By: Rajesh Patel As living costs surge, healthcare coverage can feel like a luxury, particularly for young, healthy South Africans. Yet, amid policy debates on National Health Insurance (NHI) and private healthcare, medical scheme membership remains essential, offering crucial financial protection against unpredictable medical costs. With recent premium increases, many members feel the strain, leading some to consider downgrading their options or even opting out entirely.
However, continuous medical scheme coverage is crucial for maintaining financial security and supporting long-term health. Why are premiums increasing? Reports by the Council for Medical Schemes (CMS) reveal that South African medical schemes collected R232 billion in premiums and paid over R218 billion in claims for approximately 9 million beneficiaries during the 2023/2024 period. These funds cover a wide range of healthcare needs, from hospital stays and advanced procedures to life-saving medications.
Here are some of the main drivers behind rising premiums: Medical inflation and rising healthcare costs Healthcare costs have consistently risen faster than general inflation, driven by advancements in medical technology, new treatments, and more expensive medications. Medical schemes must adjust premiums to keep pace with these rising costs to ensure adequate coverage for members. Increasing prevalence of chronic illnesses Chronic diseases, such as diabetes, hypertension, and heart disease, are on the rise.
.