The copay rate for patients with rare and intractable diseases will be lowered from the current 10% to 7% in Dec., and further to 5% in the first half of 2028.
Patients with severe type 2 diabetes will also be eligible for support for insulin pumps and continuous glucose monitors, and seniors 65 and older with no teeth at all will receive health insurance benefits for two implants.
The Ministry of Health and Welfare said on the 8th that the 15th Health Insurance Policy Deliberation Committee in 2026 (Health Insurance Committee) approved the first-stage innovation plan for health insurance coverage.
Under the plan, about 1.97 million people, including those with severe and rare intractable diseases, will receive up to 800 billion won a year in health insurance support.
The biggest change is reducing out-of-pocket costs for patients with rare diseases and severe intractable diseases. For about 1.36 million people covered by the special calculation exception, the copay rate will go from 10% to 7% in Dec., and to 5% in the first half of 2028. As a result, the average annual out-of-pocket cost per person is expected to fall from the current 750,000 won to 530,000 won in 2027 and 390,000 won in 2028.
The greater the medical cost burden, as with hemophilia, the greater the benefit. For a person with hemophilia who pays 13.5 million won a year for clotting factor therapy, out-of-pocket costs will fall to 9.45 million won starting in Dec. this year and to 6.75 million won starting in the first half of 2028.
The re-registration process for the special calculation exception will also be simplified. Currently, among 1,389 rare diseases and 234 severe intractable diseases, patients with 312 diseases—about 340,000 people—must submit separate test results in addition to a clinical diagnosis when re-registering. Going forward, even without test results, the standards will be improved to allow re-registration based on clinical diagnosis and, if needed, treatment history.
A pilot project will also be pursued to shorten the process for listing rare disease treatments under health insurance. The cost-effectiveness assessment before listing will be changed to an assessment based on actual clinical outcomes after listing, and price and drug expense aggregates negotiations will apply pre-agreed contract terms.
Coverage for severe diabetes will also be expanded. Previously, support centered on type 1 diabetes, but going forward, patients with severe type 2 diabetes will also be included. Patients with type 2 diabetes with pancreatic impairment will be eligible for health insurance support for insulin pumps and continuous glucose monitors. The finances needed for the expanded support for severe diabetes are about 70 billion won a year.
Support will also increase for patients with glycogen storage disease and neurogenic bladder. Glycogen storage disease is a rare genetic disorder in which abnormalities occur in the process of storing and breaking down glycogen. For patients with glycogen storage disease, blood glucose test strips and lancets and electrodes for continuous glucose monitoring will be supported. For patients with neurogenic bladder, support for intermittent self-catheterization will be expanded. For those under 19, the maximum number supported per day will increase to eight, and the standard amount will rise from 9,000 won per day to 18,000 won. For those 19 and older, it will rise to 13,500 won.
Dental coverage will also be expanded. Starting in Jan. next year, seniors 65 and older with no teeth at all will be supported for two implants. Previously, implant benefits were available only if the person had remaining teeth.
About 70,000 people are expected to receive medical expense support benefits of about 2.28 million won per person under this measure. However, patients with complete edentulism who received fully covered dentures under health insurance can receive implant benefits only after seven years have passed since denture support.
The age for coverage of light-cured composite resin for children and adolescents will also be expanded from ages 5 and older up to 12 to up to 13. As a result, about 140,000 13-year-olds are expected to receive 220,000 won a year in medical expense support.
The government plans to gradually expand health insurance coverage starting with this plan. In light of new treatments and therapies emerging with technological advances and increased medical demand due to aging, the policy is to prioritize strengthening coverage for severe and rare diseases, severe diabetes, and dental care. The finances投入 for this first-stage task amount to 600 billion to 800 billion won a year.
Meanwhile, the 2027 health insurance premium rate (health insurance premium increase rate) was frozen at 7.19%, the same as this year.
The ministry said, "We will actively identify and pursue expenditure efficiency tasks so that the premiums paid by the public can be used effectively for medical services that are truly needed." It also plans to continuously pursue strengthening regional, essential, and public healthcare and easing the burden of medical expenses for the public, including rare and severe intractable diseases.