The short version
- Emergency and PMB-related surgery that requires a prosthesis is covered on every registered option, but the scheme may still apply a prosthesis sub-limit and require a designated supplier.
- Elective joint replacement typically carries a substantial fixed co-payment. Several 2026 brochures publish the exact rand co-payment for hip, knee and cataract procedures.
- External appliances such as hearing aids and wheelchairs are usually funded from a separate appliance limit granted on a multi-year cycle.
- Where a scheme uses a designated prosthesis supplier, going elsewhere shifts the price difference onto you.
Computed from 2026 plan data
Cheapest plan with any-private-hospital access
Fedhealth flexiFED 1Elect HospitalR2 051 a month with no hospital network restriction.
Cheapest hospital-only plan
Fedhealth flexiFEDSavvy HospitalR1 155 a month for in-hospital cover plus PMBs.
Widest chronic condition list
Medshield MediBonusCovers 71 chronic conditions (27 PMB plus 44 additional).
Computed from published 2026 contributions and brochure figures. Not financial advice.
What the 2026 brochures say
Verbatim mentions from each scheme's own 2026 brochure summary.
A 30% co-payment applies for not using a hospital on the applicable network. Co-payments also apply to certain procedures including but not limited to: R38,560 for hip and knee replacements, R7,420 for cataract surgery, and R2,800 for MRI/CT scans. Using a DSP can help avoid some co-payments.
R2 800 co-payment per scan event except for PMB for MRIs and CT scans. 20% co-payment for non-network or non-formulary use in above threshold benefit for acute and over-the-counter medicine. A 20% co-payment applies when homeopathic medicine is paid from above threshold benefit. Avoid a 10% co-payment by using a DSP for hearing aids.
R2 800 co-payment per scan event except for PMB for MRIs and CT scans. 20% co-payment for non-network or non-formulary use in above threshold benefit for acute and over-the-counter medicine. A 20% co-payment applies when homeopathic medicine is paid from above threshold benefit. Avoid a 10% co-payment by using a DSP for hearing aids.
Top-tier flexiFED hospital plan with prosthesis benefits
Comprehensive oncology, mental health & prosthetics
Comprehensive in-hospital, oncology & prosthetics cover
Comprehensive oncology, mental health and prosthesis cover
Comprehensive oncology, mental health & prosthetics
Designed for affordable scheme membership
87 of 95 plans in our 2026 data don't mention this in the brochure summary we hold. That doesn't mean they exclude it — check the plan's own brochure.
Where our data stops
Our 2026 data set does not carry a typed prosthesis sub-limit per plan. What it does carry, and what we show below, is each plan's published hospital co-payment notes — which is where the joint-replacement and device co-payments appear verbatim.
Questions people ask
Does medical aid cover a hip or knee replacement?
Yes, as an in-hospital procedure with pre-authorisation, but most 2026 options apply a fixed co-payment for elective joint replacement and cap what they pay for the prosthesis itself. Both amounts are published in the scheme's 2026 brochure; where we hold the co-payment note it is quoted on the plan page.
Are hearing aids covered?
Usually from a separate appliance or external device benefit, granted on a two- or three-year cycle, rather than from the hospital benefit. Entry-level and hospital-only plans often exclude them entirely.
What is the difference between an internal and an external prosthesis?
An internal prosthesis is implanted during surgery — a joint, a stent, a pacemaker, a spinal cage. An external prosthesis is worn or used outside the body — a limb prosthesis, a brace, a wheelchair. They are funded from different benefits with very different limits.
Will gap cover pay the prosthesis shortfall?
Gap cover pays the shortfall between the provider's fee and the scheme rate for in-hospital treatment, subject to the annual limit set by regulation. Some gap products also offer a separate co-payment benefit that covers a fixed procedure co-payment. It does not top up a prosthesis sub-limit unless the product specifically says so.
Related on Medical Aid Online
Sources
This guide is general information, not financial or medical advice. Medical Aid Online is not a medical scheme. Scheme rules and benefits change every year, so check the scheme's own rules and brochure before you decide.
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