Can I claim out-of-pocket medical expenses that medical aid did not pay?

Direct answer

An expense your medical aid did not reimburse is not automatically a tax deduction. It can be relevant to the additional medical expenses tax credit, but the taxpayer's circumstances, qualifying nature of the cost, medical scheme information and current statutory calculation all matter.

Do not rely on the total you paid from your bank account. Keep provider invoices, receipts, proof of payment and the scheme's remittance advice so the expense can be identified accurately.

What this means in practice

Medical schemes can decline, partially pay or apply a co-payment to a claim. Those outcomes do not by themselves decide the tax result. The tax analysis asks different questions, including whether the expense is of a qualifying kind, who paid it, which tax year it relates to and what the relevant medical tax credit rules provide.

The annual medical scheme tax certificate is important, but it may not contain every out-of-pocket payment. Pair it with invoices and remittance advice. The remittance advice helps distinguish between amounts paid by the scheme, rejected claims, member co-payments and amounts that were never submitted to the scheme.

Avoid broad categories such as wellness, supplements or general household costs unless you have checked the applicable tax guidance. An invoice from a healthcare business is not automatically proof that the amount qualifies. Disability-related expenses can require additional, specific evidence and should be handled carefully.

Step-by-step

1. Gather the annual medical certificate.

Download the certificate for the correct tax year and retain it with your return records. Check that the member and dependant details are accurate.

1. Organise invoices and receipts.

Record provider, date, service, amount and patient. Match each invoice to proof of payment and, where applicable, a prescription or referral.

1. Obtain remittance advice.

Keep the scheme's statement showing what it paid, rejected or left for the member. Do not treat the full provider invoice as unreimbursed where the scheme paid part.

1. Separate years and taxpayers.

A medical bill may be received or paid in a different period from treatment. Keep dates clear and do not claim the same expense under more than one taxpayer.

1. Check the return from evidence.

Use current SARS guidance and supporting documents. If an item is unusual, material or disability related, obtain advice rather than guessing.

1. Save the assessment and records.

Retain the certificate, invoices, proof, remittance advice, ITR12 and ITA34. SARS may request these during verification.

Documents and records to keep

• Medical scheme tax certificate and membership schedule.
• Provider invoices, receipts and proof of payment.
• Scheme remittance advice and rejected-claim correspondence.
• Prescriptions or referrals where relevant.
• ITR12, ITA34 and advice for material or disability-related costs.

Important limits and exceptions

This article does not say every unreimbursed healthcare payment qualifies. It does not calculate a threshold or the final credit, because those depend on the applicable tax year and personal circumstances. It is not advice on disputing a medical scheme decision.

Keep disability-related expenses distinct from ordinary expenses. Do not disclose unnecessary sensitive medical information in a general query, but retain the evidence that a qualified adviser or SARS legitimately requires.

When to get tailored advice

Get tailored advice when the expenses are material, involve disability, relate to an adult dependant, arise from foreign treatment, or the scheme and invoices do not reconcile. TaxProof can help prepare an evidence schedule.

An evidence schedule should identify the patient, date, provider, invoice, scheme outcome and amount personally paid. It is more useful than a single annual bank total when completing or verifying a return.

Related TaxProof guides

• How do medical tax credits work?
• Can I claim medical tax credits for my adult dependent child? (B06-IND-007)

Sources

• SARS, Medical tax credits
• SARS, Comprehensive Guide to the ITR12 Income Tax Return for Individuals