5 myths about medical aid schemes to leave behind in 2025

There are various myths about medical aid schemes going around, especially among young people who start work for the first time and get the opportunity to join their own medical aid scheme. The volume of choices can be very complicated, and it is often easier to just believe the myths and see how it goes. From tracking steps and calories to getting the gains at the gym and taking care of mental and emotional wellness, South Africans have never been more health conscious.

At the same time, there is a growing disconnect in how we perceive the systems that protect that health, Lee Callakoppen, principal officer of Bonitas Medical Fund, says. “As we step further into 2026, it is important to debunk the myths around medical aid that often cloud our judgement when it comes to looking after our own health and that of our families. Cover without interruption should be high up on our list of resolutions this year and to achieve this, it is important that South Africans get the facts straight.” The most pervasive myth is that medical aid is a luxury.

The data, in fact, suggests otherwise, Callakoppen says. According to the Council for Medical Schemes (CMS) 2024 Industry Report, hospital expenditure remains the dominant cost driver in South Africa, accounting for nearly 36% of total benefits paid. “Medical aid acts as a bridge to immediate, specialised intervention.” There is a common fear that moving to a different plan within a scheme is a step backwards but in reality, the healthcare market is defined by customisation, allowing you to choose a plan that fits your specific lifestyle and healthcare needs without paying for bells and whistles you do not use, Callakoppen says.

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Callakoppen says they have noticed a dangerous trend where some people view gap cover or health insurance as areplacement for full medical aid membership. “While these tools have their place, they are designed as supplements and not replacements. “Gap cover, for instance, is a vital tool for managing specialist shortfalls, but it relies on the foundation of a medical aid to function.

Without that foundation, the protection is incomplete. “Real security comes from a holistic ecosystem, with Prescribed Minimum Benefits (PMBs) ensuring that a pre-determined list of chronic conditions and emergency procedures are covered by law, regardless of the plan you choose. While the integration of public and private care is a key pillar of national health policy, the immediate reality for many consumers this year comes down to capacity, he says. “Public facilities are under significant strain and while insurance products linked to public care provide a basic entry point, they often lack the elective agility that private medical aid provides.

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