Koreans who overpaid medical bills last year can claim refunds starting Monday

About 2.26 million people to receive 3.08 trillion won in out-of-pocket cap excess refunds; those with pre-registered accounts to receive payments automatically starting Wednesday

People who spent more than their annual national health insurance out-of-pocket cap on medical bills last year can begin receiving refunds Monday.

The Ministry of Health and Welfare and the National Health Insurance Service announced Sunday that individual out-of-pocket cap amounts for 2025 medical claims have been finalized, and the reimbursement process will begin Monday.

Under the out-of-pocket cap system, when a patient's annual cost-sharing payments — covering only health insurance-eligible expenses and excluding non-covered and selectively covered services — exceed the individual cap (ranging from 890,000 won to 10.74 million won ($7,780) for 2025), the National Health Insurance Service covers the excess and refunds it to policyholders and their dependents.

With the individual caps now finalized, 3.08 trillion won will be paid out to 2,262,605 people whose 2025 annual medical expenses exceeded their respective caps — a 5.9 percent increase from the 2,135,776 recipients in 2024, with the total payout up 10.2 percent from 2.79 trillion won the previous year. Each recipient will receive an average refund of about 1.36 million won.

A breakdown of recipients shows that those in the bottom 50 percent of income earners and people aged 65 and older benefited the most from the system.

Recipients in the bottom half of the income distribution numbered 2,016,503, with payouts totaling 2.36 trillion won — accounting for 89.1 percent of all recipients and 76.6 percent of the total payout.

By age, 1,310,761 recipients aged 65 and older will receive 2.06 trillion won in excess refunds, representing 57.9 percent of all recipients and 67 percent of the total payout.

Excluding amounts already paid directly by medical institutions to the National Health Insurance Service on behalf of patients, 1,312,819 of the 2,261,271 confirmed recipients — about 58 percent — have pre-registered a payment-consent account and will receive their refunds automatically starting Wednesday, with payments processed in sequence.

The National Health Insurance Service will begin sending payment application notices to the remaining eligible recipients Monday. Starting this year, the service will send electronic documents first through Naver, KT Corp's PASS app and KakaoTalk, in that order, with postal notices sent to those who do not use or open the electronic documents.

Recipients who receive a notice can apply to have the refund deposited into an account in their name through the National Health Insurance Service website, the Health Insurance 24/7 mobile app, fax, phone, mail or in-person visit.

However, starting this year, if a recipient has unpaid national health insurance premiums or other charges subject to collection under the National Health Insurance Act, the overdue amount will be deducted from the refund before payment. Recipients with outstanding balances should take note of this change.

Yoo Ju-heon, director general of the Health Insurance Policy Bureau at the Ministry of Health and Welfare, said the out-of-pocket cap system "has firmly established itself as a vital medical safety net that eases the financial burden on vulnerable groups, including low-income households and the elderly." He added that the ministry would "continue to push for system improvements to ensure the public does not face financial hardship from high medical costs."

thlee@heraldcorp.com