Medical Aid Tax Credits in 2026: What You Actually Get Back
How South African medical tax credits work in 2026: the flat Section 6A scheme credit, the Section 6B out-of-pocket credit, and a full worked family example.
Published 2026-06-01 · Updated 2026-06-29
A credit, not a deduction — and why that one word changes everything
Most tax breaks you hear about are deductions. A retirement annuity contribution, for example, comes off your taxable income before SARS works out what you owe, so a R10,000 contribution saves a 36%-bracket taxpayer R3,600 but only saves an 18%-bracket taxpayer R1,800. The richer you are, the more a deduction is worth. Medical scheme contributions used to work that way too, until 2012.
The Section 6A medical scheme fees tax credit is different. It is a credit — it comes off the tax you owe, rand for rand, after SARS has already calculated your liability. A R14,640 credit wipes out R14,640 of tax whether you earn R200,000 or R2,000,000. Your marginal bracket is irrelevant. This was a deliberate policy choice: the old deduction handed the biggest subsidy to high earners, and converting it to a flat credit spread the benefit more evenly across the income scale.
The practical consequence is that you should stop thinking of your medical aid as something that 'reduces your taxable income'. It does not. It reduces your final tax bill by a fixed monthly amount per person on the scheme, set by National Treasury, regardless of what you actually pay your scheme each month. Whether your plan costs R3,000 or R9,000 per member, the 6A credit per member is exactly the same.
The 2026 Section 6A numbers, member by member
For the 2026 tax year the monthly credits are R364 for the main member, R364 for the first dependant, and R246 for each additional dependant. 'Dependant' here means anyone registered on your medical scheme — spouse, children, or other dependants the scheme recognises. It is the headcount on the scheme that matters, not who pays the premium.
Work it as a simple monthly sum. A single person gets R364 a month, which is R4,368 a year. A couple gets R364 + R364 = R728 a month, or R8,736 a year. Add one child and you add R246, taking it to R974 a month. The numbers are flat per head, so the arithmetic never gets complicated — you are only ever adding R364s and R246s.
One detail that trips people up: the credit is tied to who is the registered main member and who is paying. If your employer deducts the medical aid from your salary, the 6A credit is usually already baked into your monthly PAYE, so you see the benefit as slightly higher take-home pay rather than a refund at year-end. If you pay your scheme privately from after-tax money, you claim the full credit on assessment and it comes back as a refund. Either way the annual total is identical.
Worked example: a family of four on R450,000 taxable income
Take the Naidoos: two adults, two children, all four on the same medical scheme. The 6A credit is R364 (main) + R364 (first dependant) + R246 + R246 (two additional dependants) = R1,220 a month. Over twelve months that is R14,640 — a fixed reduction in their tax bill before we even look at out-of-pocket costs. Say they earn R450,000 in taxable income and pay R6,500 a month (R78,000 a year) to the scheme.
Now the Section 6B additional medical expenses tax credit, which is meant for the gap between what the scheme covers and what you actually spend. For under-65s with no disability, SARS first takes your total contributions and subtracts four times the annual 6A credit: R78,000 − (4 × R14,640) = R19,440. It adds your qualifying out-of-pocket spend — say R18,000 in co-payments, dentistry and prescriptions the scheme did not cover — giving a pool of R37,440. From that it subtracts 7.5% of taxable income, which is R33,750. Only R3,690 survives, and you get 25% of it: a Section 6B credit of R922.50.
So the Naidoos' total medical tax benefit for the year is R14,640 + R922.50 = R15,562.50. The 6A portion is rock-solid and automatic; the 6B portion is small and only appears because their out-of-pocket spend was high relative to income. Most healthy families on medical aid get little or no 6B at all — the 7.5% threshold is steep, and a family on R450,000 has to clear R33,750 of qualifying spend (over and above the contribution offset) before a single rand of 6B kicks in.
Why the credit does not scale with your marginal rate
Here is the part worth internalising. The Naidoos' R14,640 6A credit is worth exactly R14,640 to them — and it would be worth exactly R14,640 to a household earning R1.5 million on the same four-person scheme. Compare that to what would happen if their R78,000 of contributions were instead a deduction: at 18% it would save R14,040, at 31% it would save R24,180, and at 45% it would save R35,100. The flat credit gives the lower earner slightly more than a deduction would, and the high earner dramatically less.
