Medical Aid Dependent Support Cost System Abolished After 26 Years

The dependent family support calculation system for Medical Aid will be abolished in January next year, ending after 26 years. This change aims to prevent low-income individuals from being excluded from Medical Aid eligibility simply because they have family members. The abolition of the dependent family support calculation system is part of a national policy initiative under the Lee Jaemyung administration. The system was introduced in 2000 alongside the enactment of the National Basic Living Security Act and will now be discontinued after 26 years.

Yonhap News Agency

The Ministry of Health and Welfare held the 3rd Central Medical Aid Review Committee meeting on the afternoon of December 9 to report on these improvements to next year’s Medical Aid system and related budget plans.

Medical Aid is a program in which the government subsidizes almost all medical expenses for low-income individuals whose income is at or below 40% of the median. The dependent family support calculation system assumes that a legal supporter, such as a family member, provides living expenses to the beneficiary. In practice, this is also called “deemed family support.”

Medical Aid has been criticized for being out of touch with reality because, when assessing a beneficiary’s income, it included deemed family support as income. In many cases, applicants were denied eligibility for Medical Aid solely due to the supposed income of their legal supporters, even when they did not actually receive any support.

With the abolition of the dependent family support calculation system, the Ministry of Health and Welfare expects that the unfair exclusion of individuals from Medical Aid eligibility due to family income will be resolved, and the number of beneficiaries will increase. Additionally, the ministry plans to simplify the complex criteria for legal supporters and gradually ease the system so that the criteria apply only to supporters with high income or significant assets.

From next year, a differentiated copayment system will be implemented for Medical Aid beneficiaries who excessively use outpatient services. Under this system, if a Medical Aid beneficiary uses outpatient services more than 365 times in a year, a 30% copayment will be applied to each visit exceeding the 365th. In the National Health Insurance system, since July last year, users who exceed 365 outpatient visits per year have been subject to a 90% copayment.

In this context, outpatient visits refer only to actual outpatient appointments, excluding days for prescription refills and inpatient stays. The number of visits is counted from January 1 each year, and the copayment is applied from the point the 366th visit occurs. However, vulnerable groups such as those registered for special calculation exemptions, individuals with severe disabilities, children, and pregnant women will be excluded from the differentiated copayment system and will maintain the current copayment (1,000-2,000 KRW).

The Ministry of Health and Welfare estimates that, based on last year’s data, this measure will apply to about 550 people (approximately the top 0.03%) among 1.56 million Medical Aid beneficiaries. The ministry will also increase the number of supported psychiatric outpatient counseling sessions for Medical Aid beneficiaries and raise reimbursement rates for intensive initial treatment of patients with acute mental illness.

Support for individual psychiatric counseling will be expanded from a maximum of 2 sessions per week to 7, and family counseling will increase from once per week to a maximum of 3 times per week. Medical institutions designated as “hospitals for intensive treatment of acute mental illness” will receive new reimbursement rates for intensive care units, and the psychiatric closed ward hospitalization fee, newly established in July this year, will be increased by about 5.7% for hospital-level institutions.

In the second half of next year, the government will promote support for nursing care expenses for seriously ill inpatients in long-term care hospitals among Medical Aid beneficiaries. Alongside the initiative to include nursing care in the National Health Insurance for long-term care hospitals, specific measures will be developed.

The Medical Aid budget for next year has been set at approximately 9.84 trillion KRW. This is an increase of about 1.1518 trillion KRW, or 13.3%, compared to this year’s 8.6882 trillion KRW. First Vice Minister of Health and Welfare Lee Seuran stated, “The expansion of next year’s Medical Aid budget and the abolition of the dependent family support calculation system after 26 years reflect the government’s policy commitment to eliminating medical blind spots and strengthening coverage for low-income groups. We will also consider the appropriateness and sustainability of medical use to create a Medical Aid system that the public can trust.”

This content was produced with the assistance of AI translation services.