As healthcare costs rise and household budgets remain under pressure, South Africans are being forced to rethink what value from medical aid really means. While claims protection remains essential, new insights suggest that long-term value may also come from benefits that help people understand risks earlier and avoid or delay more serious health events.
Momentum Medical Scheme’s 2025 data shows the scale of medical aid’s protection role. The Scheme paid R6.88 billion in claims during 2025, bringing total claims paid to more than R84.8 billion to date.
However, the same data also points to a growing affordability challenge. Critical illness claims increased by more than 15% year on year in 2025, surpassing R1 billion for the first time, with cardiovascular diseases and nervous system disorders among the major contributors.
Against this backdrop, prevention is becoming more than a wellness conversation. It is becoming a practical affordability strategy.
“Medical aid value can no longer be judged only at the point of claim,” says Damian McHugh, Chief Marketing Officer at Momentum Health. “The more important question is whether people are being helped to understand their risks earlier, act sooner and build habits that could reduce avoidable health and financial strain over time.”
Serious illness can have a financial impact beyond treatment costs. Households may also face rehabilitation, transport, caregiving, reduced income and time away from work. This can have an overwhelming negative impact on households, making it even more difficult for them to recover, particularly in the context of South Africa’s ongoing economic challenges. The national unemployment rate stood at 32.7% in the first quarter of 2026, while youth unemployment reached 60.9%. Combined with the country’s growing debt burden, these pressures leave many households with little financial resilience.
Prevention is also becoming more measurable.
Screenings, health checks, physical activity data and health scores can help people identify warning signs earlier and make more informed decisions. Momentum Health’s wellness data suggests behaviour change can be sustained when people receive both feedback and incentives. In 2025, R26 million in HealthReturns+ went back into members’ pockets for staying active, while R80 million in cashbacks and discounts was returned to members for choosing to shop at Momentum Multiply+ partners.
Momentum Multiply data also shows that 80% of members maintain or improve their health scores, while members claim 12% less on average, with a 15% lower cost differential.
“The challenge is not only telling people to be healthier,” says McHugh. “It is making healthier choices easier, more relevant and more rewarding in daily life. That is where personalised data, digital tools and incentives can make prevention more practical.”
As affordability pressures continue, the conversation is likely to move beyond whether people have cover, to whether they are using that cover in ways that help them stay healthier for longer.
South Africans are encouraged to review their medical aid benefits, complete recommended screenings and use available digital tools to monitor and manage their health.
