Medical Expenses You Can Claim from SARS: Credits, Not Deductions
The single most common mistake about medical tax in South Africa is treating it as a deduction. It is not. Since 2012 the system has run on credits — fixed rand amounts subtracted from the tax you owe, rather than amounts subtracted from the income you are taxed on.
The difference matters. A deduction is worth more to a high earner than a low earner, because it removes income from the top of their bracket. A credit is worth exactly the same to both, because it comes off the tax itself. That was the point of the change.
There are two separate mechanisms, and they behave very differently.
The Medical Scheme Fees Tax Credit
This one is simple, fixed, and automatic. For the 2026/27 tax year:
| Members | Credit per month |
|---|---|
| Main member | R376 |
| First dependant | R376 |
| Each additional dependant | R254 |
A family of four — main member, spouse, two children — receives R376 + R376 + R254 + R254 = R1,260 a month, or R15,120 for the year, off their tax.
Three things worth knowing:
- It does not depend on what you pay. Whether your contribution is R2,000 or R9,000 a month, the credit is the same. It depends only on how many people are on the scheme.
- It goes to whoever pays. The credit belongs to the person who pays the contributions, which is usually but not always the main member.
- It should already be in your PAYE. Your employer applies it monthly if the scheme is run through payroll. If you pay privately, you claim it on assessment — and this is a common reason people who pay their own medical aid get a refund.
Check your payslip. If you are on a medical scheme and no credit appears, you are paying too much PAYE every month. Our medical tax credit calculator gives the figure for any household size.
The Additional Medical Expenses Tax Credit
This is the one people ask about, and the one that rarely pays out for anyone under 65 in ordinary health.
It covers two things: contributions above a multiple of your scheme credit, and qualifying out-of-pocket medical costs your scheme did not pay. How they combine depends on your circumstances.
If you are under 65 with no disability in the family, the sum works like this: take your excess contributions plus your out-of-pocket costs, subtract 7.5% of your taxable income, and you get 25% of whatever remains.
That 7.5% threshold is why most people get nothing. On a taxable income of R500,000, the first R37,500 of qualifying medical spending produces no credit at all. You need genuinely large unrecovered costs before anything survives the subtraction — and then only a quarter of the excess comes back.
If you are 65 or older, or a member of the household has a SARS-recognised disability, the rules are materially more generous: the 7.5% threshold falls away, a smaller multiple applies to contributions, and the rate is 33.3% rather than 25%.
That second case is where the AMTC genuinely matters, and where it is most often missed.
Why our calculator deliberately stops short
Our medical tax credit calculator computes the scheme fees credit and does not compute the AMTC. That is a deliberate boundary, not an oversight.
The AMTC formula changes shape depending on age, disability status and taxable income, and a disability claim requires a completed ITR-DD confirmed by a registered practitioner. A calculator that produced a confident number from three inputs would be wrong often enough to be harmful — and people plan around these figures.
So the tool gives you the part that is fixed and certain, names the AMTC explicitly, and points you at SARS or a practitioner for the part that is not. Where an amount is a guideline rather than a formula, we would rather say so than guess.
A worked example of the threshold
Take a family of four on a taxable income of R600,000, paying R7,500 a month to their scheme, with R18,000 of out-of-pocket costs the scheme did not cover during the year.
Their scheme fees credit is fixed: R376 + R376 + R254 + R254 = R1,260 a month, or R15,120 off their tax for the year. That part is certain and requires no calculation beyond counting members.
Now the additional credit. The 7.5% threshold on R600,000 is R45,000. Their qualifying spend has to exceed that before anything comes back. Out-of-pocket costs are R18,000, and only contributions above four times the scheme credit count toward the rest — four times R15,120 is R60,480, against annual contributions of R90,000, leaving R29,520.
Added together that is R47,520, which exceeds the R45,000 threshold by R2,520. A quarter of that is R630.
So a family spending R108,000 across contributions and unrecovered costs receives R15,120 automatically and R630 from the additional credit. The second figure is not a mistake; it is how the mechanism is designed. It is relief for catastrophic cost, not for ordinary medical spending.
Change one fact — make a household member 65 or older, or bring a recognised disability into the family — and the threshold disappears, the multiple drops, and the rate rises to a third. The same numbers then produce several thousand rand rather than several hundred. That is why the age and disability question is the first one to establish, not the last.
When the scheme year and the tax year disagree
Most medical schemes run on a calendar year and the tax year ends on 28 February. That two-month offset causes two recurring problems at filing time.
First, the tax certificate your scheme issues covers the tax year, not the scheme year, so it will not match the benefit statement you have been reading all year. Use the tax certificate.
Second, a January or February expense sits in the tax year that is about to close, while the scheme has already rolled into a new benefit cycle. If you are close to the 7.5% threshold, the timing of an elective procedure across that boundary genuinely changes the outcome. It is one of the few places where scheduling a cost a few weeks earlier or later has a tax consequence worth thinking about.
What actually qualifies as an out-of-pocket expense
Only amounts you paid and your scheme did not reimburse, and only for services by a registered practitioner:
- Doctors, dentists, specialists, hospitals, and registered nurses
- Prescribed medicines from a pharmacist — prescribed, which excludes most over-the-counter purchases
- Physiotherapy, optometry and similar, where properly registered
- Certain expenses relating to a disability, which have their own list
What does not qualify: cosmetic procedures, gym memberships, supplements bought off a shelf, and anything your scheme paid on your behalf. If the scheme covered it, it is not your expense.
Keep the invoices and the scheme's statement showing what was not paid. That statement is the document SARS asks for, and it is the one people never think to download.
Where this sits in the wider picture
Medical credits reduce tax; they do not make cover cheap. The decision about which scheme and which plan is a separate question, and a much larger amount of money.
Two related points people conflate. Gap cover is not medical aid and its premiums do not attract the scheme fees credit — it is a short-term insurance product covering shortfalls between what a specialist charges and what your scheme pays. And hospital plans do attract the credit, because they are registered medical schemes, even though they cover far less than a comprehensive option.
If you are reviewing cover rather than tax, start with comparing medical aid options.
Practical points
- Check your payslip for the credit. Its absence is the most common and most easily fixed error.
- If you pay privately, claim it. It does not apply itself.
- Download the annual scheme statement — the one showing claims not paid — before filing.
- Do the 7.5% sum before hoping for an AMTC refund. Most people under 65 will not clear it.
- If disability applies, get the ITR-DD completed. It changes the calculation substantially and is valid for several years.
- Do not confuse gap cover with medical aid when totalling contributions.
Frequently asked questions
Is my medical aid contribution tax deductible?
No. It gives you a fixed monthly credit — R376 for the main member and first dependant, R254 for each additional one — which comes off your tax rather than off your income.
Can I claim medical expenses if I am not on a scheme?
Yes, out-of-pocket qualifying expenses can go through the AMTC even without scheme membership. The same 7.5% threshold applies if you are under 65, so a claim rarely survives it.
Does the credit change if my contribution goes up?
No. It depends only on the number of people on the scheme, not on what you pay.