The crossover sits right at the bottom bracket. A R14,640 credit against R78,000 of contributions behaves like an effective 'rate' of about 18.8% — just above the 18% first bracket. So for anyone in the 18% bracket, the credit is marginally better than a deduction would have been; for everyone above that, the credit is worse than the old deduction, by a margin that widens with income. That is the redistribution the 2012 reform was designed to achieve, and it is why high earners quietly grumble about it.
The takeaway for planning is blunt: do not expect a fancier, more expensive medical plan to buy you a bigger tax break. The 6A credit is per person, not per rand. Upgrading from a R4,000 plan to an R8,000 plan doubles your premium and changes your 6A credit by zero. The only lever that moves 6A is the number of people on the scheme.
Over-65, disability, and the more generous 6B treatment
The harsh 7.5%-of-income threshold and the 25% haircut apply only to under-65s without a disability. If you, your spouse, or a dependant is 65 or older, or if anyone in the household has a disability as defined for tax (confirmed on the prescribed SARS form by a registered practitioner), the Section 6B calculation flips to a far more generous basis. The 7.5% threshold falls away, and a much larger share of both the unused 6A contributions and the out-of-pocket spend converts into credit — 33.3% rather than 25% for the qualifying components.
In plain terms, an over-65 couple or a family supporting a disabled dependant recovers a meaningfully larger chunk of their real medical costs through the tax system than a healthy under-65 household does. If the Naidoos were instead a retired couple aged 68 with the same R18,000 of out-of-pocket spend and R78,000 of contributions, their 6B credit would run into several thousand rand rather than under a thousand, because there is no 7.5% threshold eating the first R33,750.
This is the single biggest reason to keep meticulous records of co-payments, prescriptions, and any medical expense the scheme declined — especially once anyone in the household turns 65 or qualifies on disability grounds. Under-65 households often skip the 6B claim because the threshold makes it worthless, but the same paperwork can be worth real money the moment the more generous rules apply. Keep every statement and the scheme's annual tax certificate, which lists both contributions and the claims it did not pay.
Run your own numbers before you file
The shape of your medical tax benefit is mostly decided for you: count the people on your scheme, multiply by the R364 and R246 monthly figures, and you have your 6A credit to the rand. The 6B side is where individual circumstances — taxable income, out-of-pocket spend, age, and disability status — swing the answer from nothing to a few thousand rand. The only way to know which side of the 7.5% threshold you land on is to plug in your actual figures.
If you are weighing medical aid against other tax-efficient moves like a retirement annuity or a tax-free savings account, it helps to see them side by side, because RA contributions are deductions that do scale with your bracket while the medical credit does not. Our tax tool lets you model your RA, TFSA and overall tax position for the 2026 year so you can see where each rand of contribution is actually working hardest.
This is general information, not personalised financial advice — your scheme's tax certificate and your specific income will determine the final figures on assessment. Run the numbers for your own household, and check whether you, your spouse or a dependant crosses the over-65 or disability line, because that single fact can more than double the out-of-pocket portion you get back.
Run the numbers yourself
Open the tax tool to model your RA, TFSA and 2026 tax position
Open the toolFAQ
How much is the medical tax credit per person in 2026?
For the 2026 tax year the Section 6A medical scheme fees tax credit is R364 a month for the main member, R364 for the first dependant, and R246 for each additional dependant on the scheme. A family of four therefore gets R364 + R364 + R246 + R246 = R1,220 a month, which is R14,640 a year. It is a credit off your tax owed, not a deduction off your income.
Does a more expensive medical aid give me a bigger tax credit?
No. The Section 6A credit is a fixed amount per person on the scheme, not a percentage of what you pay. Upgrading from a R4,000-a-month plan to an R8,000-a-month plan doubles your premium but changes your 6A credit by exactly zero. The only thing that increases 6A is adding more people to the scheme.
Why doesn't my medical aid reduce my taxable income like my retirement annuity does?
Because medical scheme contributions stopped being a deduction in 2012 and became a flat tax credit instead. A deduction scales with your marginal rate — worth more to high earners — whereas the medical credit is the same rand amount for everyone. That is why a R14,640 credit is worth R14,640 whether you are in the 18% bracket or the 45% bracket.
How does the Section 6B out-of-pocket credit work for under-65s?
SARS takes your annual contributions, subtracts four times your annual 6A credit, adds your qualifying out-of-pocket medical spend, then subtracts 7.5% of your taxable income. You get 25% of whatever is left. The 7.5% threshold is high, so most healthy under-65 families get little or no 6B — but over-65s and people with a disability are taxed on a more generous basis with no 7.5% threshold and a 33.3% rate.