2027 Medical Scheme Outlook

A fundamental shift in how we use medical schemes

The 2027 medical scheme environment continues to be shaped by affordability pressures, healthcare costs above inflation and increasingly complex benefit structures. As a result, the outlook for 2027 appears more evolutionary than revolutionary, with schemes trying to balance affordability, sustainability and member value through lower-cost options, networks, prevention, wellness incentives and managed care rather than major benefit increases.

According to Jacqui Nel, Business Unit Head of Healthcare at Aon South Africa, contribution increases remain broadly in the 7.5% to 9% and certain instances above this range, placing additional pressure on members already managing higher household costs. “Medical Schemes are trying to preserve value while addressing affordability and sustainability,” says Nel. “Instead of widespread, expensive benefit expansion, the market is utilising networks, managed care, prevention, digital engagement and wellness-linked funding to better manage healthcare costs.”

“We are seeing a greater emphasis on prevention, screening, mental health and chronic disease across the board, which will improve long-term health outcomes. But there is also an important tension in healthcare benefits that are becoming smarter, but not necessarily simpler. The caveat lies in the fact that complexity itself can become a barrier to receiving value and for members already under financial pressure, this means that professional advice plays an increasingly important role,” says Nel.

The conversation cannot centre around which medical scheme option is the cheapest but rather needs to look at what combination of cover gives appropriate member protection, at a contribution level that is sustainable and affordable, with a clear understanding of how to use it. Based on this, Aon highlights the key medical scheme trends that are likely to play out in 2027:

• Trend #1: Affordability

Affordability will drive medical scheme decisions in 2027 with more members considering buying down to lower-cost options, moving to network plans or restructuring their healthcare cover to manage monthly expenses. But lower cost does not necessarily mean lower financial risk. More affordable options often make greater use of provider networks, co-payments, deductibles, formularies and managed-care rules. Members therefore need to understand both the contribution saving and the potential for greater out-of-pocket exposure that they will need to carry.

• Trend #2: Complex Benefits

Healthcare benefits are becoming more complex, which means that medical scheme members need to understand how to navigate networks, chronic medicine formularies, authorisation requirements, savings structures and wellness-linked benefits. This creates a greater need for clear communication, education and decision support from a professional healthcare broker.

• Trend #3: Prevention and Wellness

Prevention and wellness are becoming integral to benefit design with medical schemes rewarding health assessments, screenings and proactive health management with additional benefits. It makes sense as an early diagnosis is more likely to lead to better health outcomes, but it does mean that members need to actively engage with their medical scheme to access additional benefits. Where meaningful value is linked to engagement, failing to participate can effectively mean leaving available healthcare funding unused.

• Trend #4: Mental Health and Chronic Disease

Mental health and chronic disease is becoming more prominent with medical schemes focusing more on mental wellbeing, diabetes, obesity and weight management. With that said, it is important to have a clear understanding of benefit limits and access requirements when assessing the value of these benefits.

• Trend #5: Networks and Managed Care

Medical schemes are increasingly using networks, prevention, wellness incentives, digital healthcare and managed care to balance affordability with sustainability. It means that members can materially reduce unnecessary out-of-pocket costs by understanding hospital, GP, specialist, pharmacy and chronic medicine networks, even where their option does not strictly require network use. While these developments can provide additional value, they can also make healthcare benefits difficult to understand and navigate.

• Trend #6: Alternative Healthcare Funding

It is essential to have a holistic overview of all the benefits offered by a medical scheme and to explore different combinations of medical scheme cover, primary healthcare insurance, gap cover and other complementary solutions. It allows members to select cover based on actual healthcare utilisation, anticipated needs and available budget rather than merely retaining the same option each year that may not necessarily serve their needs adequately enough.

• Trend #7: Employer Benefit Strategy

For employers, the focus is shifting from which medical scheme or option provides the richest benefits, to providing employees with access to appropriate and sustainable healthcare within both employer and employee affordability constraints. The challenge then becomes navigating the medical scheme trends mentioned above and packaging employee benefits in such a way that it is affordable and sustainable from a contribution and subsidy perspective, while offering appropriate flexibility to select cover that aligns to their personal healthcare needs.

The biggest focal point for 2027 is that advice and member education is increasingly important, says Nel. “A successful healthcare strategy should balance three objectives: affordability, appropriate protection against healthcare costs and sustainable value. Making informed healthcare decisions can be daunting when there are so many different aspects to consider, which is why the annual option review is becoming more important than ever. Take your time and weigh up all the options available to you, with the guidance and support of a professional advisor, to find the best solution that works for your unique needs and budget,” Jacqui concludes.