The government will revise the national health insurance premium system to increase the burden on ultra-high earners and to align the minimum premium, effectively frozen for 26 years, with current realities. The move aims to improve fairness based on ability to pay and to secure stable health insurance finances.
On the 26th, according to the health care sector, the Ministry of Health and Welfare recently convened a subcommittee of the Health Insurance Policy Deliberation Committee and reported a reform plan for the health insurance premium system reflecting these measures.
The core of the plan is to adjust both the cap and the floor of premiums. While raising the premium cap applied to the top 0.01% of ultra-high-income enrollees, it links the minimum premium threshold, which had remained unchanged for 26 years because it was not tied to the minimum wage, to the minimum wage to bring it in line with reality.
The premium cap for ultra-high earners will be significantly increased. Under the current system, no matter how high the income, enrollees do not pay beyond a fixed ceiling, prompting criticism that a salaried worker earning 120 million won a month and one earning 1 billion won a month pay the same premium.
Under the plan, the cap on salary-based premiums for workplace enrollees (monthly remuneration premiums) will rise from 30 times to 40 times last year's average premium. As a result, the maximum monthly premium for workplace enrollees will increase from 4.59 million won to 6.12 million won.
The caps on non-salary income of workplace enrollees and on premiums for regional enrollees will also increase from 15 times to 20 times the average premium. Accordingly, their monthly premium cap will also be adjusted from 4.59 million won to 6.12 million won.
Those subject to the higher cap include 7,060 workplace enrollees in the top 0.04% and 1,891 regional households in the top 0.02%. The government expects the measure to secure an additional 175.1 billion won in health insurance finances annually.
The premium floor will also be revised for the first time since the National Health Insurance Act was enacted in 2000. The system will be changed so that the workplace enrollee floor, currently maintained based on a minimum monthly remuneration of 280,000 won, is linked to the annually announced minimum wage going forward.
Accordingly, the minimum out-of-pocket premium for workplace enrollees will rise from 10,080 won per month to 22,260 won. The floor for regional enrollees, calculated at 50% of the workplace floor, will edge up from 20,160 won to 22,260 won.
Considering the burden on low-income groups, the government will phase in the increase to the floor. From Jan. 2027 to Dec. 2028, only 50% of the increase will be applied, and from Jan. 2029, 100% will be applied.
Those affected by the floor adjustment include about 193,000 workplace enrollees in the bottom 1.0% and 4.86 million regional households in the bottom 50.7%. The government expects this to generate about 141.7 billion won in additional annual revenue.
Through this reform, the government plans to strengthen an income-centered health insurance contribution system that levies premiums in proportion to ability to pay and to use the secured funds to expand support for regional and essential medical services and to enhance coverage for rare and severe diseases.