Estimate Korean NHI copays for anti-VEGF injections, retinal laser, vitrectomy, and follow-up from an itemized hospital quote, then check public DME reimbursement basics, confirmed indemnity insurance, and the incremental medical tax credit.
Enter covered totals from a Korean hospital quote instead of relying on a national average. This tool does not diagnose disease or select treatment.
Effective plan cost after insurance and estimated tax credit
KRW 0
Monthly reserve KRW 0 over 12 months
This screens only the public basics effective October 1, 2024. It is not reimbursement approval, a product indication check, or a treatment recommendation. Current notices and medical-record review control.
3% salary threshold
KRW 1,500,000
Annual credit after this plan
KRW 0
Diabetic retinopathy care rarely fits into a single-price box. Anti-VEGF intravitreal injections, focal or panretinal laser photocoagulation, vitrectomy, OCT, and follow-up visits can be combined in different sequences. The stage of retinopathy, whether diabetic macular edema involves the center, the number of treated eyes, drug choice, Korean National Health Insurance review, and the hospital setting all change the patient budget.
This calculator therefore does not claim a nationwide average treatment price. It asks for the total covered charge quoted by the hospital for each treatment unit, plus separately quoted non-covered or full-self-pay items. The covered total means the insurer-paid and patient-paid covered portions before the copay. It is not the copay already printed on a receipt.
The result separates outpatient and inpatient copays, subtracts only an indemnity-insurance payment confirmed under the patient’s policy, estimates the incremental Korean medical-expense tax credit, and turns the remaining plan cost into a monthly reserve. It is a budgeting and question-preparation tool, not a diagnosis, reimbursement decision, or treatment recommendation.
Sudden vision loss, a sudden shower of floaters, flashes of light, or a curtain-like field defect needs prompt eye or emergency assessment. Do not wait for a calculator result. Vitreous hemorrhage and retinal detachment are among the urgent problems that must be excluded.
The calculator uses the latest comprehensive Korean guideline available during the July 22, 2026 review. It supports the screening schedule, stage-based follow-up context, prompt panretinal photocoagulation referral for proliferative disease, and intravitreal treatment options for diabetic macular edema.
Read the guideline articleThe national health-information page explains diabetic macular edema, OCT, anti-VEGF and steroid injections, focal and panretinal laser, and vitrectomy. These descriptions provide educational context only; a retinal specialist selects care for the individual eye.
Open the national health pageThe public Faricimab criterion under Ministry notice 2024-186, effective October 1, 2024, lists DME basics including HbA1c no higher than 10%, minimum central retinal thickness of at least 300 μm, stated exclusions, and a patient total of no more than 14 administrations including other anti-VEGF products.
Open the HIRA criterionOrdinary copays come from Article 19 and Annex 2 of the National Health Insurance Act Enforcement Decree effective February 19, 2026. The tax estimate follows Income Tax Act Article 59-4 and Enforcement Decree Article 118-5 effective July 1, 2026.
Drug notices and eligibility can change after this review. The prescription-date notice, product authorization, OCT and vision records, prior response, and HIRA review remain controlling. A green checklist result is not an approval guarantee.
| Treatment or test | Typical role | Quantity | Quote |
|---|---|---|---|
| Anti-VEGF injection | Reduce edema and vision loss in center-involving DME | Planned sessions per eye | Covered total per administration |
| Focal or panretinal laser | Address focal leakage or proliferative neovascular risk | Planned sessions per eye | Covered total per session |
| Vitrectomy | Treat non-clearing hemorrhage or tractional retinal detachment when indicated | Planned procedures per eye | Covered inpatient total per procedure |
| Follow-up and OCT | Monitor edema, retinal status, response, and retreatment timing | Total visits during the plan | Covered total per visit |
Injection, laser, and vitrectomy counts are entered per eye. Selecting both eyes multiplies those units and their unit quotes by two. Monitoring is entered as total visits because both eyes may be examined in one appointment. Actual bilateral billing can differ from a simple multiplication because same-day second procedures, repeated tests, and inpatient schedules have separate billing rules. Replace the planning output with the combined hospital quote whenever available.
Outpatient covered total = injection units × quote + laser units × quote + follow-up visits × quote
Inpatient covered total = vitrectomy units × inpatient quote
Gross patient payment = outpatient covered copay + inpatient covered copay + non-covered total
After insurance = gross patient payment − confirmed insurer payment
Effective plan cost = after insurance − incremental estimated medical tax credit
Assume three anti-VEGF administrations at a covered total of KRW 700,000 each, two laser sessions at KRW 200,000 each, and four monitoring visits at KRW 100,000 each. The outpatient covered total is KRW 2,900,000. At an ordinary clinic outpatient copay of 30%, the covered patient amount is KRW 870,000. Adding KRW 100,000 of non-covered items and subtracting a confirmed KRW 70,000 insurer payment leaves KRW 900,000 after insurance.
If annual gross salary is KRW 100,000,000 and no earlier eligible medical expense exists, the 3% threshold is KRW 3,000,000. This treatment alone does not cross the threshold, so its estimated incremental credit is zero. The example demonstrates arithmetic only. It is not an official drug price, hospital average, or recommended treatment plan.
