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Medical aid myth busting

ARTICLE BY

  • Lee Callakoppen
  • Principal Officer
  • Bonitas Medical Fund

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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.

As we step further into 2026, it’s 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, and to achieve this, it’s important that South Africans get the facts straight.

Myth 1: Medical aid is a luxury

The most pervasive myth is that medical aid is a luxury. The data, in fact, suggests otherwise. 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. For a scheme like Bonitas, being a member is a guarantee of access to a network of private facilities when time is the most critical variable.

Myth 2: Plan adjustments mean lower quality

There is a common fear that moving to a different plan within a scheme is a step backwards. In reality, the healthcare market is defined by customisation, allowing clients to choose a plan that fits their specific lifestyle and healthcare needs without paying for bells and whistles they don’t use.

This is best seen in the rise of options that make strict use of networks and digital-first plans like Bonitas’ BonCore that was unveiled in September last year. Network options offer reduced monthly premiums by requiring members to use a specific group of healthcare providers with whom preferential rates have been negotiated. BonCore takes this further by offering a digitally enabled hospital plan that combines unlimited hospital cover with virtual-first primary care. This means that simple GP consultations happen via video link, which lowers costs and increases convenience while still providing a Benefit Booster for physical visits and specialised tests.

Myth 3: Secondary products can stand alone

A dangerous trend has seen some people viewing gap cover or health insurance as a replacement 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.

Myth 4: Public-private hybrids are a universal quick fix

While the integration of public and private care is a key pillar of national health policy, the immediate reality for many in 2026 comes down to capacity. 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.

In simple terms, this means that while your client might be covered for a life-threatening emergency, they could face a very long wait for elective procedures like hip replacements, cataract surgery or specialised scans.

Securing private care through a scheme with a broad national footprint allows for proactive health management and the ability to treat a condition before it becomes a surgical emergency.

Myth 5: Medical schemes prioritise the young and healthy

South African medical schemes operate on a principle of social solidarity. This means that all contributions go into a collective pool of funds to be used by all members, as and when needed.

As per the Medical Scheme’s Act 131 of 1998, open schemes are legally required to accept all applicants. At Bonitas we emphasise preventative care for all life stages, which includes a series of health screenings, vaccinations and wellness assessments. This ensures that the scheme’s R9 billion in reserves is used to keep all members healthy for longer, regardless of age.

Ultimately, being a member of a medical aid is about having a partner that bridges the gap between health consciousness and health security. We must move beyond viewing healthcare as a grudge purchase to seeing it as a vital tool for long-term resilience.

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