Calculators & guides
Medical aid quotes: how to compare medical aid plans properly
By MedicalAidZA editorial team · 6 min read · Updated 29 September 2026
To compare medical aid plans fairly, put every quote against the same checks: contribution for your whole family, hospital rate, how day-to-day costs are funded, network rules, co-payments and sub-limits, chronic cover, and the 2027 rate. Price alone misleads, because two plans at the same price can leave you thousands apart on a claim.
Get every quote in writing, with the option name and the date the price applies. Then use the checklist below and the blank table at the end to line up two or three plans.
Decide on cover first and price second. The right plan covers what you actually use, at a contribution you can keep paying.
Before you ask for quotes
Have these ready so each quote is for the same household:
- ages of everyone who will be on the plan, and any dependants you may add this year
- your income, because many options price by income band or salary band
- any chronic conditions and the medicine you take
- doctors, specialists and hospitals you want to keep using
- the most you can pay each month without missing a debit order
The seven checks
- Contribution for your household. Adult and child rates differ, and some plans cap the number of children charged.
- Hospital rate. Benefits are paid as a percentage of the scheme rate. A plan paying specialists at 100% can leave a shortfall when a specialist charges more. Profmed's ProSecure Plus, for example, pays doctors at 200% of the Profmed Tariff. See gap cover explained.
- Day-to-day funding. A medical savings account is your own money for the year. An above-threshold benefit pays once you have spent a set amount. A pure hospital plan pays nothing day to day.
- Network rules. Which hospitals, doctors and pharmacies you must use, and the penalty if you do not. See network vs traditional plans.
- Co-payments and sub-limits. A co-payment is a fixed amount or percentage you pay on a procedure. A sub-limit caps one benefit even if the overall limit is higher. See co-payments and sub-limits.
- Chronic and PMB cover. Find the Chronic Disease List conditions, the medicine formulary and the designated provider. Prescribed Minimum Benefits must be paid in full on every plan, and are covered on the cheapest one too.
- Waiting periods and late joiner penalties. A scheme may apply up to three months' general and 12 months' condition-specific waiting periods, and a penalty of up to 75% on your part of the contribution if you join at 35 or older without creditable cover.
Same price, different rules
These four 2026 network hospital plans sit in a similar price band. The differences are in the rules, and that is what a quote does not show.
| Plan | Main member, per month | Rule to check |
|---|---|---|
| Bestmed Beat1 Network | R2 269 | R15 025 co-payment for voluntary use of a non-network hospital |
| Bonitas BonEssential Select | R2 345 | Hospital cover unlimited, network applies. The related Hospital Standard applies a 30% non-network co-payment |
| Medihelp MedVital Elect | R2 412 | Private hospitalisation, trauma and emergency cover, maternity, limited day-to-day benefits |
| Discovery Essential Delta Core | R2,681 | Unlimited private hospital cover and essential chronic medicine cover, no day-to-day cover |
These are single examples from each scheme, not a ranking. Compare the plans that suit your household, and see hospital plan prices for more.
How to read a benefit schedule
- Scheme rate. Almost everything is paid as a percentage of it. Find the rate for hospitals, specialists and GPs.
- Day-to-day section. Is it a savings account, an above-threshold benefit, or nothing? What happens when it runs out?
- Sub-limits. Look for per-category caps on dentistry, optical and specialists, not just the annual limit.
- Co-payments and deductibles. A co-payment is a share you pay on a procedure. A deductible is an amount you pay before the scheme pays.
- PMB and chronic section. It names covered chronic conditions, formulary medicine and designated providers. The CMS says PMBs cover 271 conditions and 26 chronic conditions, plus emergencies.
Read prescribed minimum benefits for what must be paid in full.
Compare the 2027 rate, not just 2026
A quote that shows 2026 contributions can be out of date within months. The CMS recommended in Circular 20 of 2026 that schemes anchor 2027 increases at 3.8%. It is a benchmark, not a cap, and schemes that need more must justify it. Two schemes have already published: Fedhealth said 60% of members get an average weighted increase of 8.9%, and Medshield announced a 7.9% weighted average. Discovery, Bonitas, GEMS and Momentum typically announce in October and November.
Ask each scheme for the 2027 contribution and benefit changes before you decide, and note the date any increase starts. Discovery, for example, deferred its 2026 increases to April. See medical aid increases for 2027.
Brokers, online quotes and comparison tools
A broker is usually paid by the scheme, not by you, and can compare across schemes. The CMS regulates brokers, so complaints can go to the CMS. Ask a broker to show the trade-offs and the plans they did not pick, not only the cheapest one.
Online quote tools show only the schemes and plans they list. If a tool shows insurance products next to schemes, check which are medical schemes, because health insurance does not have to cover PMBs. See medical aid vs health insurance. Gap cover is a separate quote from a separate insurer. If you compare it, use the gap cover checklist.
Blank comparison table
Copy this and fill it in for each quote.
| Feature | Plan A | Plan B | Plan C |
|---|---|---|---|
| Scheme, option and price date | |||
| Monthly contribution, whole household | R | R | R |
| Hospital rate for specialists | % | % | % |
| Day-to-day funding and limits | |||
| Network and non-network penalty | |||
| Co-payments on scopes and scans | R | R | R |
| Chronic cover and formulary | |||
| 2027 contribution | R | R | R |
| Waiting periods that apply to you |
Frequently asked questions
How do I compare medical aid plans in South Africa?
Line up every quote on the same checks: household contribution, hospital rate, day-to-day funding, network rules, co-payments and sub-limits, chronic cover, and the 2027 rate. Use the table above and get each quote in writing.
Is the cheapest medical aid plan the best value?
Not usually. A cheaper plan may pay specialists at a lower rate, apply network penalties or have thin day-to-day cover. The best value is the plan that covers what you actually claim for, at a price you can keep paying.
What does hospital rate mean on a plan?
It is the percentage of the scheme rate that the plan pays. A plan paying 100% can leave a shortfall if a specialist charges more. Some plans pay a higher rate, such as Profmed's ProSecure Plus at 200%.
Should I use a broker to compare medical aid?
A broker can compare across schemes and is usually paid by the scheme, not you. Ask to see the trade-offs and the plans not chosen. The CMS regulates brokers if you need to complain.
What is the difference between savings and day-to-day cover?
A savings account is your own money set aside for day-to-day claims. Once it is used up you pay cash, unless the plan has an above-threshold benefit. Hospital plans usually have no day-to-day cover.
Do medical aid quotes include gap cover?
No. Gap cover is insurance sold separately, and its 2026 annual limit is R226 881.03 per insured person. Get a separate quote and compare the multiple, sub-limits and waiting periods.
How often should I compare plans?
At least once a year, before the scheme's yearly change window. The CMS says to finalise switch decisions by late November or early December. Your health, family and budget change, and so do rules and prices.
Are all the options in an online quote medical aid?
Not necessarily. Some products shown next to schemes are health insurance, which does not have to cover PMBs. Check for a medical scheme registration and the wording 'not a medical scheme'.
