Retiring to South Africa? Don't Make This Healthcare Mistake

I thought it was just toothache. In 2025, we were in Hermanas heading along the Garden Route, and suddenly the trip changed. It stopped being about where we were staying, what we were eating, what sightseeing trip we were going to do next. Instead, it became about finding a dentist because I had really, really bad toothache. And if you've ever been unfortunate enough to experience it, you know how painful and completely all-consuming it is. And when you're away from home and in pain and trying to work out what dentist to trust, healthcare suddenly becomes very real. We went from dentist to dentist as one treatment after another on the Garden Route didn't work, and eventually, after rounds of antibiotics and X-rays back in Cape Town, the tooth had to come out. And then this year, I had an implant done privately in South Africa. And this is the bit that really surprised us, because as you'll see, it was less than half the cost of what we would expect to pay privately in the UK, and you can't get an implant done on the NHS. But it wasn't only the price. The care felt much more personal, the bedside manner was better, and the whole thing felt calmer than I expected. But that's only one side of the story, because dental care is one thing, a real emergency is something else completely. So in this video, and after a few people have requested this previously in comments, we're talking about healthcare in South Africa, comparing it with the UK, what is free and what is not, what private healthcare costs, and what medical aid might cost if you are a couple in your 50s or 60s and spending extended lengths of time in South Africa, and what it actually feels like when you genuinely need help. Now, we have used the UK health system our whole lives because that is where we are based, and we have been navigating the South African system for around 12 years, using travel insurance when needed and also paying privately. So this isn't a medical lecture, and honestly, we are not doctors making suggestions to you guys. This is just our honest experience based up with current research and statistics. Because when you move abroad or when you spend time in a country like South Africa, you stop thinking just about the exchange rate and you start asking more serious questions such as, what happens if I get ill? Or what happens maybe if one of us needs a scan? 'Or what happens if we actually need a hospital bed?' And 'What happens if we need ongoing medication?' And some basic questions like, 'How do I get my repeat prescription?' And 'What happens if I genuinely need help urgently and quickly?' So today we're breaking down where the money actually goes in Cape Town compared with the UK, and what that money buys you when you need more than just a 30-day travel insurance policy. Now, this topic matters even more when you are over 50, because when you're younger, healthcare feel like something you only think about if there is an accident. But when you're in your 50s, 60s, or 70s, it changes. You start thinking about things like blood pressure, cholesterol, dental work, eye tests, skin checks, repeat prescriptions, scans, heart health, and the cost of staying well. So the question is not only what happens if I have an emergency, the real question is what does a normal year of healthcare actually cost, and that is where the UK and South Africa can feel really different. So let's start with what we know best, the NHS, or the National Health Service. In the UK, the big comfort is really simple— most care is free at the point of use. You do not normally walk into a hospital thinking, can I afford this? And you don't usually leave A&E, Accident and Emergency, with a huge bill., and for many people that's the big advantage of the UK system. It gives you peace of mind, but there is a trade-off, and that trade-off is time, because as we probably all know, the NHS is under huge pressure. In England, the March 2026 referral to treatment data shows around 7.11 million people on the waiting list. Now, that doesn't mean there are over 7 million separate people because some people are waiting for more than one thing, but it's still a huge number. The same analysis showed a median wait time of just over 11 weeks with around 94,000 people waiting more than a year for treatment. So the UK question is not, can I afford it? It is often, how long will I have to wait? And that is a big emotional difference. In the UK, the bill is mostly hidden, but it's why many people, including me in the past, have taken out private medical cover. And when I had it, my monthly cost with Bupa was around about £140 a month. And I started it just before I turned 60, but I actually, fortunately I guess, never claimed from it. So I cancelled it recently. After all, when you retire, you want to lower your costs as much as possible, so that was one cost that had to go. South Africa is very different. The first thing you need to understand is that there is not one healthcare