Health insurance products are growing rapidly in South Africa as many households downgrade from comprehensive medical schemes or delay joining them entirely in search of lower premiums, industry figures show.
Shift driven by affordability pressures
Market data cited by Momentum Health indicate that open medical scheme membership fell by about 3% between 2019 and 2024, a reflection of pressure on household finances and difficulties attracting younger members to traditional private medical schemes. At the same time, Momentum estimates the health insurance market is expanding at between 14% and 16% per year — substantially faster than the largely stagnant medical scheme sector.
The company says more than 1.2-million principal members now hold health insurance policies, which translates to almost 2-million beneficiaries when dependants are included. By comparison, about 8-million beneficiaries are covered by South Africa’s medical schemes.
What health insurance covers — and what it does not
Health insurance products, offered by both medical schemes and commercial firms such as Dis-Chem, Tyme Bank and employer-sponsored arrangements, typically cover day-to-day items: general practitioner consultations, medication, blood tests and limited emergency or hospital-related benefits. They tend to carry significantly lower premiums than comprehensive medical scheme plans but also offer narrower benefit packages.
- Lower premiums make private cover accessible to people who cannot afford traditional schemes.
- Benefits are generally more limited — chronic-condition cover and full prescribed minimum benefits commonly found in medical schemes are usually absent or restricted.
- Employer-sponsored health insurance is an important distribution channel for lower-cost products.
Retail and employer arrangements are growing: Momentum Health said companies such as Woolworths provide health insurance to employees through Momentum Health4Me, broadening coverage for workers who might otherwise rely solely on public facilities.
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Industry response and implications for private healthcare
Momentum’s marketing chief, Damian McHugh, characterised health insurance as complementary to traditional medical schemes rather than an outright threat. The shift is prompting scheme administrators to rethink offerings to retain members and appeal to cost-conscious consumers, especially younger cohorts who are critical to long-term scheme viability.
For policy makers and regulators, the trend raises questions about consumer protection and clarity of product design. Unlike regulated medical schemes that must provide certain prescribed minimum benefits, the range and limits of health insurance products vary widely. Consumers who select cheaper cover without understanding exclusions risk facing high bills if they need chronic care or hospitalisation.
What patients should consider
Health consumers weighing options should review benefits and exclusions carefully, compare costs against likely health needs, and seek independent advice where possible. Those with chronic conditions should be particularly cautious: comprehensive medical schemes are more likely to include chronic disease management and chronic medicine cover, while some health insurance products may not.
Ultimately, the rise in health insurance reflects a broader affordability challenge in South Africa. As households balance rising living costs against health needs, the private health market is adjusting: some consumers retain access to private primary care at lower cost, while others risk gaps in cover if they opt for cheaper but narrower policies.
Readers concerned about their own cover or health should consult a healthcare professional or visit a clinic rather than self-diagnose. For questions on benefits and rights, contact your scheme or insurer for full policy terms and conditions.
