As we head into 2026, it’s a smart time to review your health cover, and here’s why. Medical aid contributions in South Africa have been rising steeply: for example, one scheme announced increases near 20% for 2026, and many plans saw jumps well above inflation in 2025.
With inflation, healthcare costs and service demands all growing, what seemed affordable this year may no longer offer the protection you need next year.
By reviewing your cover before the January renewal season, you give yourself time to assess whether your plan still fits your health needs, budget and life situation, rather than being forced into a rushed decision later.
At Bloom, we help South Africans choose affordable, relevant cover — whether that’s health insurance, medical aid, or gap cover — and do so with clarity and care.
Step 1: Reflect on Your Health and Family Needs
Before choosing your 2026 health cover, take a moment to look back on the year that’s passed. Your health needs, and your family’s, may have changed more than you realise.
Ask yourself a few important questions:
- How often did you visit the doctor in 2025? If you had frequent consultations or recurring prescriptions, you may benefit from a plan with stronger day-to-day or chronic cover.
- Did you or a family member need hospitalisation, chronic medication, or specialist treatment? Hospital admissions or ongoing conditions can reveal whether your current plan offers enough protection.
- Were there any surprise medical expenses? Unexpected costs may mean you’re under-insured or missing key benefits, such as gap cover.
- Is your current plan still serving your family’s changing needs? A new baby, a chronic diagnosis, or an ageing parent can all shift your healthcare priorities.
Tip: Reviewing your past year’s healthcare usage and expenses helps you identify whether you’re over-insured (paying for benefits you don’t use) or under-insured (lacking cover when you need it most), ensuring your 2026 health cover truly fits your life.
Step 2: Understand the Types of Health Cover Available
Choosing the right health cover starts with understanding what each type of product offers. South Africa’s healthcare landscape can be confusing, but once you know the difference between health insurance, medical aid, and gap cover, it’s much easier to find what fits your lifestyle and budget.
Health Insurance
Health insurance provides affordable access to private healthcare by covering day-to-day medical needs, such as GP consultations, prescribed medication, basic dentistry, and limited hospital benefits.
Example: Health4Me by Momentum, offered through Bloom, is designed to be affordable, offering members unlimited GP visits, basic health screenings, and access to private care without the high monthly premiums of full medical aid.
Best for: Individuals or families who want private healthcare at a lower cost, especially if they visit the doctor often and want predictable, affordable benefits.
Medical Aid
Medical aid schemes are regulated by the Medical Schemes Act, ensuring comprehensive cover that includes hospitalisation, specialist care, and Prescribed Minimum Benefits (PMBs), a legal requirement for all registered schemes.
Momentum Medical Scheme offers a range of options through Bloom, including:
- Ingwe: An affordable entry-level option offering network-based hospital and day-to-day cover.
- Evolve: Ideal for young professionals wanting private hospital access at specific networks.
- Custom: A flexible plan with broader hospital choice and strong day-to-day benefits.
Best for: Those who want private hospital access, peace of mind during emergencies, and more comprehensive coverage for themselves and their families.
Gap Cover
Even with a strong medical aid, there are times when specialists charge more than your scheme pays, and that’s where gap cover comes in. It bridges the shortfall between what your medical aid covers and what healthcare providers actually charge, especially for hospital procedures.
Best for: Medical aid members who want to avoid unexpected bills after hospitalisation.
Tip: Combining medical aid and gap cover can give you complete protection, ensuring you’re covered both for everyday healthcare needs and for major medical events without facing surprise costs.
Step 3: Consider Your Budget and Upcoming Price Changes
As 2026 approaches, most South Africans will see medical aid and health insurance premiums increase, in some cases, quite significantly. Industry reports from Daily Maverick and BusinessTech indicate that some medical schemes are raising contributions by as much as 10–20% for 2026, depending on plan type, inflation, and benefit adjustments.
These increases mean it’s more important than ever to balance affordability with protection. Before renewing your plan or switching providers, take a closer look at your financial picture.
Here’s what to consider:
- Compare your monthly premium to your actual healthcare spending. If you rarely use your benefits, a more affordable plan might be enough. But if you faced frequent doctor visits or hospital stays, investing in stronger cover could save you money in the long run.
- Account for life changes. Adding dependents, starting a new job, or relocating can all affect your medical needs and budget.
- Factor in tax savings. Contributions to registered medical aids may qualify for tax deductions or credits, helping offset some of the cost.
- Tip: Premium increases often come with benefit changes, so always review your scheme’s 2026 benefit brochure before making a decision. What seems like a small increase could come with new limits or exclusions that affect your coverage.
By planning now, you’ll start 2026 with health cover that truly fits both your medical needs and your financial goals.
Step 4: Check if You’re Over- or Under-Insured
When it comes to health cover, more isn’t always better, and less can sometimes cost you more in the long run. That’s why it’s essential to check whether you’re over-insured or under-insured before renewing for 2026.
Over-Insurance
Over-insurance happens when you’re paying for benefits you hardly ever use. For example:
- You’re on a high-end plan with unlimited specialist visits or private hospital access, but you’ve only needed a GP a few times all year.
- You’re covered for large hospital expenses, but you’ve never been admitted or had major procedures.
If that sounds familiar, you could be spending more than necessary, and a lower-tier plan might give you the same peace of mind for less.
