Maybe you've just turned 65. Maybe you're helping a parent sort out their tax. Either way, the same question comes up: does anything change now? For medical expenses, yes, quite a lot changes. SARS's formula for your Additional Medical Expenses Tax Credit shifts in your favour from the tax year you turn 65.
This post walks through what changes, with a worked example so you can see the difference in Rand, not just percentages.
What are the two medical tax credits?
SARS gives medical scheme members two separate tax credits. It helps to know which is which before we get to the age-65 change.
- The Medical Scheme Fees Tax Credit (MTC) is a fixed monthly amount for belonging to a registered medical scheme. For the 2026 tax year: R364 for the main member, R364 for the first dependant, and R246 for each dependant after that. This applies at any age. It doesn't change when you turn 65.
- The Additional Medical Expenses Tax Credit (AMTC) is a further credit calculated on top of the MTC, based on your medical scheme contributions and whatever qualifying medical expenses you paid out of pocket and never recovered from your scheme. This is the one where age changes everything.
(SARS reviews these Rand amounts most years, so confirm the current tax year's figures at sars.gov.za or with a registered tax practitioner before you calculate anything final. The structure of the formulas below, the percentages, the multiples, the thresholds, has been stable for a long time.)
What changes when you turn 65?
If you're under 65, and there's no disability in the picture for you, your spouse or a dependant, the AMTC formula is:
25% × [ (annual medical scheme contributions − 4 × annual MTC) + other qualifying out-of-pocket expenses − 7.5% × taxable income ], and it never goes below zero.
From the tax year you turn 65, the formula changes. The same formula also applies at any age if you, your spouse or a dependant has a disability confirmed via an ITR-DD form, completed by a registered medical practitioner:
33.3% × [ (annual medical scheme contributions − 3 × annual MTC) + other qualifying out-of-pocket expenses ]
Three things move, and each one helps you:
- The credit rate jumps from 25% to 33.3%. You get back a bigger slice of the same qualifying spend.
- The contributions offset drops from 4× your annual MTC to 3×. More of what you paid your medical scheme counts toward the credit calculation.
- The 7.5%-of-taxable-income reduction disappears entirely. This is the biggest change of all. Under 65, you only start benefiting once your qualifying expenses clear a bar set at 7.5% of your taxable income. For many people that bar is high enough to wipe out most or all of the credit (though the formula never pushes it below zero). At 65, that bar is gone.
If you're helping a parent with this, explain it gently: it isn't a loophole, and there's nothing extra to apply for. It's how SARS's formula is built once you reach this age bracket, or when a disability applies. It rewards the steady, ongoing medical spending that tends to increase later in life.
A worked example: the same numbers, a year apart
Picture a taxpayer with a spouse as a dependant, no other dependants, medical scheme contributions of R60,000 for the year, and R30,000 in other qualifying out-of-pocket expenses that never appeared on the medical scheme certificate. Assume taxable income of R350,000. We'll work out the AMTC twice: once as though this taxpayer were still under 65, and once as though they'd turned 65. Everything else stays the same. Only the formula changes.
Annual MTC for main member plus one dependant: (R364 + R364) × 12 = R8,736. This figure is the same in both calculations. Only the AMTC formula around it changes.
Under 65:
- Contributions minus 4× MTC: R60,000 − (4 × R8,736) = R60,000 − R34,944 = R25,056
- Plus other qualifying expenses: R25,056 + R30,000 = R55,056
- Minus 7.5% of taxable income: R55,056 − (7.5% × R350,000) = R55,056 − R26,250 = R28,806
- AMTC = 25% × R28,806 = R7,201.50
At 65 or older:
- Contributions minus 3× MTC: R60,000 − (3 × R8,736) = R60,000 − R26,208 = R33,792
- Plus other qualifying expenses: R33,792 + R30,000 = R63,792
- No income reduction applied
- AMTC = 33.3% × R63,792 = roughly R21,243
Same medical scheme, same contributions, same receipts, same taxable income. The AMTC nearly triples, from about R7,200 to about R21,200. That's why it's worth checking your numbers, or your parent's, again in the year the 65th birthday falls, rather than assuming the claim looks the same as last year's.
Why this matters
A few things tend to add up around this age. That's part of why the formula is built this way:
- Medical spend often rises: more specialists, more chronic medication, more procedures not fully covered by a scheme's benefit limits.
- Retirees are often on a fixed income, so every Rand of tax credit recovered matters more.
- Disability or frailty-related costs (home nursing, mobility equipment, assistive devices) start appearing too, and some may qualify under the disability provisions even before you turn 65. If that applies to your situation, our post on the medical tax credit for disability and caregivers covers the overlap.
The risk is that whoever does the tax return, the taxpayer or an adult child helping out, just carries over last year's approach and doesn't realise the formula has shifted. Given how large the difference can be, that's an expensive mistake to repeat every year.
The real work: finding the R30,000
The formula change only pays off if the R30,000 (or whatever the real figure is) in "other qualifying out-of-pocket expenses" is documented and correctly claimed. That number is SARS code 4034 on the ITR12: the qualifying expenses that never appear on any medical scheme certificate, because they were paid directly and never claimed back from the scheme. Unlike the contributions figure, which the scheme hands you on a single certificate, this one has to be reconstructed from a year of receipts, invoices and bank statements.
For many people, especially an elderly parent who may not have kept things as tidy as they'd like, that reconstruction is the hard part, not the arithmetic. For the fuller picture of how that figure is built, and why it's so often under-claimed, our post on Code 4034 and the receipt pile goes through it in detail. Our documents checklist lists what to gather.
How SecureSlip fits in
This is the gap SecureSlip was built to close. You send through a year's medical documents: receipts and invoices, the medical scheme's tax certificates and claims extract, bank or credit-card statements for the year, and proof of the relationship if you're claiming for a spouse or dependant. Private, on-device AI reads and classifies every document, so your medical and banking records don't need to leave the device for a third-party cloud service. Every figure it extracts is then cross-checked by deterministic arithmetic (the AI never totals anything itself), and anything uncertain is flagged for a human reviewer before it's finalised.
The result is a numbered, submission-ready pack: a schedule and cover letter you or your tax practitioner can use to file. SecureSlip prepares the supporting documentation. It doesn't file your return for you. In one real, SARS-verified case in our files, 155 source documents were reconciled this way into a verified R177,459.64 in additional out-of-pocket expenses across 68 line items, money that had never appeared on any medical scheme certificate. That's one real case. Everyone's year is different, so treat it as an example, not a promise. It shows the scale of what can sit unclaimed in a thorough year's worth of receipts.
If you'd like a rough sense of what this age-65 shift is worth in your situation, our free calculator walks through the same formula shown above. If you want to understand the full process before sending anything through, how it works sets it out step by step.
This article is general information, not tax advice. The Rand amounts and thresholds mentioned may change from one tax year to the next, so confirm the figures that apply to your specific tax year with SARS or a registered tax practitioner before you file.
If you'd like help turning a year of documents into a reconciled claim, try our free estimator at /calculator, read more about the process at /how-it-works, or get in touch if you have questions about your own situation.