experience, there are two: public healthcare and private healthcare. And the public system serves most of the population. It's a safety net and it's absolutely vital, and for many, many people in South Africa it is the only option. But it is also under pressure. Only a small percentage of South Africans have medical aid. StatsSA reported that around 14.1% of South Africans had medical aid cover, and in the Western Cape where Cape Town is, that figure was slightly higher at around 23%. %. That tells you something really important. Most people in South Africa are not using private healthcare in the way that many expats would expect to use it. And I want to say this clearly because I know this is going to come up in the comments. Private healthcare in South Africa is not the reality for most people. It's mainly available to people who can afford it— medical aid insurance or a cash treatment— and that is a huge issue. As I said, only 14.1% of South Africans have medical aid or medical insurance. South Africa, as we know, also has very high unemployment. The official unemployment rate was around about 32.7% in the first quarter of 2026. So no, this video isn't saying South African healthcare is amazing for everyone. It's saying this: if you're a foreigner or a tourist or a 50+ expat with the means to pay, you need to understand the private system because that's probably the system that you're going to use. And if you can afford private healthcare, you should not arrive assuming that the public system is your backup plan. The public system is vital, and it's already carrying most of the country. That means you're going to think about private GPs, private dentists, as I've used, private hospitals, taking out medical insurance, or paying for your treatment in cash. And this is the part that most people often miss. They compare the NHS with one GP, cheap GP appointment in Cape Town, but that's not the full comparison. The full comparison is this: in the UK, you have a public system that is familiar and low cost at the point of use, but often really slow and delayed. In South Africa, private healthcare can be quicker and more personal, but you need a plan to pay for it. You may also hear people talk about NHI in South Africa. That stands for National Health Insurance. The idea is to create a more equal healthcare system in South Africa, but right now I would not build my expat healthcare plan around NHI. It has been signed into law, but key parts are still delayed and being legally challenged. So for now, if you're watching this in 2026 and thinking about living extended periods of time in South Africa, spending your winters there, or even retiring there, the practical advice is more simple: plan as if you need private healthcare and understand the costs before you need it. Now let's talk about money, because this is where the two systems feel completely different. In the UK, healthcare is mostly funded through tax and National Insurance. You do not get a separate NHS bill every month, but of course you're still paying into the system. So for example, if someone earns around about £35,000 a year in the UK, their income tax and their employee National Insurance could be roughly around about £6,000 £6,000 a year. Now, this isn't an NHS premium. It pays for more than just healthcare, but it gives you a sense of how the UK system is funded. In South Africa, the cost is much more obvious. If you want private healthcare, you normally need to have medical aid, and medical aid can be a serious monthly cost. So, for example, a couple in their early 50s looking at South African medical aid you could be looking at something like this. So for sort of a low to mid-level cover, might be around R5,800 a month for 2 people. Stronger cover might be around R8,000, and then the highest cover can go anything up to R15,000 to R20,000 a month. Bear in mind that these numbers are for 2 people in their 50s and 60s, and that is before you think about any extras such as gap cover, any specific network rules, waiting periods, late joiner penalties, i.e., when you're older, how much more does it cost, any extra cost for covering pre-existing conditions, and also understanding what is and isn't covered in your medical aid. Now, Discovery is one of the names that you'll hear all the time in South Africa, and a lot of our friends use Discovery, and we will be getting quotes from them when we're next in Cape Town. But of course, there are other schemes as well, like Bonitas,. The key thing is this: do not look at only the monthly premium. Look at what actually happens when you need care. Which hospitals can you use? Do you need pre-authorisation? And what happens in an emergency? Are specialists covered? And how much do you actually have to pay as excess for out-of-pocket fees? And what happens if you have a pre-existing condition? And also look at the benefits that these schemes offer, such as discounted gym membership, and food discounts and so on. Okay, now let's make this practical. What happens if you