KRW 3.076 Trillion to Be Refunded to 2.26 Million Who Paid High Medical Expenses Last Year

NHIS Begins Out-of-Pocket Maximum Refunds on August 31
Average KRW 1.36 Million Per Recipient
89% of Beneficiaries Are in the Bottom 50% Income Bracket

Last year, a total of KRW 3.076 trillion will be refunded to approximately 2.26 million people who paid more in insured medical expenses than their individual out-of-pocket maximum. The average refund amount per person is about KRW 1.36 million.

The Ministry of Health and Welfare and the National Health Insurance Service announced on August 30 that with the individual out-of-pocket maximum for 2025 finalized, the process of paying out the excess above the maximum will begin on the 31st.

The out-of-pocket maximum system is designed to refund the portion exceeding the government-determined annual cap on medical expenses covered by health insurance that each patient must pay—excluding non-insured items and selectively insured services. This scheme aims to ease the financial burden on households caused by excessive medical expenses.

For 2025, the individual out-of-pocket maximum is set between KRW 890,000 and KRW 8,260,000, depending on income level. However, for patients hospitalized in long-term care hospitals for more than 120 days, a separate ceiling applies, ranging from KRW 1,410,000 to a maximum of KRW 10,740,000.

The total number of recipients this time is 2,262,605, marking a 5.9% increase from 2,135,776 in 2024. The payout amount also rose by 10.2% from KRW 2.792 trillion in 2024 to KRW 3.076 trillion in 2025. The number of beneficiaries of the out-of-pocket maximum system has steadily increased from 1,749,831 in 2021 to 2,011,580 in 2023, and 2,262,605 in 2025.

In particular, the benefits were significant for low-income groups and the elderly. The income bottom 50% (levels 1 to 5) accounted for 2,016,503 people, or 89.1% of the total, and received KRW 2.3556 trillion, or 76.6% of the total payout. In terms of age, individuals aged 65 or older numbered 1,310,761—57.9% of all recipients—and their refund amount reached KRW 2.0596 trillion, representing 67% of the total. Among the beneficiaries, those aged 65 to 89 constituted the largest group at 1,236,377 (54.6%), and those aged 90 or older totaled 74,384.

Among the refund recipients, 27,742 people had already exceeded the highest ceiling of KRW 8,260,000 in personal co-payments at the same healthcare institution; for these cases, the hospital claimed the excess directly from the insurance service and received advance payment. Excluding this amount, of the 2,261,271 people eligible for post-payment, 1,312,819 who have pre-registered a payment consent account will automatically receive the refund in sequence starting from September 2, without additional application.

The remaining recipients must apply after receiving a payment guidance notice, which will be sent starting on the 31st. From this year, electronic documents will be sent first via Naver, KT (through the PASS app), and KakaoTalk. For those who do not use or read electronic documents, guidance will be provided by mail. Recipients may apply through the insurance service website, the Health Insurance 25 app, fax, phone, mail, or in person.

However, starting this year, in accordance with relevant legislation, if insurance premiums or other contributions under the National Health Insurance Act are in arrears, only the excess amount after deducting the overdue sum will be paid out. Therefore, those with outstanding payments should take note.

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