By Tony Singleton, CEO at Turnberry Management Risk Solutions
21 October 2025
You plan for retirement, save for your child’s education, and try to build a financial cushion, but what happens when medical co-payments chip away at those plans, year after year? It starts small: a R5,000 co-payment for a scope. Then a few months later, a R12,000 shortfall for a hospital admission. Fast forward five years, and you’ve spent tens of thousands on out-of-pocket medical costs that your medical aid didn’t fully cover.
Medical aids cannot keep pace with the rate of medical inflation while still maintaining affordable premiums, so co-payments grow each year, more sub-limits are introduced, and specialist fees continue to outpace medical aid rates. This means more and more South Africans are finding themselves forced to draw from their retirement funds or take on debt to cover medical aid shortfalls. Medical aid alone is no longer enough to protect your financial future – gap cover has become essential.
How medical expense shortfalls silently accumulate
Medical scheme members, especially those on higher-end plans, often assume they are covered for any medical eventuality – until it is time to actually claim for a significant medical event. Even comprehensive plans can fall short when it comes to specialist charges, hospital procedures, or newer, high-tech treatments. Many specialists charge as much as five or six times the scheme rate, and certain procedures have limits to what medical aid will pay or require an up-front co-payment. While your medical aid might pay a portion, the remainder becomes your responsibility.
This can become a compounding problem. What starts as a few isolated bills adds up. Over time, shortfalls from surgeries, diagnostics, scopes, chronic illness treatment, or specialist consultations can add up to hundreds of thousands of Rands. For example, one Turnberry client managing spinal conditions, lupus, and gastro-oesophageal reflux disease (GERD) claimed R478,000 across 27 incidents in only five years. Another has claimed R450,000 across 54 incidents related to lung disease and spinal conditions, and a third, with multiple chronic issues, has received over R448,000 in gap cover payments over the same period. As the years go by, these amounts continue to add up, and this is becoming an increasingly typical pattern. Many families are forced to pause investments, take out loans, or remove money from their retirement annuities to keep up with these uncovered and unanticipated expenses.
Gap cover has become essential
Gap cover was created precisely to tackle these medical expense shortfalls, with an affordable policy that sits alongside medical aid and offers cover for medical expense shortfalls, co-payments, sub-limit cover, oncology shortfalls, prosthesis costs, and even casualty visits. Where medical aid benefits have tightened to control premiums, gap cover has expanded to fill the void.
Many South Africans still believe gap cover is a nice-to-have or something that is only necessary later in life. The reality, though, is that shortfalls affect people no matter what age they are, from broken bones in their 20s to maternity bills in their 30s or chronic conditions emerging in their 40s and beyond. Joining early also makes a difference, as you are covered from the start and your premiums will remain lower than someone beginning their cover at 65, when age-based premium increases and health exclusions may apply. Gap cover is not just for major surgeries or cancer treatments; it is valuable for more routine procedures as well as accidents and emergencies. And its value increases over time, especially if you remain continuously covered and avoid reintroducing waiting periods.
A long-term strategy, not a short-term fix
By staying on gap cover year after year, members build a stable financial buffer against the cumulative effect of medical costs. We’ve seen clients rely on gap cover for decades of health events, not just one-off emergencies, and the value of continuous cover is evident in our lifetime claims figures. Gap cover is no longer a luxury, it is an essential tool for building long-term financial resilience. Without it, medical aid shortfalls can easily undo years of careful financial planning. Talk to your broker about finding the best gap cover solution to fit your needs.
About Turnberry Management Risk Solutions
Founded in 2001, Turnberry is a registered financial services provider (FSP no. 36571) that specialises in Accident and Health Insurance, Travel Insurance, and Funeral Cover.
With extensive experience across healthcare and insurance industries in South Africa, Turnberry offers unsurpassed service to Brokers and clients. Turnberry’s gap cover products are available to clients on all medical aid schemes, as they are independently provided and are therefore transferable in the event of a change in the client’s medical aid scheme.
Turnberry is well represented nationally, with its Head Office based in Bedfordview, Johannesburg with Business Development Managers in Cape Town and Durban. The Turnberry Team’s focus on outstanding client service comes from having extensive knowledge and experience in the financial services sector and is underwritten by Lombard Insurance Company Limited. Lombard Insurance Company Limited is an Authorised Financial Services Provider (FSP 1596) and Insurer conducting non-life insurance business.
