Claiming Out-of-Pocket Medical Expenses in South Africa

Medical costs you pay yourself, the ones your medical scheme does not cover, can reduce your tax through the section 6B additional medical expenses tax credit. For a person under 65 with no disability, this credit is 25% of the amount by which your qualifying out-of-pocket expenses (plus any scheme fees above four times your annual section 6A credit) exceed 7.5% of your taxable income. Because of that 7.5% floor, modest out-of-pocket costs often produce no credit at all.

This is a separate mechanism from the monthly section 6A medical scheme fees tax credit. The 6A credit is a fixed monthly amount for belonging to a medical scheme. The 6B credit is the one that deals with the extra costs you carry yourself.

The two medical credits, kept apart

There are two credits, and they are calculated differently.

The section 6A medical scheme fees tax credit is a fixed monthly amount, given because you contribute to a registered medical scheme. For the 2026 year of assessment 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 a percentage-based credit for two kinds of spending: qualifying medical costs you paid out of your own pocket, and any medical scheme contributions that exceed four times your annual 6A credit. Both credits reduce tax owed directly, rand for rand, rather than lowering the income your tax is calculated on.

The section 6B rule for a person under 65

If you are under 65 and no member of your household has a disability as defined, the 6B credit is worked out like this.

1. Start with your qualifying out-of-pocket medical expenses for the year.
2. Add the amount by which your medical scheme fees exceed four times your annual section 6A credit.
3. Subtract 7.5% of your taxable income from that total.
4. If the result is positive, your 6B credit is 25% of it. If the result is zero or negative, there is no 6B credit.

The 7.5% figure is a floor, not a starting point. You only get a credit on the part of your qualifying spending that sits above 7.5% of taxable income. This is why someone with a reasonable income and only a few thousand rand of out-of-pocket costs usually claims nothing under 6B: their spending never climbs above the floor.

Qualifying out-of-pocket expenses are amounts you actually paid and were not reimbursed for: doctor and specialist accounts, prescribed medicine, dentistry, optometry, and similar costs that SARS recognises. Keep the invoices and proof of payment, because SARS can ask for them.

A worked example

Take a single member of a medical scheme, under 65, with no disability, and a taxable income of R400,000 for the 2026 year of assessment. During the year the scheme paid its share, but this person also paid R40,000 of qualifying medical costs out of pocket, and paid R20,000 in scheme contributions.

Step one, the annual section 6A credit. As a main member with no dependants, the monthly credit is R364:

R364 × 12 = R4,368

Step two, four times that annual credit:

4 × R4,368 = R17,472

Step three, scheme fees above the four-times cap. Contributions were R20,000:

R20,000 − R17,472 = R2,528

Step four, add that excess to the out-of-pocket costs:

R2,528 + R40,000 = R42,528

Step five, the 7.5% floor on taxable income:

7.5% × R400,000 = R30,000

Step six, the amount above the floor:

R42,528 − R30,000 = R12,528

Step seven, the 6B credit is 25% of that:

25% × R12,528 = R3,132

So this person's additional medical expenses tax credit is R3,132. That amount comes off the tax they owe, on top of the section 6A credit of R4,368 they already receive for scheme membership.

Notice how much spending it took to get there. Had the out-of-pocket costs been R10,000 instead of R40,000, the total in step four would have been R12,528, which is below the R30,000 floor, and the 6B credit would have been zero.

Why the floor matters

The 7.5% floor is the reason many people who pay for their own medicine or dental work still see no benefit under 6B. On a taxable income of R400,000 the floor is R30,000, so only qualifying spending above R30,000 counts. On higher incomes the floor is higher still. The credit is built for years where medical costs run unusually heavy relative to income, which is a different case from ordinary top-up spending that a scheme mostly covers.

If you are 65 or older, or you or a dependant has a disability as defined, a more generous route applies at 33.3% and without the 7.5% floor. The mechanics of that route are different and are not covered here.