Understand Your Medical Aid Before You Make Changes for 2027

As we approach the end of the year, medical aid once again becomes an important topic of conversation. New contributions, benefit changes and plan options can leave members wondering whether they should stay where they are, upgrade their cover or consider a different option for 2027.

But before making any changes, there is an important first step: understand how you have actually used your medical aid during the past year.

The information available through your Discovery Health app can provide a useful starting point. From your Medical Savings Account and chronic conditions to personalised health information, understanding what is reflected on your profile can help you have a more informed conversation about your cover for the year ahead.

1. Start by Exploring Your Discovery Health App

How often do you actually look at the information available on your medical scheme profile?

The Discovery Health app brings a range of health and medical scheme information together in one place. Members can access the app using the same username and password used across Discovery's digital platforms.

Rather than only opening the app when you need to submit a claim or find information urgently, take some time to explore the different sections and understand what they tell you about your healthcare usage.

One area worth exploring is Personal Health Pathways, where you can access personalised health information and gain a better understanding of your health journey.

Having this information at your fingertips can help you become more engaged with both your healthcare and your medical scheme benefits.

2. Check How Much of Your Medical Savings You Have Used

Your Medical Savings Account can play an important role in covering day-to-day healthcare expenses, depending on the medical scheme option you have selected.

But do you know how much of your savings you have already used this year?

Within the Discovery Health app, navigate to My Cover to view information about your Medical Savings Account, including the available balance and how much has already been used.

This becomes particularly valuable towards the end of the year.

Consider:

• How quickly did you use your Medical Savings Account?
• Do you still have savings available?
• At what point during the year did your savings begin running low?
• Did you have significant out-of-pocket healthcare expenses?
• Did your current benefits adequately support your healthcare needs?

Understanding your usage can provide valuable context when assessing whether your current medical aid option remains suitable for you and your family.

3. Understand the Thresholds That Apply to Your Plan

Looking at your Medical Savings Account balance is only part of the picture.

Depending on your plan, there may be different benefits, limits and thresholds that determine how certain healthcare expenses are funded throughout the year.

This is where simply looking at the monthly medical aid contribution isn't enough when comparing options.

A plan that initially appears more affordable may not necessarily provide the most appropriate cover for your individual healthcare needs. Similarly, moving to a more expensive plan doesn't automatically mean it is the right solution.

Understanding how you used your benefits during 2026 provides a much stronger foundation for evaluating your options for 2027.

4. Check Whether Your Chronic Conditions Are Correctly Registered

If you have a chronic condition, take the time to check what is actually reflected on your medical scheme profile.

We sometimes encounter individuals who are receiving ongoing medication for a chronic condition, but the condition or medication has not been correctly registered or approved on their profile.

You can check this information through the Discovery Health app.

Navigate to My Health, scroll down to Chronic Conditions, and review the chronic conditions and related medication reflected on your profile.

Compare this information with the medication and prescriptions you are currently receiving from your healthcare providers.

If something appears to be missing or incorrect, speak to your doctor and medical scheme about the appropriate process for updating your information.

A simple check could help identify discrepancies before they become a problem when you need to access your benefits.

5. Understand How Your Medical Savings Claims Are Reimbursed

Another area that members may overlook is how claims are reimbursed from their Medical Savings Account.

Depending on your plan and the applicable options, certain claims may be reimbursed at either COST or the Discovery Health Rate.

Why does this matter?

If a claim is reimbursed at COST, a greater amount may be deducted from your Medical Savings Account where the healthcare provider charges more than the Discovery Health Rate. This could result in your available savings being depleted more quickly.

Understanding how your claims are being reimbursed can therefore form an important part of managing your Medical Savings Account throughout the year.

The main member can contact Discovery Health to establish which reimbursement option applies to their plan and whether an alternative option is available.

The objective isn't necessarily to choose one option over another. It is to understand the financial impact of the choice you are making.

6. Use Your 2026 Experience to Plan for 2027

By this point in the year, you have something extremely useful when evaluating your medical aid: almost a full year's worth of actual experience.

Instead of choosing your 2027 medical aid option based purely on price or assumptions about what you might need, look at what actually happened during 2026.

Ask yourself:

• How much medical care did I use?
• How much of my Medical Savings Account did I use?
• Did my savings last throughout the year?
• Were my chronic conditions and medication appropriately covered?
• Did I regularly have to pay healthcare expenses from my own pocket?
• Did I understand the benefits available to me?
• Has anything changed in my health or my family's healthcare needs?
• Is my current medical aid option still appropriate for my circumstances?

