2.8 Trillion Won in Reimbursements for 2.13 Million Who Exceeded Out-of-Pocket Medical Expense Limits Last Year

89% of Beneficiaries Are in the Bottom 50% Income Bracket
57% Are Seniors Aged 65 or Older

Approximately 2.8 trillion won in reimbursements will be paid to 2.13 million National Health Insurance subscribers whose out-of-pocket medical expenses exceeded the individual annual limit last year.

The Ministry of Health and Welfare and the National Health Insurance Service announced on the 27th that they will begin the process of reimbursing out-of-pocket medical expenses exceeding the annual limit starting on the 28th.

The out-of-pocket maximum system is designed to alleviate the financial burden of excessive medical expenses for citizens. Under this system, if the total annual out-of-pocket medical expenses paid by a National Health Insurance subscriber-excluding non-covered and selectively covered services-exceed the individual limit (ranging from 870,000 to 10.5 million won in 2024), the excess amount is reimbursed.

This year, 2,135,776 people are eligible for reimbursement, with a total payout of 2.792 trillion won. The average payment per person is approximately 1.31 million won.

The largest portion of beneficiaries were those in the bottom 50% income bracket and seniors aged 65 or older. Specifically, 1,900,287 people in the bottom 50% income group will receive a total of 2.1352 trillion won, accounting for 89% of all beneficiaries and 76.5% of the total payout. By age group, 1,211,616 people aged 65 or older will receive 1.844 trillion won, representing 56.7% of all beneficiaries and 66% of the total payout.

Both the number of beneficiaries and the total reimbursement amount under the out-of-pocket maximum system have increased annually. The number of beneficiaries rose from 1,660,643 in 2020 to 2,135,776 last year, with an average annual growth rate of 6.5%. The total payout increased from 2.2471 trillion won to 2.792 trillion won over the same period, reflecting an average annual growth rate of 5.6%.

Starting on the 28th, the National Health Insurance Service will sequentially send out notifications to eligible individuals regarding the reimbursement application process. Of these, 1,085,660 people who have already registered a payment consent account will receive the reimbursement directly to their registered accounts without any additional application process. The remaining beneficiaries will be required to apply individually to receive their payments.