The Disability Route to the Medical Tax Credit in South Africa
If you, your spouse or a dependant has a disability that SARS has confirmed on an ITR-DD form, your additional medical expenses tax credit is worked out on a more generous basis: 33.3% of your qualifying costs, with no 7.5%-of-income floor to clear first. This is the section 6B credit, and the disability version is far easier to benefit from than the ordinary route for a person under 65. The one gate is that a registered medical practitioner must complete the ITR-DD confirmation of disability, and SARS must accept it.
The word "disability" here is a defined term, not a general description of ill health. It means a moderate to severe limitation of a person's ability to function or perform daily activities, expected to last more than a year, and diagnosed by a duly registered medical practitioner on the ITR-DD.
Two credits, and where the disability route sits
Medical costs give rise to two separate credits, and it helps to keep them apart.
The section 6A medical scheme fees tax credit is a fixed monthly amount for belonging to a registered medical scheme. For the 2026 year of assessment (1 March 2025 to 28 February 2026) it is:
| Who | Monthly section 6A credit |
|---|---|
| Main member | R364 |
| First dependant | R364 |
| Each additional dependant | R246 |
The section 6B additional medical expenses tax credit is the percentage-based credit for the costs the scheme does not carry. How 6B is calculated depends on your circumstances, and disability changes the formula in two important ways.
How the disability formula differs
For a person under 65 with no disability in the household, 6B is 25% of the amount by which qualifying out-of-pocket costs (plus scheme fees above four times the annual 6A credit) exceed 7.5% of taxable income. That 7.5% floor wipes out the claim for most people with ordinary top-up spending.
Where a person, their spouse or a dependant has a confirmed disability, two things change:
- The rate rises from 25% to 33.3%.
- The 7.5% floor falls away entirely, and the scheme-fees multiple drops from four times to three times the annual 6A credit.
So the disability version is 33.3% of scheme fees above three times the annual 6A credit, plus 33.3% of all qualifying out-of-pocket medical expenses, with no income floor. Every rand of qualifying spending counts, from the first rand.
A worked example for the 2026 year of assessment
Take a taxpayer who is the main member of a medical scheme with one dependant, a child who is a person with a disability confirmed on an ITR-DD. In the 2026 year the taxpayer paid R40,000 in scheme contributions and R30,000 of qualifying out-of-pocket costs related to the child's care.
Step one, the annual 6A credit. Main member plus one dependant is R364 + R364 = R728 a month:
- R728 × 12 = R8,736
Step two, three times that annual credit (the disability multiple):
- 3 × R8,736 = R26,208
Step three, scheme fees above the three-times amount:
- R40,000 − R26,208 = R13,792
Step four, add the out-of-pocket costs. On the disability route there is no 7.5% floor, so the full R30,000 goes in:
- R13,792 + R30,000 = R43,792
Step five, the 6B credit is 33.3% of that total:
- 33.3% × R43,792 = R14,583
The additional medical expenses tax credit is R14,583, and it comes straight off the tax owed, on top of the R8,736 section 6A credit for scheme membership.
Compare the ordinary under-65 route. There, the R30,000 out-of-pocket would first be reduced by 7.5% of taxable income before anything counted, and only a quarter of whatever survived would become a credit. On a taxable income of R400,000 the floor alone is R30,000, so most of the claim would vanish. The disability route removes that hurdle.
The ITR-DD and keeping it valid
The disability treatment stands on the ITR-DD confirmation. A registered practitioner completes it, and it is valid for a set period: a permanent disability confirmation generally lasts around ten years before it must be renewed, while a temporary one covers a shorter period. Keep the form and your medical invoices, because SARS can request them when it assesses your ITR12 return.
Frequently asked questions
What is the ITR-DD and why does it matter?
The ITR-DD is the SARS Confirmation of Diagnosis of Disability form, completed by a registered medical practitioner. Without an accepted ITR-DD you cannot use the 33.3% disability route, and your out-of-pocket costs fall under the ordinary under-65 rules with the 7.5% floor. It is the single document that unlocks the more generous calculation.
Does the disability have to be my own?
No. The disability route applies where you, your spouse, or a dependant as defined has the confirmed disability. The qualifying costs are those you pay in relation to that person, and the 33.3% rate and the removal of the 7.5% floor apply to your section 6B calculation.
Is 33.3% a deduction from income or a credit against tax?
It is a credit, meaning it reduces the tax you owe rand for rand, not the income your tax is calculated on. That is generally more valuable than a deduction, because its worth does not depend on your marginal rate.
What counts as a qualifying out-of-pocket cost?
Amounts you actually paid and were not reimbursed for, including disability-related expenses that SARS recognises, prescribed medicine, therapy, and similar care. SARS publishes a list of qualifying disability expenses. Keep the invoices and proof of payment.
Where do I claim this on my return?
On your annual ITR12 through eFiling. You declare your medical scheme contributions and qualifying out-of-pocket expenses, indicate the disability, and SARS applies the 6A and 6B credits when it works out your assessment. The ITR-DD supports the disability claim if SARS asks.
For the full picture of how both credits work, read our guide to medical tax credits and try the medical tax credit calculator. If no one in your household has a confirmed disability, the different rules for claiming out-of-pocket medical expenses apply instead, and it is worth checking the documents you need to file your return.
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