The money paid at hospital counters by people registered under the special copayment program (산정특례) for rare diseases and severe intractable diseases will go down starting this December. The Ministry of Health and Welfare held the 15th Health Insurance Policy Deliberation Committee on September 8 and approved the 'Phase 1 Innovation Plan for Health Insurance Coverage' and the decision on the 2027 health insurance premium rate. It lowers the current copayment rate of 10% to 7%, and lowers it once more to 5% in the first half of 2028. The meeting was chaired by Second Vice Minister Lee Hyung-hoon.
The overall target of the coverage expansion was put at 1.97 million people, including patients with severe, rare and intractable diseases. Of these, the group directly reached by the copayment cut from 10% to 7% is 1.36 million patients with rare diseases and severe intractable diseases. How the two figures overlap was not separately explained in the meeting results.
Three percentage points is an amount that piles up over a year for someone who goes in and out of the hospital every month.
This decision also contained items directed at diabetes patients. The copayment rate for the insulin pumps and continuous glucose monitors used by patients registered with pancreatic disability falls to 10% starting in December. The benchmark amount for insulin pumps for young people aged 19-34 rises to 4.5 million won.
The principle of supporting insulin pumps and other devices for patients with severe diabetes regardless of diabetes type was also settled. The scale of support was put at around 800 billion won a year.
The 2027 premium rate is 7.19%, keeping the same level as this year.
At the Cabinet meeting the same day, a partial amendment to the 「Enforcement Decree of the National Health Insurance Act」 was approved, and the amendments to the enforcement rules and to the rules on standards for medical care benefits are going through promulgation procedures as well. It also holds a device that tightens in the other direction. From January 1, 2027, going over 300 outpatient visits in a year brings a copayment rate of 90% on the excess.
Children, pregnant women, patients with severe illnesses and patients with rare diseases are left out of this application. From December 24, a base for checking a patient's medical use records in real time at the point of care will also be in place.
That same afternoon the ministry held the 3rd Central Medical Aid Deliberation Committee and reviewed the system improvement tasks to be included in the 「4th Basic Plan for Medical Aid (2027-2029)」 and the plan for drawing it up. The tasks taken up at the meeting, chaired by First Vice Minister Hyun Soo-yeop, included abolishing the family support obligation rule for households with severe disabilities and support for caregiving costs.
The family support obligation rule is a provision that has long been called the threshold of Medical Aid. When the income of a child or a parent is counted, the sick person themselves is pushed out of benefits. That a review of removing this rule, even if only for households with severe disabilities, has come onto the basic plan's table is itself a change.
The same goes for caregiving costs. There have been cases of giving up hospitalization because there was no money to pay for someone to stay at the bedside, even with hospital bills fully covered.
The Basic Plan for Medical Aid is a comprehensive plan drawn up every three years. 2027, when the 4th plan begins, is also the year the Medical Aid system marks the 50th anniversary of its implementation. Where a system that has continued for half a century will be reworked is what this plan holds.
The cut in the special copayment rate and the Medical Aid overhaul came out together within a single day, but the two systems move on different funding sources and different target groups. The coverage rate is an indicator that measures the burden after one has entered the consultation room.
What to check right away is whether one is registered. If you have a rare disease or a severe intractable disease and have not registered for the special copayment program, the December cut does not apply. Registration is done by filling out an application at the medical institution where you receive care and submitting it to the National Health Insurance Service. It is worth asking your doctor before December comes.
Whether the family support obligation rule for households with severe disabilities will be abolished, and in what way caregiving costs will be supported, will be settled as the 4th Basic Plan takes shape. How the ministry led by Health and Welfare Minister Jeong Eun-kyeong has designed the three years from 2027 will be written in that plan.
