What you need to know when switching Medical Aids

The short answer to "can I switch Medical Aid" is yes: South Africans can move between Medical Aid schemes whenever they like, though the timing and paperwork matter.

Public healthcare in South Africa faces heavy demand, which is one of the reasons so many South Africans review their family's Medical Aid cover each year. South Africa has more than 70 registered medical schemes, according to the Council for Medical Schemes Annual Report for 2024/25. These range from large open medical schemes (anyone can join) to smaller restricted medical schemes limited to specific employers.

Hippo's quick bites:

1. You cannot hold an active Medical Aid membership with more than one Medical Aid scheme at a time

2. Switching medical aids in South Africa is allowed at any time of year, however, waiting periods may apply

3. Moving to a different plan within your current scheme is usually only allowed in the last quarter, for a start date of 1 January. 

4. Expect a general waiting period of up to three months and possible condition specific waiting periods for pre-existing conditions, unless you can prove continuous membership. 

When can you change Medical Aid schemes?

You can change your Medical Aid scheme at any point during the year. Most medical schemes ask for one calendar month's notice in writing, so build that into your plan choice.

Moving to a different plan within your current scheme works differently. This kind of change is usually restricted to the final quarter of the year, with the change taking effect on 1 January.

Switching Medical Aid vs changing your Medical Aid plan

These two moves are not the same thing, and the paperwork differs.

Switching to a different medical scheme entirely

This means leaving your existing scheme (say Bonitas) and joining a different Medical Aid scheme (say Discovery Health Medical Scheme), with no gap between the old cover ending and the new cover starting. 

NB: Holding active medical scheme membership with two schemes at once is illegal in South Africa.

Changing your plan within the same scheme

If you are happy with your scheme but want a different level of cover, you can usually move to a higher or lower tier plan within it, though the same last quarter restriction applies.

Can you downgrade your Medical Aid?

Yes, you can downgrade your Medical Aid plan, and many members do this when monthly contributions become difficult to manage. A more affordable alternative on paper does not always mean better value once you make a claim.

Before you downgrade, weigh up:

• Whether the lower tier plan still covers chronic conditions adequately

• How the annual limit for day-to-day benefits compare to your current plan

• Whether major medical expenses, such as planned surgery, are still adequately covered

• Whether the monthly premium saving is worth the drop in cover

This can mean less cover for chronic conditions and reduced limits for major medical expenses, such as cancer treatment. Under the Medical Schemes Act, every scheme must still apply the same prescribed minimum benefits (271 defined conditions and 26 chronic conditions), regardless of the plan you choose.

Understanding waiting periods

Waiting periods are one of the most misunderstood parts of switching Medical Aid, and they can delay access to benefits you're already paying for.

Two types generally apply:

Medical emergencies are typically still covered during a general waiting period, since prescribed minimum benefits require it. New waiting periods can catch members off guard if timing is not planned properly.

Continuous membership can reduce or remove these waiting periods. Ask your current administrator for a membership certificate before you cancel, since most new schemes will ask you to provide proof of it as part of the required documentation.

Comparing cover before you switch

Price alone should not decide which scheme you choose; check what it pays for your day-to-day healthcare.

Not all medical schemes offer the same network options, so check the following carefully:

• Chronic cover and how many conditions are included beyond the regulated list

• Day-to-day benefits, including GP visits, medicine and basic dentistry

• Hospital plans and what they cover for major medical expenses in private healthcare

• Network options versus non network plans, which often cost less for the same cover

• Your medical savings account allocation and how quickly it runs out based on past medical costs

Medical cover is only useful if it matches your actual medical needs. Two plans can look similar on the surface and still leave you with very different medical aid cover.

Steps to switching your Medical Aid

Follow this checklist to keep your new medical aid application on track: 

1. Compare Medical Aid schemes and plans online or via a registered broker

2. Confirm your medical needs, including chronic conditions, family needs and expected treatment

3. Request your membership certificate from your current scheme to support your continuous membership

4. Give written notice to your current scheme, checking their required notice period

5. Apply to the new scheme with proof of income, ID and any required documentation

6. Confirm your exact start date with the new scheme so there is no gap in medical cover

7. Set up your new debit order and cancel the old one once cover is confirmed

Gap Cover and your Medical Aid plan

Even a strong Medical Aid plan will not always pay a specialist's account in full, since private healthcare specialists often charge more than scheme rates allow. Gap Cover exists to cover that shortfall, paying the difference between what your scheme settles and what specialists charge.

Should you switch Gap Cover providers too? 

Not necessarily. You can often keep the same Gap Cover provider even after you change Medical Aid, since Gap Cover is a separate short term insurance product and is not tied to a specific scheme.

That said, check whether your new plan changes the case for switching Gap Cover providers. A main member moving from a hospital only plan to a comprehensive plan may need less Gap Cover. Some Gap Cover providers also apply their own waiting periods for pre-existing conditions, so check this first.

How to add Gap Cover to a new plan

If you are joining a new Medical Aid without existing Gap Cover, you can add Gap Cover as a separate policy once your new scheme membership is active. A new Gap Cover provider will usually ask for your Medical Aid membership number and plan details, with cover typically starting the following month.

What happens to your medical savings account

Your medical savings account does not automatically transfer between schemes; any unused balance is usually paid out or forfeited under your old scheme's rules, so check this before you cancel. Your new scheme opens a fresh medical savings account linked to your new plan, calculated on your cover option and monthly contributions. If you switch to a new Medical Aid, your membership number changes too, so update your Gap Cover provider.

Different medical schemes calculate this allowance differently, so compare the numbers rather than assuming otherwise.

Common mistakes to avoid

• Cancelling your old scheme before your new cover option is confirmed, and ending up with no Medical Aid in between

• Ignoring network restrictions and then facing co-payments for using an out of network provider

• Choosing the cheapest plan without checking prescribed minimum benefits and chronic cover

• Forgetting to request a membership certificate, which can trigger new waiting periods unnecessarily

Final thoughts

Switching Medical Aid can improve your cover and reduce your monthly premiums, provided you plan around notice periods, waiting periods and paperwork. Many South Africans switch each year for better benefits or a more affordable alternative. An open scheme accepts any applicant, while restricted medical schemes are limited to specific employers or industries. 

Read the benefit schedule for both cover and exclusions, and decide whether Gap Cover belongs alongside your new plan before you sign anything.

This article is for informational purposes only and does not constitute financial, legal, medical or insurance advice. Hippo is a comparison site helping you evaluate quotes from trusted South African insurers. Always review policy details before making changes. Quotes are risk profile dependent and subject to annual review. No fees are charged for using Hippo’s comparison service. HAS (Pty) Ltd and HCS (Pty) Ltd are authorised FSPs. Terms and conditions apply.