Your medical aid should be reviewed in the context of your actual healthcare needs rather than simply renewed automatically each year.

7. Don't Miss the Year-End Opportunity to Review Your Cover

For many medical scheme members, the annual option-change period towards the end of the year is an important opportunity to review their medical aid selection for the next benefit year.

Changes generally take effect from January, although different timing may apply depending on the medical scheme and whether annual increases or option changes have been delayed.

This means you shouldn't wait until the last minute to start understanding your current cover.

By reviewing your benefits, usage, savings and healthcare needs ahead of the deadline, you have more time to ask questions and understand the implications of changing your medical aid option.

Once the applicable option-change window has closed, your ability to upgrade or change your plan may be restricted until the next opportunity.

8. Make Medical Aid Part of Your Broader Financial Planning

Medical aid isn't an isolated monthly expense.

Healthcare costs can affect your household cash flow, emergency savings, investments and broader financial security. The decisions you make about your medical scheme should therefore form part of your overall financial planning.

Choosing the cheapest plan without understanding the potential out-of-pocket costs can create financial pressure later. Equally, paying for benefits that don't align with your circumstances may not represent the best use of your money.

The goal is to find an appropriate balance between your healthcare needs, the benefits available to you and what you can sustainably afford.

That starts with understanding what you already have.

Before You Choose Your Medical Aid for 2027

Don't wait for a contribution increase or year-end deadline before thinking about your medical aid.

Open your Discovery Health app. Look at your Medical Savings Account. Check your chronic conditions. Understand your benefits and consider how you have used your medical aid throughout 2026.

Then use that information to have a more meaningful conversation about what you may need in 2027.

If you're unsure whether your current medical aid option remains appropriate for you and your family, get in touch with Candid 20 Twenty for an analysis of your existing cover and guidance on the best way forward.

Partnering with Candid 20 Twenty means choosing a team with decades of combined expertise in financial planning, risk management, and wealth protection. Led by Shirley, a CERTIFIED FINANCIAL PLANNER® and FIDUCIARY PRACTITIONER OF SOUTH AFRICA®, we bring over 25 years of dedication, insight, and award-winning service to every client relationship. Our approach is built on open, honest conversations that give you 20 Twenty vision for the road ahead. Whether you are building your wealth, safeguarding your family, or planning for retirement, we are here to light the way.

Frequently Asked Questions

1. Where can I see my Medical Savings Account balance?

Discovery Health members can explore the My Cover section of the Discovery Health app to access information about their medical scheme cover and Medical Savings Account, where applicable.

2. Why should I check my Medical Savings Account before choosing my 2027 plan?

Your savings usage provides an indication of how well your current benefits matched your day-to-day healthcare needs. If your savings were consistently depleted early or you experienced significant out-of-pocket expenses, this information should form part of your annual medical aid review.

3. How can I check whether my chronic condition is registered?

Within the Discovery Health app, navigate to My Health and look for the Chronic Conditions section. Review the information reflected there and compare it with your current conditions and medication. If you identify a discrepancy, speak to your doctor and Discovery Health about the appropriate process to update your information.

4. What is the difference between reimbursement at COST and the Discovery Health Rate?

Where these reimbursement options apply, reimbursement at COST relates to the actual amount charged, while reimbursement at the Discovery Health Rate is based on the applicable rate determined by Discovery Health. Where a provider charges more than this rate, reimbursement at COST may result in a larger amount being deducted from your Medical Savings Account.

5. Can I change how claims are reimbursed from my Medical Savings Account?

The options available will depend on your particular medical scheme plan and its rules. The main member can contact Discovery Health to confirm the current reimbursement method and establish whether it can be changed.

6. When should I review my medical aid for 2027?

It is worthwhile starting your review before the annual option-change deadline rather than waiting until the last minute. This gives you time to assess your 2026 usage, understand any changes for 2027 and compare the options available to you.

7. Can I upgrade my medical aid during the year?

Medical schemes generally have rules governing when members may change or upgrade their options. For many members, the annual year-end option-change period is the primary opportunity to make changes for the following benefit year. You should confirm the specific rules and deadlines applicable to your medical scheme.

8. Why should medical aid form part of my financial planning?

Healthcare expenses can have a significant effect on household cash flow and long-term financial planning. Understanding your medical scheme benefits, potential out-of-pocket expenses and healthcare requirements can help you choose cover that better aligns with both your health needs and financial circumstances.