Out-of-Pocket Rate for Rare and Severe Intractable Diseases to Drop from 10% to 7%

Ministry of Health and Welfare Seeks Public Comment on Amendment to National Health Insurance Act Enforcement Decree; Takes Effect in December
1.36 Million to Benefit; Annual Out-of-Pocket Medical Costs Expected to Fall by 220,000 Won per Patient

The out-of-pocket rate for National Health Insurance-covered medical expenses for patients with rare, severe and intractable diseases will be reduced from the current 10% to 7%. The average annual out-of-pocket medical expenses per patient are expected to fall by about KRW 220,000 for approximately 1.36 million patients.

The Ministry of Health and Welfare said it would issue a legislative notice from November 4 through November 16 on a proposed partial revision to the Enforcement Decree of the National Health Insurance Act to lower the out-of-pocket rate for patients with rare, severe and intractable diseases.

The proposed revision would lower the out-of-pocket rate for National Health Insurance-covered medical expenses from 10% to 7% when patients with rare, severe and intractable diseases registered under the special case program receive treatment for those conditions. The ministry expects that, if the revision takes effect, the average annual out-of-pocket payment per patient among approximately 1.36 million eligible patients will fall from about KRW 750,000 to about KRW 530,000.

Rare, severe and intractable diseases are often difficult to cure and require long-term treatment, placing a heavy financial burden on patients and their families. The government operates a special case program that lowers the National Health Insurance out-of-pocket rate for patients facing high medical expenses. However, the rate for patients with rare, severe and intractable diseases had been set at 10%, higher than the 5% rate for other serious conditions, including cancer and cardiovascular and cerebrovascular diseases.

This proposed revision is the first step in a phased reduction plan adopted by the Health Insurance Policy Deliberation Committee in September. The government plans to lower the out-of-pocket rate from 10% to 7% in December 2026, and then to 5% in the first half of 2028.

The reduced rate under the proposed revision is expected to apply to treatment received on or after December 1. However, out-of-pocket costs for non-covered care and the current 50% out-of-pocket rate for meals during hospitalization will remain unchanged. The ministry plans to gather public comments during the legislative notice period, then finalize the revision after review by the Ministry of Government Legislation and approval by the Cabinet.

Yoo Juheon, Director General for Health Insurance Policy at the Ministry of Health and Welfare, said, "This revision is the first step toward lowering the out-of-pocket burden for patients with rare, severe and intractable diseases to the level for other serious conditions." He added, "We will promptly complete the remaining procedures to ensure the changes take effect as scheduled on December 1."

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