Under-Insurance
Under-insurance is the opposite: your plan looks affordable upfront, but it doesn’t actually meet your needs. This can lead to costly out-of-pocket expenses when you fall ill or face an emergency. For example:
- You’re on a basic hospital plan, but you frequently visit doctors or need medication not covered.
- Your plan doesn’t include maternity, chronic, or specialist benefits, and you end up paying cash when you need them most.
Being under-insured can be financially and emotionally stressful, especially during medical emergencies.
Need Help Deciding?
Finding the right balance isn’t always easy, but you don’t have to do it alone. A Bloom consultant can help you review your current plan for free to see whether it truly fits your health, lifestyle, and budget.
Step 5: Keep Up to Date with Industry Changes
South Africa’s healthcare landscape is evolving quickly, and staying informed can make a big difference when choosing your cover for 2026. Knowing what’s changing helps you make confident decisions, avoid unexpected costs, and ensure your plan still meets your family’s needs.
Here are some key trends and updates shaping the year ahead:
Medical Aid Contribution Hikes
According to recent reports from BusinessTech and Daily Maverick, some medical schemes are increasing premiums by up to 10–20% for 2026. These hikes reflect rising medical inflation, hospital costs, and specialist fees, making it crucial to compare options before renewals take effect.
National Health Insurance (NHI) Developments
Discussions around the National Health Insurance (NHI) continue to influence how South Africans think about private healthcare. While the NHI aims to expand access to public health services, experts note that private medical aid and insurance will remain essential for faster, more comprehensive care, especially for those who value choice and shorter waiting times.
Rise of Hybrid and Digital Health Products
More South Africans are turning to hybrid products that combine health insurance with telemedicine or virtual consultations. Plans like Momentum Health4Me include benefits such as Hello Doctor (chat, phone, or video consultations), providing affordable access to private doctors without the need for in-person visits.
Why Staying Updated Matters
By keeping up with industry news and reviewing annual scheme updates, you can:
- Anticipate price increases and adjust your budget early.
- Identify new benefits or technologies that add value.
- Avoid being caught off guard by changes in cover or regulations.
Tip: Set a reminder every November to review updates from your medical aid provider and trusted industry sources. Staying informed means you can adapt proactively, not scramble at the last minute.
Step 6: Get Expert Advice Before You Switch
Choosing the right health cover can feel overwhelming, especially with so many options, price changes, and benefit updates each year. That’s where speaking to a registered broker like Bloom makes all the difference.
Here’s why professional advice matters before you make any changes:
Independent and Licensed Expertise
Bloom is a licensed financial services provider, which means our consultants are trained and authorised to give unbiased advice across multiple health products, not just one brand. Whether you’re comparing health insurance, medical aid, or gap cover, you’ll get guidance that’s personalised to your health needs, lifestyle, and budget.
Objective Plan Comparisons
Because Bloom works with a range of products and providers, we can compare different plans side by side, explaining the real differences in cost, benefits, and hospital networks. Our goal isn’t to sell; it’s to help you make a confident, informed decision.
Help with the Fine Print
From pre-authorisations to claims and benefit updates, a broker can save you hours of admin and frustration. Bloom’s team helps you understand what’s covered (and what’s not), manage claims smoothly, and stay on top of benefit changes each year.
Trusted Partnerships
Bloom is a proud, long-standing partner of Momentum Medical Scheme, two of South Africa’s most reputable healthcare brands. These partnerships allow us to offer customers affordable, trusted options with proven service excellence.
Final tip: Don’t make health cover decisions alone. Before you switch, speak to a Bloom consultant for free expert advice and ensure your 2026 health plan truly works for you and your family.
Step 7: Plan Ahead — Don’t Wait Until January
Every year, many South Africans wait until January to review their medical aid or health insurance, right when premium increases kick in and the pressure is on to decide fast. This often leads to rushed choices and unnecessary financial stress.
The smarter approach? Start planning now.
Comparing options before the new year gives you time to think clearly, ask questions, and make informed choices without the rush. You’ll also have more flexibility to switch plans or update dependents before renewal deadlines close.
Create a Simple Health Cover Checklist
To make the process easier, go through the following steps before December:
- Review your current plan documents: Make sure you understand what’s covered, what’s not, and how your benefits have changed.
- Note benefit limits: Check your day-to-day limits, chronic cover, and hospital authorisation requirements.
- Check waiting periods: If you’re considering joining a new plan, find out whether waiting periods or exclusions apply for pre-existing conditions or maternity care.
- Get an updated quote: Prices for 2026 may differ, so ensure your comparison is based on the latest premiums.
Tip: Planning early means you can avoid the January rush and start the new year with confidence that your health cover fits your life and your budget.
Protect Your Health and Your Budget in 2026
Healthcare planning isn’t just another financial task; it’s an investment in your peace of mind and long-term security. The right cover ensures you and your loved ones can access quality care when it matters most, without unexpected medical bills disrupting your budget.
By reflecting on your needs, understanding your options, and staying up to date with industry changes, you’ll be better equipped to make confident, informed decisions in 2026.
At Bloom, we believe that health cover should be simple, affordable, and personal. Whether you need health insurance, medical aid, or gap cover, our friendly consultants are here to help you every step of the way.
Need guidance choosing your 2026 health cover?
Bloom’s friendly consultants can help you compare health insurance, medical aid, and gap cover — and find the right fit for your needs.
