- Clarify your real needs based on past healthcare use and future plans.
- Shortlist options that fit your budget and lifestyle.
- Flag watchouts like hospital networks, specialist rates, or waiting periods before you commit.
Understand your 2026 benefit and rule changes
Let’s break down the basics right now. Medical aid schemes update their benefits and plan every year. They update their:
- Annual limits
These are the maximum amounts your medical aid will pay for certain benefits in a year. Once you hit the limit, you may need to start paying out-of-pocket.
- Co-payments
A co-payment is a cost that you pay to a service provider upfront when you use certain services, like seeing a specialist, going for a scan, or having a procedure done. Schemes adjust these each year, so be sure to revisit your medical aid’s policy on co-payments.
- Chronic formularies
This is the list of approved chronic medicines your scheme will pay for. If your medication falls off the list, you could lose cover, so it could be worth seeing whether your scheme will cover a generic of your current medication. If the scheme no longer covers any of your medication, you may consider upgrading to another option within your chosen medical scheme.
- Designated Service Provider (DSP) networks
DSPs are doctors, hospitals, or pharmacies your scheme prefers you to use. If you go outside of this network, you might have to pay more, or you could lose cover entirely for the service you undertake.
The fine print is often tricky to follow. If you’re not careful, you could land up paying out of pocket for things you thought were covered.
A medical aid broker explains these changes plainly and in a way that’s easy to understand. We show you what’s different, what stays the same, and how the current setup of your benefits effects your cover and your family.
Get help with chronic medication approvals
- Register your chronic condition if it hasn’t already been done and register for any chronic conditions that might have been newly diagnosed.
- Get a new script (you’ll need to renew your script every six (6) months).
- Request updated documents or a motivational letter from your doctor to support why you need the medication they recommend.
- Confirm with your broker and your scheme which service provider/s to use when obtaining your medication.
Review your medical aid and gap cover combo
Your gap cover works hand-in-hand with your medical aid. But if your 2025 benefits have changed, your current gap plan may no longer match.
Your medical aid broker will:
- Review your new plan details
- Check if your gap cover still fits your needs and medical aid plan benefits
- Recommend better alternatives if needed
January is the best time to reassess before claims start rolling in. One 10-minute chat could save you thousands of rands down the line.
Check your GP, specialist, and hospital networks
Network lists are updated every year. Your trusted GP or specialist may no longer be covered under your new 2026 plan.
A medical aid broker can:
- Confirm whether your provider is still on the listConfirm hospital networks and specialist rates: Which service providers and hospitals can I use without penalties?
- Suggest approved alternativesMaternity planning: What waiting periods apply to maternity and when should I apply? (Tip: always join before you fall pregnant)
- Help you understand what process to follow if you need to make a change
This protects you from unexpected fees and keeps your care consistent.
Update your details after a life change
- Do you have a new baby or one on the way?
- Do you have a new job?
- Have you moved to a new province?
- Has your income changed?
- Are you planning on adding or removing a dependant?
Why you should let MedXpert handle all of this
You don’t have to figure this out alone. And you don’t have to pay for help. MedXpert is a trusted, independent healthcare broker. We’re:
- Experienced and knowledgeable
- Patient and easy to talk to
- 100% free for all South Africans
We don’t work for a single scheme. We work for you. Our job is to stay independent and to make sure your plan still fits your needs and if not, help you switch with confidence. Let us handle the admin, the follow-ups, and the fine print. You just focus on staying healthy.
Speak to an expert today to make sure your 2026 benefits work for you. Start the new year with the clarity you deserve.