just need to see a GP? Well, in Cape Town, a private GP appointment can often be much cheaper than a private GP appointment in the UK. As a planning figure, Cape Town private GP cash rates can sit somewhere between R500 to R950 depending on the practice, the day, and the type of appointment. One Cape Town provider lists consultants at around R690 during normal weekday hours, going up to R950 for Saturday, Sunday, and public holiday appointments. Compare that with the UK private GP market, and Bupa lists a 15-minute face-to-face appointment at around £79, a 30-minute face-to-face appointment at £140, and DocTap lists a 15-minute weekday clinic at £75. £45. So for routine GP care, South Africa private care can feel much more accessible, and you often can get seen more quickly. You're probably going to pay in cash, and it will feel much more straightforward. But again, this is routine care. That's not the same as hospital care. Now, as an example, last year I paid £45 to see a dermatologist in Rondebosch to get a full body check and also have 2 skin tags on my eyelids removed. If you needed to see a private dermatologist in the UK, the first appointment alone is likely to cost somewhere between £200 and £350, so way more. And this is before the skin tag removal. And it's worth saying that this type of service is not covered by the NHS. And one thing I mentioned earlier, but we need to answer this properly, is repeat prescriptions, because this really matters if you're over 50 and spending 2, 3, 4, 5 months in South Africa. If you take regular medication, do not assume that your UK prescription can just be handed over at a South African pharmacy. The UK travel advice says most prescription medicines, medicines in the UK need a prescription or a script from a doctor in South Africa. The South African doctor may ask to see an electronic prescription or medical information from your UK doctor, and some pharmacists also have medical practitioners on site who may be able to help. So the practical route is this: before you travel, speak to your UK GP, take enough medication with you where it's allowed, and a UK GP will give you a maximum of 3 months of your prescription. Keep it in the original packaging, carry a copy of your prescription, and take a letter from your doctor that explains what you take the dose, and why you need it. If you run low while you're in South Africa, book a private GP appointment, show them your UK prescription, your doctor's letter, and ideally your medical history. And if they're happy, then you— they will issue you a South African script, which you can then take to a pharmacy like Clicks, Dischem, or an independent pharmacy. Now, this is much safer than turning up without— with 3 tablets left and hoping someone will sort it out. I want to take it back to some real personal experience and let's look at my dental costs. And this is where South Africa really surprised us. In the UK, NHS dental charges are fixed if you're lucky enough to get an NHS dentist. Band 1 is around £27.90 for a checkup, Band 2 is £76.60, and then Band 3 for more complex dental work is £332.10.. But to be honest, many people struggle to access an NHS dentist, including me, so they end up comparing private dental care with private dental care in South Africa. And privately, UK dental costs can climb really quickly. A private emergency appointment can be over £100, a private extraction can be several hundred pounds, root canal on a back tooth could well be over £1,000. And this is before you even start talking about implants, I was quoted over £2,100 to get one tooth implant in the UK. And bear in mind, an NHS dentist wouldn't do an implant. Now, this is where I want to add our real numbers. So in South Africa, my initial cost for x-rays and two rounds of antibiotics were R2,136.90, and my tooth removal cost around R4,000. Now the implant cost 20,000 rand, which is about £915. Now let's compare that with UK costs. If I had an infected tooth in the UK and I had to go privately, I'd have to budget between £300 and £700 to be seen, assessed, X-rays, and have the tooth removed. And if it was surgical or out of hours and in central London, it would be a lot more than that. I was quoted over £2,136.90.. And in South Africa, as I said, the implant was R20,000, which is £950, £915 at today's exchange rate. So the implant alone, South Africa was around 57% cheaper. And to be honest, I felt the care and the bedside manner is much better in South Africa than it is in the UK. Now, it's easy to talk about healthcare like it's only numbers, but when it's your tooth, your body, your anxiety, and your money, it becomes emotional really quickly. Now, before we talk about emergency care, this is a good moment to mention SafetyWing, who we've partnered with for this video. Because if you're spending more than a quick holiday in South Africa, or travelling regularly like we do, a standard holiday policy may not be enough. Many policies are based on a fixed trip length, sometimes 30 days, 45 days, or