Next year's health insurance premiums will remain unchanged, but benefits for patients will significantly increase. Starting in December, the out-of-pocket costs for patients suffering from rare diseases, severe chronic illnesses, and severe diabetes will be reduced to half of their current levels. The Ministry of Health and Welfare has finalized an innovative plan that enhances benefits for critical illnesses while keeping the insurance premium burden stable for citizens.
On the morning of September 8, the Ministry held a meeting of the Health Insurance Policy Review Committee and approved the '2027 Health Insurance Premium Rate Decision' and the 'Phase 1 Health Insurance Coverage Innovation Plan.' The health insurance premium rate for next year will be frozen at 7.19%, the same as this year, and through the first phase of the innovation plan, 1.97 million people, including those with rare and severe chronic diseases, seniors, and children, will receive new health insurance benefits worth 800 billion won annually.
The health insurance premium will not increase, remaining at 7.19%. The government decided to maintain the premium rate to alleviate the financial burden on citizens, as the health insurance fund has recorded a surplus over the past five years and currently holds about 30 trillion won in reserves. Deputy Minister Lee Hyung-hoon explained in a briefing that the government’s support has also increased, and the booming semiconductor industry is expected to boost premium revenue.
While premiums are frozen, support for those in need will not be cut. Currently, 1.36 million patients with rare and severe chronic diseases pay 10% of their total hospital costs, but starting in December, this will decrease to 7%, and by the first half of 2028, it will drop to 5%. This means that patients' out-of-pocket expenses will be halved.
For example, a hemophilia patient who spends 13.5 million won annually on blood clotting factor treatment currently pays 1.35 million won, but this will decrease to 945,000 won in December and to 675,000 won by 2028. This measure is expected to save each patient between 220,000 and 360,000 won in annual hospital costs.
Additionally, the process for renewing eligibility for special treatment will be simplified. Patients with rare diseases like Charcot-Marie-Tooth disease, which are nearly impossible to cure, will be able to re-register based on clinical diagnosis and treatment history without expensive tests. Furthermore, the period for health insurance registration of expensive new drugs for rare diseases will be significantly shortened from 240 days to a maximum of 100 days, allowing patients to access new medications more quickly.
Severe diabetes patients will also benefit, as the support for insulin pumps and continuous glucose monitors will now cover 90% of the costs for patients with severe type 2 diabetes whose pancreatic function is severely impaired. Previously, only type 1 diabetes patients received this support. This change will reduce the out-of-pocket cost to 10% for these patients.
In particular, for young adults aged 19 to 34 who are economically unstable while preparing for employment, the support limit for insulin pumps will be raised from 1.7 million won to 4.5 million won, aligning it with the pediatric level. This means that a young patient who previously had to pay 3.31 million won for a 4.5 million won device will now only need to pay 450,000 won. As a result, severe type 2 diabetes patients will save an average of 4.18 million won in medical expenses annually.
Deputy Minister Lee emphasized, "We have significantly increased the support limit for insulin pumps for young adults, who often face financial difficulties while preparing for employment, solving the issue of suddenly bearing hundreds of thousands of won in costs as they transition to adulthood."
Dental benefits for seniors and students will also expand starting in January. Previously, seniors aged 65 and older needed to have at least one remaining tooth to receive health insurance coverage for dental implants (up to two per lifetime). However, starting next year, seniors with no teeth (approximately 70,000 individuals) will also be able to receive two implants covered by health insurance.
Additionally, the age limit for health insurance coverage of the most common cavity treatment, composite resin, will be raised from 12 to 13 years old. This change considers the timing when permanent teeth fully emerge, allowing approximately 140,000 students entering the first year of middle school next year to receive affordable cavity treatment.
Deputy Minister Lee stated, "We will suppress unnecessary medical expenses and manage non-covered items that pose a risk of overuse, ensuring that the valuable premiums paid by citizens are efficiently used for essential medical care that is critical to life."
* This article has been translated by AI.
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