Covered outpatient total
KRW 2,900,000
Covered copay
KRW 870,000
After insurance
KRW 900,000
The checklist is a pre-visit organizer based on the public HIRA criterion, not a reimbursement engine. It separately shows center-involving DME, HbA1c no higher than 10%, minimum central retinal thickness at least 300 μm, absence of a stated poor-prognosis exclusion, and the remaining count within the public patient total of 14 administrations. Aflibercept’s published review example reinforces the same HbA1c and 300 μm boundaries and the need for records supporting expected visual benefit.
Even when every item passes, product authorization, vision and OCT history, prior treatment response, documentation quality, the current notice on the prescription date, and HIRA review still matter. A failed item also does not tell a patient to stop treatment. It identifies a question for the retinal clinic about coverage, an alternative product, non-covered care, laser, surgery, or another medically appropriate plan.
The public criterion counts other anti-VEGF products in the patient total. Include injections received at another hospital and administrations before a product switch. The calculator subtracts the prior cumulative count from 14 and flags a current plan that extends beyond the remainder.
The model applies ordinary outpatient rates of 30% at a clinic, 40% at an urban hospital, 35% at a rural hospital, 50% at an urban general hospital, and 45% at a rural general hospital. At a tertiary hospital outpatient visit, the entered consultation total is paid in full and 60% applies to the remaining covered outpatient amount. Vitrectomy starts with an editable ordinary inpatient rate of 20%.
These rates do not override Medical Aid, special-case registration, lower-income status, age-based rules, or other benefit categories. If the hospital has confirmed another rate, use the manual outpatient field and edit the inpatient percentage. Diabetic retinopathy by name alone is not assigned an automatic 5% or 10% rate in this calculator.
Korean indemnity insurance cannot be estimated reliably from policy generation alone. Outpatient and inpatient limits, deductibles, covered and non-covered ratios, riders, exclusions, and claims review differ by contract. Keep the field at zero until the insurer or its app provides an expected payment for this plan. The calculator caps the deduction at gross patient payment so an over-entered insurance amount cannot create a negative cost.
The simplified Korean credit applies 15% to eligible annual medical expenses above 3% of annual gross salary. The ordinary dependent category has a KRW 7,000,000 eligible-base cap. The statutory no-cap categories include the taxpayer, people age 65 or older, people with disabilities, specified registered serious or rare diseases and tuberculosis, and children age 6 or under. Insurer-reimbursed medical costs are excluded under Article 118-5.
The result compares the annual credit before and after adding this plan’s after-insurance expense, then displays only the increase. It does not model final tax liability, dual-income spouse allocation, every dependent rule, or other credits. The actual cash benefit can be lower than the estimate.
| Status | General interval | Planning focus |
|---|---|---|
| No DR with controlled glucose | 1–2 years | Routine retinal examination |
| Mild NPDR | 6–12 months | Retinal review and systemic control |
| Moderate NPDR | 3–6 months | OCT and macular-edema assessment |
| Severe NPDR | About 3 months | Monitor progression to proliferative disease |
| PDR needing treatment | May be monthly | Laser, injection, surgery, and close review |
| Stable treated PDR | 6–12 months | Check reactivation and complications |
These are general guideline intervals, not appointments generated by the calculator. DME, pregnancy, rapid progression, the fellow eye’s vision, recent surgery, and treatment response can shorten follow-up. Enter the actual schedule given by the retinal clinic rather than deriving visit count from stage alone.
Turn proposed injections and OCT visits into a calendar, then identify the covered-total and non-covered fields that the hospital quote still needs.
Expand per-eye treatment quantities, compare them with the combined hospital quote, and avoid doubling follow-up visits automatically.
Separate outpatient treatment from inpatient vitrectomy so each covered amount receives the relevant copay instead of one blended rate.
Distinguish a confirmed insurance payment from the incremental tax-credit estimate and retain the itemized receipt for both processes.
No. Observation, laser, injection, surgery, or a combination depends on retinopathy stage, center-involving edema, vision, OCT, hemorrhage, traction, and systemic status.
No. It is the cumulative limit stated in the public reimbursement criterion used here, not a medical stopping rule. The treating clinic discusses current coverage, another product, non-covered care, laser, surgery, or another appropriate plan.
No. It is one public basic criterion. Center involvement, HbA1c, exclusions, vision, records, product authorization, and the current notice still matter.
Doubling per-eye treatment units is useful for initial planning, but actual same-day second-procedure billing, shared tests, and scheduling can differ. Use the hospital’s combined quote for the final estimate.
Policy generation does not determine the final payment. Deductibles, visit limits, riders, non-covered terms, exclusions, and claims review differ, so the tool accepts only a confirmed expected amount.
No. It estimates the increase in the annual medical-expense credit. Final tax liability, other credits, and dependent allocation can reduce the realized benefit.
Save the treatment-unit totals, covered and non-covered amounts, remaining public injection count, and monthly reserve. Confirm medical questions with the retinal specialist, billing questions with the hospital, policy questions with the insurer, and tax questions with the relevant tax service or professional. Recalculate when the plan, quote, or governing notice changes.
Return to the calculator