Your Medical Aid is Getting More Expensive in 2026: Here’s the Recommended Hike

Get ready to budget a little more for your health: South Africa’s medical aid schemes are set to get more expensive in 2026. In a move to balance affordability with sustainability, the Council for Medical Schemes (CMS) has published its recommended guideline for next year’s increases.

The key number? 3.3%.

This figure isn’t plucked from thin air. The CMS has aligned it directly with the South African Reserve Bank’s consumer price inflation (CPI) forecast for 2026. The goal is simple but critical: to try and keep medical aid contributions from soaring even further beyond the reach of ordinary South Africans.

A Lifeline for Stretched Households

This recommendation comes as a direct response to a worrying trend. For years, medical aid contribution increases have consistently outpaced general consumer inflation. This has put immense pressure on household budgets already being squeezed by skyrocketing costs for essentials like electricity and food.

By pegging the suggested increase to the CPI forecast, the CMS is attempting to ease that financial strain. In their statement, they explicitly cited the desire to reduce “the risk of losing health insurance” for members who are struggling to keep up.

The 3.3% guideline applies not only to your monthly premium but also to the recommended assumption for healthcare tariff increases. Essentially, it’s a suggestion to schemes on how to calculate their overall costs for the coming year.

But What If Your Scheme Needs More?

Here’s the crucial part: the 3.3% figure is a guideline, not a legally enforced cap. The CMS openly acknowledges that some medical schemes, perhaps those in financial difficulty or with an older, sicker membership profile, might require a higher increase to remain solvent.

However, they can’t just slap a double-digit hike on your premium without justification. If a scheme proposes an increase above 3.3%, its trustees are obligated to submit a comprehensive business plan to the CMS Registrar.

This plan must include rigorous financial and actuarial reasons for the higher increase and must fully comply with strict standards set by the Actuarial Society of South Africa. This provides a layer of protection for consumers, forcing schemes to prove a higher increase is absolutely necessary.

Cracking Down on Admin Fees

In a welcome move for members, the CMS also turned its attention to non-healthcare costs. The guideline recommends that increases in administration and managed care fees what you pay for the scheme to run itself also be limited to 3.3%.

This prevents schemes from inflating their own operational costs while claiming to keep healthcare inflation low, ensuring the guideline benefits members holistically.

The Bottom Line for You

While a 3.3% increase is lower than the hikes seen in recent years, any increase adds pressure in a tough economy. It’s a proactive step from the regulator to protect consumers, but the onus is still on you to stay informed.

Later this year, when your medical scheme announces its proposed increase for 2026, you’ll know to check if it aligns with this guideline. If it’s significantly higher, you can expect that a detailed justification has been demanded by the regulator. For many South Africans, this small bit of predictability is a crucial tool in planning for another expensive year.

{Source: IOL}

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