For many South African households, the impact of rising costs for essential items and services is stretching budgets more than ever before. With global fuel shortages driving up the cost of petrol and diesel, a significant increase in April will likely be followed by another in May. Water has become more expensive and electricity charges have spiked by nearly 9%, on average.
The cost of private healthcare is also outpacing inflation and average annual salary adjustments. In January 2026, medical scheme members faced an average hike of around 9.5%, adding pressure on households to manage their monthly contributions while also saving for potential out-of-pocket medical expenses.
Bridging the expense gap
Karin Mitchelmore, Executive Head of Healthcare Consulting at advisory firm NMG Benefits, explains that this is where gap cover comes into play. “Gap cover is a separate insurance policy designed to work alongside your medical scheme. It bridges the difference between what a scheme will pay for hospitalisation, certain procedures, or specialist consultations, and what some providers actually charge.”
Many people assume that cover for 100% or 200% of the rate typically paid out by medical schemes is enough but, in reality, certain bills can far exceed these limits. And, without gap cover, the responsibility for settling any shortfall falls squarely on the member.
Gap cover is relatively inexpensive, but it can significantly improve peace of mind. Many providers now offer options designed to keep monthly premiums affordable, while still covering more of the shortfall that can follow hospitalisation, some procedures and scans, or a visit to a specialist. Some gap cover options also provide extra benefits, including trauma counselling or lump-sum payouts for serious diagnoses, adding tangible value for families managing both financial and emotional pressures.
For those who can’t stretch to comprehensive medical scheme cover, alternatives include an entry-level hospital plan from a medical scheme, building a dedicated savings fund for medical emergencies, or buying a primary healthcare insurance product. Here, it’s important to know that you can add gap cover to hospital plans, but not to individually-funded health costs or primary healthcare insurance products.
Understanding your healthcare options is also crucial. Medical scheme benefits are becoming more complex, and working with a financial advisory firm can help you identify which plan best matches your likely healthcare needs and which gap cover product is right for you. And, because advisory firms typically have preferred provider rates with healthcare providers, this guidance can often save money while still giving you the confidence that comes with knowing you’re protected.
Mitchelmore notes that, in today’s challenging economic climate, managing healthcare costs isn’t just about covering bills: “It’s about maintaining control over your financial wellbeing. The reality is that no one can predict when a medical emergency will happen. Gap cover helps ensure that, when one does, you’re not left facing unexpected expenses alone. Partnering with an experienced adviser, like those at NMG, can help make sure that your medical cover takes your life, your health risks, and your budget into account.”
