Samsung Fire & Marine Insurance: "Average Indemnity Insurance Payout for Breast Cancer to Reach 4.48 Million Won in 2025"

While Health Insurance Coverage Rose 6.4% in 3 Years, Non-Covered Expenses Increased 12.1%
Out-of-Pocket Rate for Non-Covered High-Cost Treatments at 24.1%... Three Times the Average
Average Medical Cost is 7.51 Million Won Within a Year of Treatment... Surges to 23.8 Million Won If Exceeded

The average payout of indemnity medical insurance to policyholders diagnosed with breast cancer reached 4.48 million won per person last year. It was found that if the treatment period exceeded one year, the average medical expense jumped to the 23 million won range, nearly tripling compared to cases where treatment was completed within a year.

On June 1, Samsung Fire & Marine Insurance announced that it had analyzed breast cancer treatment cases and related costs using its integrated health information platform (Health DB).

Most Cases Occur in Women in Their 40s... High Out-of-Pocket Costs

Image depicting a breast cancer patient. Getty Images

According to the 2023 National Cancer Registration Statistics released by the Ministry of Health and Welfare and the Korea Central Cancer Registry on May 16, breast cancer is the most common cancer among women in Korea, with an average annual increase of 5.9% over the four years from 2020 to 2023.

In particular, breast cancer most frequently occurs in women in their 40s in Korea. This means the onset occurs about 10 years earlier than in Western countries.

Although breast cancer is known for its high survival rate, once diagnosed, it imposes a significant financial burden. The high out-of-pocket cost, especially for non-covered items, is emerging as a social issue.

According to the Health Insurance Statistics Yearbook published by the National Health Insurance Service, the annual medical cost per breast cancer patient rose from 5.03 million won in 2021 to 5.35 million won in 2024, an increase of about 6.4%. This figure reflects costs covered by health insurance and does not include non-covered expenses.

When non-covered items are included, the rate of increase in medical expenses is about twice as high as the increase seen in health insurance-covered costs.

According to Health DB by Samsung Fire & Marine Insurance, indemnity insurance payouts related to breast cancer rose by about 12.1%, from 3.72 million won to 4.17 million won during the same period. In 2023, the payout reached 4.48 million won. This indicates that the out-of-pocket burden for non-covered items during breast cancer treatment is relatively high.

The number of customers receiving indemnity insurance payouts for breast cancer has also increased every year. The number grew from 7,445 in 2021 to 8,021 in 2022, 8,730 in 2023, 9,320 in 2024, and 10,772 last year, marking a 44.7% increase over five years.

According to the 2024 Health Insurance Patient Medical Expense Status Survey released by the National Health Insurance Service, the out-of-pocket rate for non-covered items in breast cancer cases was 24.1% per person. This is about three times higher than the average out-of-pocket rate of 8.8% for the top 30 severe and high-cost diseases.

Medical Expenses Surge When Treatment Exceeds One Year

There were also many cases involving extremely high medical costs. Samsung Fire & Marine Insurance analyzed cases of policyholders diagnosed with breast cancer between 2021 and 2022 whose direct treatment costs exceeded 50 million won, finding that about 1.2% of the total fell into this high-cost category.

All of these high-cost patients received either targeted anticancer therapy or immunotherapy. The proportion of breast cancer patients receiving targeted or immunotherapy has steadily increased over the past five years, reaching 56.2% last year, up 20 percentage points from 36.2% in 2021.

In some cases, after a combination of targeted therapy and chemotherapy, patients continued taking oral targeted anticancer drugs for an extended period as a preventive measure against recurrence, resulting in medical expenses reaching as high as 100 million won.

According to National Cancer Registration Statistics, 91.7% of breast cancer patients are diagnosed at the localized or regional stage. When detected early, the five-year survival rate reaches 99.2% for localized and 93.6% for regional stages.

"Localized" means the cancer has not spread beyond the organ where it originated. "Regional" refers to limited spread to nearby tissues or surrounding lymph nodes. A higher proportion of localized cases suggests that many cancers are detected at an early stage.

Samsung Fire & Marine Insurance also confirmed through its own analysis that treatment costs vary significantly depending on the duration of treatment. When treatment was completed within one year, the average medical expense was 7.51 million won; if the treatment period exceeded one year, the amount soared to 23.8 million won, more than tripling.

An official from the Samsung Fire & Marine Insurance Long-Term Future Value Research Institute stated, "Through this analysis, we confirmed that in cancer types where treatment options are rapidly expanding, the pattern of medical expenses can also change. We will continue to analyze treatment status and medical expense trends by disease to better understand customer coverage needs and contribute to healthier lives."

Meanwhile, Samsung Fire & Marine Insurance is conducting various studies to reduce the physical and financial burden on cancer patients through the Cancer Patient Quality of Life Research Center, which was jointly established with Samsung Medical Center in 2024.

This content was produced with the assistance of AI translation services.