What the medical aid increase 2027 guideline actually says
The Council for Medical Schemes has published its medical aid increase 2027 guidance, asking schemes to anchor contribution rises at 3.8%. That number is not what members will pay.
The anchor is a base point relative to inflation. It excludes what the regulator calls reasonable utilisation estimates, which are added on top.
The Board of Healthcare Funders says the regulator has given no indication of what counts as reasonable utilisation. On the regulator’s own historical data, utilisation has added roughly 3.5 percentage points, which would put a compliant 2027 increase somewhere between 5.8% and 7.3%.
Even that range assumes schemes stay inside the guidance. The guidance is a recommendation, not a cap. Schemes set their own increases and submit them for approval.
This matters to every household already tracking the rising cost of private healthcare cover.
What happened the last time the regulator set a number
For 2026, Circular 24 of 2025 recommended that increases be “limited to 3.3% plus reasonable utilisation estimates”.
The regulator’s own later evaluation put the industry-wide weighted contribution increase assumption for 2026 at 8.10%, against a projected CPI of 3.0%. That is 4.8 percentage points above the anchor, roughly two and a half times the guidance, and about 2.7 times inflation.
Individual schemes went further.
| Scheme | 2026 increase announced | Points above the 3.3% anchor |
|---|---|---|
| Sizwe Hosmed | 19.15% | 15.85 |
| Momentum | 9.9% | 6.6 |
| GEMS | 9.8% | 6.5 |
| Fedhealth | 9.6% | 6.3 |
| Bonitas | 8.88% | 5.58 |
| Medihelp | 8.46% | 5.16 |
| Discovery | 7.2% | 3.9 |
| Bestmed | 6.8% | 3.5 |
| Industry weighted | 8.10% | 4.8 |
Two of those need qualification. Sizwe Hosmed’s increase took effect on 1 November 2025, and Discovery deferred its increase to 1 April 2026, which produced an effective annual increase of 5.4%.
The pattern is not new. The anchor was 5% for 2024, 4.4% for 2025 and 3.3% for 2026. Jill Larkan, head of healthcare consulting at GTC, observed as far back as October 2021 that schemes had typically exceeded the guideline by around four percentage points. That observation is five years old and is offered as context rather than as a current assessment.
The 2027 anchor of 3.8% is half a percentage point higher than the 2026 anchor, not lower.
What 3.8% could mean in rands
Applying the 2026 gap of 4.8 percentage points to the new 3.8% anchor gives about 8.6%. Applying the 2026 ratio instead gives about 9.3%.
Both figures are Southafriworld arithmetic on a single year of precedent. Neither is a forecast, and neither comes from the regulator or any scheme.
On a contribution of R5 000 a month, an 8.6% increase adds R430 a month, or R5 160 over a year. On R3 000 a month it adds R258 a month, or R3 096 a year. On R8 000 a month it adds R688 a month, or R8 256 a year.
Those are worked examples on stated amounts, not an average. Members can run the same calculation on their own January statement.
Against that, average salaries have been under pressure, with earnings hitting a two-year low earlier this year. Medical scheme tax credits offset part of the cost, and an adjustment to those credits has been under discussion.
Why costs are rising faster than the number of members
The regulator’s figures point to utilisation rather than membership growth.
Total healthcare benefits paid by medical schemes rose from about R218.4 billion in 2022 to R239 billion in 2023 and R259.3 billion in 2024. That is an increase of roughly 18.7% over two years.
Over the same period, beneficiary growth was 1.04% in 2023 and 0.45% in 2024, compounding to about 1.5%.
Indexing one against the other, benefits paid per beneficiary rose about 17% in two years. That calculation is Southafriworld’s, from the regulator’s own published figures. Broadly the same group of people is consuming substantially more healthcare, at higher prices.
For 2026, the industry-weighted increase assumptions for specialist costs and hospital costs were 8.61% and 8.51% respectively, both more than double the 3.3% tariff benchmark.
Dr Katlego Mothudi, managing director of the Board of Healthcare Funders, heads the body arguing that contribution guidance alone cannot fix this. In comments published by BusinessTech, the BHF said that “currently, healthcare providers and large hospital groups are effectively price setters”, with schemes and their members as price takers.
The BHF wants collective tariff negotiation between schemes and willing providers within a regulated framework, a reform the Competition Commission’s Health Market Inquiry identified in its 2019 final report. Seven years on, it has not been implemented.
The organisation also wants Prescribed Minimum Benefits modernised and schemes allowed to offer Low Cost Benefit Options. The regulator is reviewing the PMB framework. Low Cost Benefit Options remain blocked.
Global cost pressure is not unique to South Africa. The WTW 2026 Global Medical Trends Survey, covering 91 countries, projects medical costs rising 10.3% globally in 2026 and 11.3% across the Middle East and Africa region.
What members should watch between now and January
Schemes announce their 2027 contribution increases and benefit changes from around October, and the regulator must approve them. Until those announcements land, the 3.8% anchor tells members very little.
Three things are worth checking when the announcement arrives. The weighted average increase across all plans, which is the headline number schemes publish. The increase on the specific plan a member is on, which can differ sharply from the weighted average. And the effective date, because a deferred increase, as Discovery applied for 2026, changes the actual annual cost.
The regulator has not published a date for its 2027 evaluation circular, which is where the industry-wide outcome will eventually be recorded. It has not said what reasonable utilisation means for 2027. Neither figure exists yet.
What does exist is a 3.8% anchor, and a 2026 record in which the comparable anchor was 3.3% and the approved industry outcome was 8.10%. Anyone budgeting for January should work from the second number, not the first. The full picture of last year’s scheme-by-scheme increases remains the closest available guide.
HOW WE REPORTED THIS CROSS-CHECKED
- This article was built from the Council for Medical Schemes guidance on contribution increases for the 2027 benefit year, read alongside the published text of Circular 24 of 2025 which set the 3.3% anchor for 2026 and Circular 35 of 2024 which set 4.4% for 2025, all issued by the regulator itself.
- The comparison between guidance and outcome was built by setting the regulator's own 2026 anchor of 3.3% against the contribution increases announced by eight named schemes for that year and against the industry-weighted figure of 8.10% reported from the regulator's later evaluation.
- The illustrative 2027 figures of about 8.6% and about 9.3% are Southafriworld calculations that apply the 2026 percentage-point gap and the 2026 ratio to the new 3.8% anchor, they rest on a single year of precedent, they are labelled as arithmetic in the article and they are not forecasts.
- The finding that benefits paid per beneficiary rose about 17% over two years is also a Southafriworld calculation, derived by indexing total benefits paid against the regulator's own reported beneficiary growth of 1.04% in 2023 and 0.45% in 2024.
- No official of the Council for Medical Schemes was named in any available account of the 2027 guidance, which is why one of the two named individuals in this article is quoted from dated material, and no comment was sought from the regulator, the Board of Healthcare Funders or any medical scheme.
- This article was drafted with AI assistance and the facts, figures and quotations were checked against the primary source by the editor before publication.
