Photo: amanderson2, Wikimedia Commons, CC BY 2.0Medical aid for pensioners in South Africa
Age, penalties, staying on after retirement and tax
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No age pricing, no refusal
- Community rating: contributions may be based only on income, the number of dependants, or both — not on age, sex or health (s 29(1)(n) of the Medical Schemes Act).
- Open schemes may not refuse you (s 29(3)(a)). There were 16 open schemes at 31 March 2026 — the list is on our medical aid page.
- Income-banded options price by income: a lower pension can mean a lower band, where the option has bands.
The CMS reports that pensioners make up 9.97% of medical scheme beneficiaries, and that between 2018 and 2024 beneficiaries aged 65 and older — particularly those 85 and older — grew sharply, by 26% for women and 29% for men (CMS Annual Report 2025/26).
Staying on your scheme when you retire
Section 29(1)(s) of the Medical Schemes Act requires every scheme's rules to provide for the continuation of membership of a member who retires from the employer's service, or whose employment is ended because of age, ill health or disability, together with the dependants, subject to prescribed conditions.
- After the member's death, the dependants may stay on the scheme until they join another scheme or become a dependant elsewhere (s 29(1)(t)).
- If the employer moves everyone to another scheme, the new scheme must accept these pensioners and dependants without a waiting period or new health restrictions (s 29(1)(u)).
- Changing option within the same scheme brings no new waiting period (s 29A(4)) — moving from a comprehensive option to a hospital plan is one way to lower the contribution while keeping the PMBs.
The late-joiner penalty for pensioners
A late joiner is an applicant or adult dependant aged 35 or older when applying, unless covered by a scheme since before 1 April 2001 without a break of more than three consecutive months (Regulation 11). The scheme may load that person's contribution by a band found with A = age − (35 + years of creditable coverage) (Regulation 13):
| A (years) | Maximum penalty | Example at age 66 |
|---|---|---|
| 1 – 4 | 5% of the contribution | 66 − (35 + 27 years of cover) = 4 |
| 5 – 14 | 25% | 66 − (35 + 20 years of cover) = 11 |
| 15 – 24 | 50% | 66 − (35 + 10 years of cover) = 21 |
| 25 or more | 75% | 66 − (35 + 0) = 31: no earlier cover |
Creditable coverage counts years as a member or dependant of a medical scheme (not as a dependant under 21), and service as a uniformed SANDF employee with military medical benefits. Proof can be a sworn affidavit naming the schemes and periods (Regulation 13(6)), and the penalty must be recalculated when you produce new proof (Regulation 13(4)). Try your numbers in the late-joiner penalty calculator.
The tax credit from 65
The monthly medical scheme fees tax credit is the same at every age: R376 for the member, R752 with one dependant and R254 for each further dependant in the 2027 tax year (SARS).
From 65, the additional medical expenses tax credit is larger: 33.3% of the fees above 3 × your credits, plus 33.3% of qualifying out-of-pocket expenses, with no 7.5%-of-income threshold (SARS, Taxation in South Africa 2026, §2.18). SARS's own example: a taxpayer aged 66 with no medical aid who paid R13,800 of qualifying expenses gets R4,595.40.
Details and examples: medical aid tax credit.
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Frequently asked questions
Can a medical aid charge me more because I am a pensioner?
Not because of your age: contributions may depend only on income and number of dependants (s 29(1)(n)). But if you join at 35 or older without enough earlier cover, a late-joiner penalty of up to 75% of the contribution may apply (Regulation 13).
Can a medical aid refuse a pensioner?
An open scheme may not refuse any applicant (s 29(3)(a)). It may apply the waiting periods of section 29A and a late-joiner penalty.
Can I keep my medical aid after I retire?
Yes. Every scheme's rules must provide for the continuation of membership of a member who retires, or whose employment ends because of age, ill health or disability, and of the dependants (s 29(1)(s)).
What is the late-joiner penalty if I join medical aid at 65 with no previous cover?
A = 65 − 35 = 30 years, so the band is 25 years or more: the scheme may add up to 75% to your contribution (Regulation 13). Proof of earlier membership reduces the band.
Do pensioners get a bigger medical tax credit?
The monthly credit is the same, but from 65 the additional credit is 33.3% of fees above three times the credits plus 33.3% of qualifying expenses, with no 7.5%-of-income threshold (SARS).
Sources
- Council for Medical Schemes — Medical Schemes Act 131 of 1998 and Regulations (consolidated copy, Web Archive)
- Council for Medical Schemes — Annual Report 2025/26 (copy tabled in Parliament, hosted by PMG): registered schemes at 31 March 2026, complaints, contributions (Tables 60–62)
- SARS — Medical tax credit rates (2027, 2026 and 2025 tax years; page updated 25 February 2026)
- SARS — Taxation in South Africa 2026, §2.17 (section 6A) and §2.18 (section 6B), with worked examples