of creditable coverage, meaning years on a medical scheme. The formula is your age at application minus (35 plus your years of coverage), and the result decides the band.

Worked examples for someone applying at 65:

• No cover ever: 65 minus 35 leaves 30 years, so the top band, up to 75%.
• 20 years of earlier cover: 65 minus (35 plus 20) leaves 10 years, so the 5 to 14 year band, up to 25%.

Three more rules help. The penalty applies only to the late joiner's part of the contribution. If you find proof of cover later, the scheme must recalculate from that date, and a sworn affidavit is enough if documents cannot be obtained. And anyone continuously covered by medical schemes since before 1 April 2001, without a break longer than three months, is not a late joiner at all. Penalties can follow you when you move schemes. See the late-joiner penalty guide.

If you have had no medical scheme cover in the 90 days before you apply, a scheme may impose a general waiting period of up to 3 months and a condition-specific waiting period of up to 12 months. These are maximums.

If you switch schemes and the gap is under 90 days, the limits are shorter: with up to 24 months of earlier cover, only a condition-specific wait of up to 12 months, and with more than 24 months, only a general wait of up to 3 months. Neither applies to prescribed minimum benefit treatment. Moving between options within one scheme carries no waiting period, unless you are still serving one.

Continuity is what removes the wait, so if you already have cover, keep it. Read waiting periods and exclusions.

A hospital plan pays for admissions and prescribed minimum benefits, including CDL chronic conditions, but not routine GP visits. Older members claim mostly for hospital care and chronic medicine, so this is a common choice. Prices are monthly for 2026.

Momentum's Custom price depends on your choice of hospital and chronic provider, from R2 585 with Associated hospitals and State chronic providers to R4 472 with Any hospital and Any chronic. Cape Medical Plan's MyHealth 200 lets you use any doctor at Life Health, Mediclinic or Netcare hospitals. See hospital plans in South Africa and the hospital plan guide.

A network plan pays in full only at its listed hospitals: Bestmed's Beat1 Network charges R15 025 for voluntary use of a non-network hospital.

Chronic conditions on the Chronic Disease List, which includes common conditions such as hypertension and diabetes, are prescribed minimum benefits. Every plan must pay for their diagnosis, treatment and care in full, but the scheme may require its designated service provider, a formulary and pre-authorisation. Register your condition and use the right pharmacy, or you may face a co-payment. See chronic disease benefits.

Some plans cover more than the list, for example KeyHealth's higher tiers with 29 to 55 conditions. Ask for the scheme's chronic list for your medicine before you join.

Gap cover pays specialist shortfalls above scheme rates. It is a health insurance product, not medical aid, and its premiums can rise with age. Dis-Chem Health's Gap Cover Base costs from R219 a month for a main member aged 18 to 39 and R386 at 60 and over. Complaints about gap cover go to the National Financial Ombud. Read gap cover explained.

Public hospitals and clinics remain open to everyone, and PMB emergencies are treated there. For private cover on a small income, the lowest-priced registered options are income-based network plans. Prices are for one main member and rise with household income.

These plans use a network of doctors and hospitals, and you will be asked for proof of income. Check which band your household income falls into first. The low-income medical aid guide has more.

Some health insurance products target older people. Affinity Health's Senior Hospital Plan, for members aged 55 and up, costs R1 578 for a main member. It is not a medical scheme: it pays fixed amounts, such as hospitalisation from R22 000 a day for illness, does not have to cover prescribed minimum benefits, and carries a 3-month wait for illness cover and 12 months for pre-existing conditions. Complaints go to the National Financial Ombud. See medical aid vs health insurance.

For 2026/27 the medical scheme fees tax credit is R376 a month for the main member and R752 a month for you and one dependant, such as a spouse. Each additional dependant adds R254. It reduces the income tax you owe and does not depend on your premium.

From age 65 you can also claim an additional credit: 33.3% of the scheme fees you paid above three times the credit you are entitled to, plus 33.3% of your qualifying medical costs that the scheme did not pay, such as out-of-pocket doctor visits and medicine. People under 65 get 25%, with a limit tied to 7.5% of taxable income, so the over-65 rule is more generous.

Both credits are non-refundable and cannot be carried to the next year. If you pay little or no income tax, there may be nothing for them to reduce, so ask SARS or a tax practitioner before you count on it. Keep your receipts and tax certificate. The rules are in the medical aid tax credit guide and on the SARS medical credits page.

A fixed pension makes annual increases hurt. Reported 2026 increases included Momentum 9.9%, Medihelp 8.46% and Discovery 7.2% (from April). For 2027 the Council for Medical Schemes has recommended a benchmark of 3.8%, which is not a cap. Fedhealth has announced 0% on its two new sureFED plans and Medshield 7.9% as a weighted average. See medical aid increases for 2027.

If cost becomes a problem, do not cancel: rejoining after 35 can bring waiting periods and a late-joiner penalty. Moving to a cheaper option within the same scheme carries no new waiting period, so ask when your scheme allows option changes. See what to do if you cannot pay.

If you have a dispute, use the scheme's own complaints process first, then the Council for Medical Schemes on 0861 123 267 or [email protected]. The steps are on the CMS complaints procedure page.