Medical schemes review their contributions and benefits every year, and the 2027 changes have now been announced. Members have a limited window to stay on their current option or move to one that suits them better.
This year’s review deserves attention. The Council for Medical Schemes (CMS) recommended that 2027 increases be anchored at 3.8%, in line with projected inflation, but several of the larger open schemes have announced average increases between roughly 7% and 9%. Benefits, networks and limits have also changed on many options.
What worked well for you in 2026 may not be the best fit in 2027. You don’t have to work through the scheme brochures alone, though. The Overberg Wealth & Risk Management team does the medical aid comparisons for you and gives you a clear overview of the options that suit your budget and needs.
What is the annual option change?
The annual option change is the period, usually in the last quarter of the year, when medical scheme members may move to a different option within their scheme. The new option normally takes effect on 1 January.
Key points:
- Most schemes allow one voluntary option change a year.
- Each scheme sets its own deadline.
- If you do nothing, you stay on your current option at the new 2027 contribution.
- Moving to a different scheme is not the same as changing options. It may involve waiting periods under section 29A of the Medical Schemes Act 131 of 1998.
What to look for in your 2027 option
Your contribution and what you get for it
Compare the increase on your option with the changes to its benefits. A higher increase with improved benefits can still be better value than a smaller increase where limits have been reduced. On income-based options, your contribution depends on the income you declare, so confirm which band applies to you.
Hospital cover and networks
Hospital cover is the core of any medical aid option. Check:
- Networks: Network options cost less but require you to use specific hospitals. Make sure a network hospital is within reasonable reach of where you live.
- Co-payments: Some options charge a fixed amount for certain procedures or for using a hospital outside the network.
- Specialist rates: If a specialist charges more than your scheme pays, you cover the difference. Gap cover can help with these shortfalls.
Day-to-day cover
Look at how you actually used your cover this year. If your savings ran out early, your option may be too lean. If you seldom claim, you may be paying for benefits you don’t use. Unused savings carry over to the following year.
Chronic medicine
Check whether your chronic medicine is still covered in 2027, and whether you must use a specific pharmacy or medicine list to avoid co-payments.
Prescribed minimum benefits
Every option must cover prescribed minimum benefits (PMBs) under the Medical Schemes Act. These include emergency treatment, a defined list of serious conditions and 26 chronic conditions. To be covered in full, you may need to use your scheme’s designated providers.
Your plans for next year
Think ahead. A pregnancy, planned operation, new diagnosis or change in your family can make a different option more suitable. It’s better to plan for these now than to find a gap in your cover later in the year.
Downgrading or upgrading
- Downgrading reduces your monthly cost but can leave you paying for specialist visits, scans or medicine that your current option covers.
- Upgrading gives you broader cover, but scheme rules may restrict when you can upgrade or limit certain benefits at first.
The right move depends on your health, your family and your budget. That’s where an informed comparison makes a difference.
You don’t have to compare it all yourself
Scheme brochures often run to dozens of pages, and the important differences are usually in the detail. Comparing several options side by side takes time and knowledge of how schemes structure their benefits.
The Overberg Risk & Management team will:
- review your current option against the 2027 changes
- assess your claims history and expected needs for next year
- compare suitable options side by side
- give you a clear, easy-to-read overview of the cost and cover of each option
- recommend the option that best fits your budget and needs
- help you submit your option change before the deadline
You receive a straightforward comparison that lets you make your decision with confidence, without spending hours on the detail.
Conclusion
The 2027 changes are a good reason to check whether your current option still suits you. Rather than waiting until the deadline approaches, speak to us early. We’ll do the comparisons, explain the differences in plain terms, and help you choose cover that fits your needs and your budget for the year ahead.
Review your medical scheme option. Contact Overberg Wealth & Risk Management today.
Frequently asked questions
1. When can I change my medical aid option for 2027?
Most schemes allow one option change a year, effective 1 January. Each scheme sets its own deadline.
2. How much are medical aid increases for 2027?
The Council for Medical Schemes (CMS) recommended anchoring increases at 3.8%. Several large open schemes have announced average increases of roughly 7% to 9%, which remain subject to CMS approval.
3. Can I change to a cheaper medical aid option?
Yes, within your scheme’s rules. Before you downgrade, check that the cheaper option still covers the care you’re likely to need.
4. Will I have a waiting period if I change options?
Changes within the same scheme are governed by that scheme’s rules. Moving to a new scheme may involve waiting periods under section 29A of the Medical Schemes Act.
5. Do I need a broker to change my medical aid option?
No, but a broker can compare the options for you, explain the differences, and recommend one that fits your budget and needs.
While every reasonable effort is taken to ensure the accuracy and soundness of the contents of this publication, neither the writers of articles nor the publisher will bear any responsibility for the consequences of any actions based on information or recommendations contained herein. Our material is for informational purposes.
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