whatever you chose when you bought it, But if your trip gets extended or if you're doing longer stays abroad, you need to check what still applies. SafetyWing's Nomad Insurance Essential is a travel medical insurance designed for travelers and people spending time abroad. It can cover unexpected illness and injury, including hospital visits, doctor's fees, and emergency medical evacuations. It also covers you in 180 countries, works as a pay-as-you-go subscription, and one that you can cancel at any time. One useful thing is that you can buy it even after your trip has already started, which helps if your plans change. As always, read the policy properly and make sure it fits your own situation. There's a QR code on screen now and our link is in the description. If you use that link, it helps support the channel at no extra cost to you. Now this is the most important part of the video. Routine care and emergency care are not the same thing. For routine care, private healthcare in South Africa can feel excellent. In our experience, that side of the system feels fast, personal, and efficient, but emergency care is something different completely. In the UK, if something serious happens, you're not normally thinking, oh my God, can I pay for this hospital bed? You may worry about wait times, you may worry about how long you're going to be stuck in A&E, and the pressures there, but you're not usually worrying about a private hospital bill. In South Africa, if you're using a private system, you need to know how that emergency gets paid for. So first of all, if you got medical aid or insurance, knowing which hospitals you can go to, do you need to get pre-authorization, what scheme will cover, what it won't cover. As I said earlier, do you need gap insurance to pay for the difference between what it costs and what your insurance covers? And what happens if you are admitted to hospital? That is why I would never treat healthcare in South Africa casually. Yes, private healthcare can be brilliant. Yes, routine appointments are definitely quicker. Yes, some costs are way lower in South Africa than the UK, but you need a plan for a bad day, not just an easy or a good day. So if you are over 50 and thinking about South Africa, here is what I would check before spending serious time there. First, get a medical aid or medical insurance quote before you need it. Second, ask about waiting periods. Third, ask about any preconditions and how they're covered. Fourth, ask about those late joiner penalties, i.e., higher cost due to age. Fifth, check which private hospitals you can use that are in part of their network. Sixth, ask what happens in an emergency. Seven, 8th, budget separately for dental because your insurance probably won't cover it, or it may cover it, so check it out. 9th, look into that gap cover. And 10th, think carefully before giving up any healthcare safety net that you already have. One more thing, do not assume that you can permanently leave the UK and still use the NHS in exactly the same way. The NHS sees it as a residence-based system,, and if you move abroad permanently, you're no longer automatically entitled to NHS treatment under normal rules. So check your own position before you make these big decisions. So which system is better? Well, honestly, I think that's the wrong question to ask. The UK gives you peace of mind on cost, but you may well wait, and the bedside manner is not going to be as good because they're so under pressure. South Africa gives you speed, and choice in the private system, but you need to budget for that properly. For us, routine private care in South Africa has often felt more personal and more accessible. My dental treatment was a good example of that, but we would not spend extended time there without a proper plan for emergencies. So if you're thinking about retiring in South Africa, buying a place there like we have, or spending your winters in Cape Town like we do, don't only ask what the rent cost. Do not ask how much the wine and food cost. Do not think about only what eating out costs, but what happens on that worst day, because that is where healthcare really matters. Now, I want to say again, we're not doctors, as in this isn't medical advice, but this is our experience over 12 years mixed with some current research. And if you've navigated the healthcare system in South Africa as an ex— expat, let us know your experience in the comments. Did you use public healthcare, private healthcare, medical aid, or did you pay in cash? And did it, did it match what you expected and match our experience? Because I think this is one of the most important conversations anyone over 50 should have before spending serious time abroad. So I hope you found that useful. And if you're planning a move or a long stay in South Africa, watch this video next where we break down the real cost of living in Cape Town and the expenses that surprised us most. Other than that, this is James and Rob, and we will see you next time for more travel adventures.