Out-of-Pocket Medical Costs for Rare & Severe Diseases Cut to 5% in Korea
Out-of-Pocket Medical Costs Cut to 5% for Rare & Severe Diseases
Expanded Coverage and Faster Access to Treatments
If you or your family member is living with a rare or severe intractable disease,
you may be struggling with medical bills reaching millions of won every month.
Even with national health insurance, many patients still ask,
“Why is the financial burden so high?”
By the end of this article, you will clearly understand:
- How out-of-pocket costs will be reduced from 10% to 5%
- Which new rare diseases are added to special coverage
- When faster access to new treatments will begin
What Is Changing in Medical Cost Support?
The Korean government announced a comprehensive plan titled “Strengthened Support Measures for Rare and Severe Diseases” to significantly reduce high medical expenses faced by patients.
- Lower out-of-pocket rates under special insurance coverage
- Expanded list of eligible rare diseases
- Shorter timelines for treatment and drug access
These changes go beyond administrative reform—they are designed to deliver real, measurable relief to patients and families.
Out-of-Pocket Costs Reduced from 10% to 5%
Currently, patients covered under the special insurance program for rare and severe diseases pay 10% of their total medical expenses.
The government plans to gradually reduce this rate to as low as 5%, with implementation expected to begin in the second half of 2026.
| Category | Current | After Reform |
|---|---|---|
| Out-of-pocket rate | 10% | Up to 5% |
| Expected start | - | Second half of 2026 |
For example, if total medical costs amount to 10 million KRW, the patient’s share would drop from 1 million KRW to just 500,000 KRW.
70 More Rare Diseases Added to Special Coverage
Starting January 2026, 70 additional rare diseases will be newly included in the special insurance coverage program.
- Includes congenital functional short bowel syndrome
- Further expansions planned on a rolling basis
To ease administrative burdens, unnecessary re-registration tests will also be gradually eliminated.
- Testing removed for 9 diseases, including Charcot–Marie–Tooth disease
- Expansion to all eligible diseases planned
Expanded Support for Low-Income Patients
The Rare Disease Medical Expense Support Program will also be expanded.
- Gradual removal of income and asset criteria for family supporters
- Broader eligibility for low-income households
In addition, disease-specific nutritional support will be strengthened, including:
- Special medical formula milk
- Low-protein instant rice products
- Special corn starch for glycogen storage disease patients
Drug Approval Time Cut from 240 Days to 100 Days
One of the biggest challenges for rare disease patients has been delayed access to essential treatments.
To address this, the government will reduce the health insurance drug listing timeline from approximately 240 days to within 100 days.
| Category | Before | After |
|---|---|---|
| Drug approval period | ~240 days | ~100 days |
For drugs at risk of supply disruption, the government will ensure stable access through emergency imports or custom manufacturing.
Integrated Medical and Welfare Support
Support will extend beyond treatment to create a continuous care system from diagnosis to welfare services.
- Genetic testing support expanded from 810 to 1,150 cases
- Additional designation of specialized institutions in underserved regions
- Establishment of region-based integrated care systems
A Rare Disease Policy Council will also be operated to continuously improve patient-centered policies.
Summary: What Patients Will Feel Most
✔ Out-of-pocket costs reduced to as low as 5%
✔ 70 more rare diseases covered under special insurance
✔ Much faster approval and supply of treatments
Recommended Reading
- How to apply for special medical coverage
- Complete guide to high medical cost reimbursements
- One-stop check for government support for severe illnesses
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