The procedure will begin on the 28th…6.2% increase in the target from last year
Patients in the lowest income brackets account for 89%… “Easing the medical expense burden on low-income individuals”,
Jeong Eun-kyeong, Minister of Health and Welfare. /News1 ⓒ News1 Yoo Seung-kwan,
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, ‘(Seoul=News1) Reporter Koo Gyo-un’,
, # In their 70s, person A incurred total medical expenses of 81.75 million won last year for geriatric diseases and musculoskeletal disorders, excluding non-covered costs. After the insurance kicked in for 65.2 million won, A was responsible for 16.55 million won. Last month, in the post-settlement process of the out-of-pocket maximum scheme, A was classified in the lowest income bracket with a determined out-of-pocket limit of 870,000 won, allowing them to receive an excess refund of 13.56 million won from the insurance. This means A only had to pay 870,000 won out of 14.43 million won in out-of-pocket expenses, excluding 2.12 million won for non-covered services (selective benefits, higher-grade hospital rooms, etc.), with the insurance covering the remaining 13.56 million won, significantly reducing their household’s medical expense burden.,
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, ‘The refund process for exceeding the out-of-pocket maximum on medical expenses will begin on the 28th. About 2.13 million people are eligible, with each receiving an average refund of about 1.3 million won.’,
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, ‘The Ministry of Health and Welfare and the National Health Insurance Service announced on the 27th that, following the determination of individual out-of-pocket maximums for 2024’s medical expenses, they will initiate the refund process for exceeding these limits starting on the 28th.’,
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, ‘The out-of-pocket maximum scheme provides that if a patient’s annual (January to December) medical expenses, covered by health insurance, exceed their personal maximum (87,000 to 1,050,000 won for 2024), the excess will be covered by the insurance. Non-covered or selective expenditures are excluded.’,
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, ‘This year’s refund target for exceeding the out-of-pocket maximum is 2,135,776 people, a 6.2% increase from last year’s 2,011,580. The total refund will also increase by the same percentage to 2.792 trillion won. The average refund per person is about 1.31 million won.’,
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, ‘Notably, patients from the bottom 50% income bracket make up 89% (1.9 million) of the total refund recipients and receive 76.5% (2.1352 trillion won) of the total refund, suggesting a reduction in the medical expense burden for low-income individuals.’,
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, ‘By age group, 1.211,616 individuals aged 65 and over will receive 1.844 trillion won in out-of-pocket maximum refunds, accounting for 56.7% of the target recipients and 66% of the refund amount.’,
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, ‘There are cases where refunds were directly paid through healthcare institutions. For instance, 25,703 patients exceeded the maximum out-of-pocket amount of 8.08 million won at the same institution, prompting the insurance to prepay the facility 160.7 billion won.’,
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, “Of the 2,134,502 confirmed for refund, 1,085,660 who have registered consented bank accounts will receive refunds directly without separate application. Those unregistered will need to apply using the guidance letter from the insurance through the website, mobile app ‘The Health Insurance’, fax, phone, mail, or in-person visits.”,
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, ‘The National Health Insurance Service will start sending guidance letters to refund recipients sequentially from the 28th.’,
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, “Kwon Byeong-ki, essential medical services director at the Ministry of Health and Welfare, said, ‘It seems the out-of-pocket maximum scheme is effectively functioning as a medical safety net for social vulnerabilities, including low-income individuals and the elderly.'”,
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, “Kim Nam-hoon, executive director of the insurance’s reimbursement division, expressed hope that the out-of-pocket maximum scheme would serve as a reliable support for citizens struggling with unexpected medical expenses, assuring that the insurance will stand by the public and strive for the best implementation of the scheme, ensuring people can receive medical treatment with peace of mind.”