Costs & contributions
What affects your medical aid contribution
By Naledi Mokoena · 6 min read · Updated 24 June 2026
Your medical aid contribution is driven mainly by the plan you choose, the number of dependants, your income on income-based plans, any late-joiner penalty and whether you accept a network restriction. Unlike insurance, an open scheme cannot charge you more because you are older or sicker, since community rating applies.
Understanding these levers helps you lower your cost without losing the cover you need. Some levers, like plan type and network, are in your control; others, like the annual increase, are not.
This guide breaks down each factor and how to manage it.
Community rating: what schemes cannot do
South African medical schemes use community rating. An open scheme cannot refuse you or charge you a higher contribution because of your age, health status or claims history. Everyone on the same plan pays the same base contribution. The main legal exception is the late-joiner penalty for joining late, and waiting periods for new members. This protects sicker and older members from being priced out.
The factors that set your price
| Factor | Effect on contribution | In your control? |
|---|---|---|
| Plan type | Biggest driver; comprehensive costs most | Yes |
| Dependants | Each adult and child adds cost | Partly |
| Income (income-based plans) | Higher band, higher cost | No |
| Late-joiner penalty | Adds a percentage for joining late | Avoidable by joining earlier |
| Network choice | Network is cheaper | Yes |
| Annual increase | Rises each year | No |
How to lower your contribution
- Choose a network plan over a traditional one if there is a network hospital near you.
- Drop from comprehensive to a savings or hospital plan if your day-to-day use is low.
- Use an income-based plan if you are a lower earner.
- Join before age 35 and keep continuous cover to avoid a late-joiner penalty.
- Review your plan each year at the change window, since your needs and the rates change.
Late-joiner penalties in detail
If you first join a medical scheme after age 35 without continuous prior cover, a late-joiner penalty is added as a percentage of your contribution, rising with the length of the gap. It can apply for the rest of your membership. The way to avoid it is to take out cover earlier and keep it continuous. This is set by the Medical Schemes Act, not the individual scheme.
Your rights
Community rating and PMBs are legal protections, not scheme favours. If you believe a scheme has rated you unfairly or applied a penalty incorrectly, you can challenge it. If a scheme does not resolve a complaint, you can escalate to the Council for Medical Schemes (CMS) at medicalschemes.co.za, the statutory regulator for all registered medical schemes in South Africa.
Frequently asked questions
What affects my medical aid contribution?
Mainly the plan type, number of dependants, your income on income-based plans, any late-joiner penalty and whether you accept a network. Open schemes use community rating, so they cannot charge you more for being older or sicker.
Can medical aid charge more because I am older?
No. Open schemes use community rating, so they cannot charge a higher base contribution because of your age, health or claims history. The main exception is a late-joiner penalty if you first join after 35 without prior cover.
How can I lower my medical aid contribution?
Move to a network plan if a network hospital is near you, drop to a savings or hospital plan if your day-to-day use is low, use an income-based plan if you earn less, and review your plan each year.
What is community rating?
Community rating means everyone on the same plan pays the same base contribution, regardless of age or health. It stops schemes from pricing out older and sicker members. It is a legal protection under South African medical scheme rules.
Does my income affect my medical aid price?
Only on income-based plans, where the contribution scales with your salary band. On other plans, income does not change the price. The plan type and dependants matter more there. Choose the design that fits your earnings.
How do I avoid a late-joiner penalty?
Join a medical scheme before age 35 and keep continuous cover. The penalty applies when you first take out cover after 35 with a gap in prior membership, and it rises with the length of that gap.
