[Edaily Reporter Lee Ji-hyun ] The government will reimburse over 3 trillion won in medical expenses to approximately 2.26 million National Health Insurance subscribers who paid more than the out-of-pocket maximum last year. The average refund per person is about 1.36 million won.

The Ministry of Health and Welfare and the National Health Insurance Service announced on the 29th that they have finalized the individual out-of-pocket maximum limits for medical services received in 2025 and will begin the process of reimbursing excess payments starting on the 31st.

The out-of-pocket maximum system is a program under which the National Health Insurance Service reimburses the excess amount if a patient’s out-of-pocket medical expenses covered by health insurance exceed the individual’s annual maximum limit. Non-covered services and selective benefits are excluded. The individual out-of-pocket maximum for 2025 ranges from 890,000 to 10.74 million won, depending on income level.

A total of 2,262,605 people are eligible for this round of payments. This represents a 5.9% increase from the 2,135,776 recipients in the previous year. The total payment amount is 3.076 trillion won, a 10.2% increase from the previous year’s 2.792 trillion won. Accordingly, the average refund per eligible person is approximately 1.36 million won.

The number of beneficiaries under the out-of-pocket maximum system has been steadily increasing. The number of eligible recipients, which stood at 1,749,831 in 2021, rose to △2,011,580 in 2023 and △2,262,605 in 2025. During the same period, the total payout also increased to △2.386 trillion won, △2.6278 trillion won, and △3.076 trillion won.

In particular, refunds were concentrated among low-income and elderly recipients. Recipients in the bottom 50% of the income distribution totaled 2,016,503, accounting for 89.1% of the total. The amount paid to this group was 2.3556 trillion won, representing 76.6% of the total disbursement.

Recipients aged 65 and older numbered 1,310,761, accounting for 57.9% of the total. The amount refunded to them was 2.0596 trillion won, representing 67% of the total payout.

The National Health Insurance Service had previously made advance payments totaling 184.6 billion won to medical institutions on behalf of 27,742 people whose out-of-pocket expenses at the same medical institution exceeded the pre-payment cap.

Excluding this group, 1,312,819 eligible recipients who had previously registered a bank account for payment will receive their refunds sequentially starting September 2 without having to apply separately. This represents approximately 58% of all eligible recipients.

For the remaining beneficiaries, application notices will be sent out sequentially starting on the 31st. Starting this year, electronic documents will be sent via Naver, KT PASS, and KakaoTalk as the primary method; if beneficiaries do not use or view these electronic documents, they will receive notices by mail.

Eligible recipients can apply to have payments deposited into an account in their own name via the National Health Insurance Service (NHIS) website, the “Health Insurance 24/7” mobile app, or by fax, phone, mail, or in-person visit. Once a payment consent account is registered, any excess amounts exceeding the out-of-pocket maximum will be automatically paid into that account without the need for a separate application.

However, starting October 8, if an individual has overdue health insurance premiums or other charges collected under the National Health Insurance Act, the overdue amount will be deducted from the excess reimbursement before payment is issued.

Yoo Ju-heon, Director General of the Health Insurance Policy Bureau at the Ministry of Health and Welfare, emphasized, “The out-of-pocket maximum system has established itself as a medical safety net that reduces the burden of medical expenses for socially vulnerable groups, such as the economically disadvantaged and the elderly,” adding, “We will continue to improve the system to ensure that people do not face financial hardship due to high medical bills.”