The same medical spend can be worth very different amounts.
SARS gives two credits side by side. There’s a fixed monthly rebate for belonging to a medical scheme, and a second credit, the Additional Medical Expenses Tax Credit (AMTC), for medical bills you paid yourself and never submitted to your scheme, along with anything your scheme processed but didn’t pay. The AMTC formula changes with age and disability status. Below is how it works, with worked Rand examples for the 2026 tax year.
You get 25% of what clears the 7.5%-of-income bar.
This is where most working-age taxpayers fall. It rewards a big medical year, like an operation or a new baby, far more than steady, modest spending.
| Taxable income | R280,000 |
| Medical scheme contributions | R33,600 / yr |
| Other qualifying expenses | R8,500 |
| Less 4 × annual MTC for 2026 (R4,368) | − R17,472 |
| Less 7.5% of taxable income | − R21,000 |
At 65 the rate rises to 33.3% and the income test falls away.
From the tax year you turn 65, SARS drops the 7.5%-of-income threshold and lifts the credit rate to 33.3%. The same spend, at the same income, is worth far more. It’s also worth checking whether an earlier year was under-claimed.
Age 64
| Contributions | R33,600 / yr |
| Other expenses | R10,000 |
| Less 4 × MTC | − R17,472 |
| Less 7.5% of R280,000 | − R21,000 |
Age 65, same spend
| Contributions | R33,600 / yr |
| Other expenses | R10,000 |
| Less 3 × MTC | − R13,104 |
| No income threshold | None |
The same treatment applies for disability, at any age.
If you, your spouse, or a dependant has a disability as SARS defines it, confirmed on form ITR-DD by a registered medical practitioner, the same 33.3% rate and no-threshold treatment applies. It often counts against a larger base of therapy, equipment and specialist costs too.
Disability claims use their own out-of-pocket codes. Alongside code 4034, SARS provides code 4022/4023 for disability-linked expenses (the SARS-published list of physical-impairment and disability expenditure) claimed with a valid ITR-DD. We build the pack so each expense sits under the correct code. Mixing them up is one of the commonest reasons disability claims get queried.
| Medical scheme contributions | R28,800 / yr |
| Therapy, equipment, specialist costs | R45,000 |
| Less 3 × annual MTC for 2026 (R4,368) | − R13,104 |
| No income threshold | None |
Generally qualifies
- GP, specialist, dentist and optometrist fees
- Prescribed medicines dispensed by a pharmacy
- Hospital and theatre fees not covered by your scheme
- Home nursing
- Disability-related equipment and therapy
Generally doesn’t
- Over-the-counter medication without a prescription
- Vitamins and supplements not tied to a diagnosed condition
- Purely cosmetic procedures
- Gym memberships and general wellness purchases
- Health food and lifestyle products
The credit reduces tax. It isn't a payout.
The medical tax credits reduce the income tax you owe for the year. If the credit is bigger than the tax you actually paid, the difference is lost: it can't create a refund larger than your tax paid, and it can't be carried to next year. If your taxable income is below the tax threshold, this claim is worth R0 to you. We'll tell you that at triage, before you spend anything.
The worked examples use 2026 tax year figures and are illustrations, not quotes. SARS reviews the Rand value of the medical scheme fees tax credit every year, so confirm the current tax year’s figures at sars.gov.za or with a registered tax practitioner. This page is general information, not tax advice.