Price the private-pay hours that begin after covered home-visit care
When a parent's NHIS-covered home-visit care does not cover the full day, a family may add a separate private-pay extension, rearrange covered visits, or fill the gap itself. Looking only at the covered-service copay can substantially understate the monthly cash need. The household may also face a full-payment amount above the monthly benefit ceiling, minimum billable hours in the private contract, surcharges, travel expenses, meals, or fixed monthly charges.
This calculator first applies the official 2026 home-visit care fee schedule to the entered covered visits. It combines those gross benefit costs with other Korean long-term-care home benefits, separates the amount within the monthly ceiling from the amount above it, and applies the selected 15%, 9%, 6%, or 0% copay only to the within-ceiling portion. It then calculates a separate private contract from needed, delivered, and billable hours. The two ledgers remain separate so a private payment is never presented as an NHIS benefit.
Covered benefit ledger
Use the official duration fee, provider-confirmed add-on, visit count, other counted home-care benefits, and the NHIS-confirmed monthly ceiling.
Above-ceiling payment
Benefit cost above the ceiling is paid in full by the beneficiary. A reduction or exemption does not turn that excess into a 9%, 6%, or 0% copay.
Private contract ledger
Compare care needed, hours actually delivered, hours billed under the minimum, labor cost, surcharge, travel, meals, and other written charges.
Keep the covered visit and private extension separate in time, service scope, records, and payment. The calculator estimates cost; it does not decide whether a provider's private arrangement, staffing model, or requested expense is lawful. Ask the provider and NHIS to confirm the boundary before signing.
Official 2026 basis and South Korea jurisdiction
The rate table used here comes from MOHW Notice No. 2025-247, issued by the Ministry of Health and Welfare and effective January 1, 2026. The Long-Term Care Insurance Act defines home-visit care, authorizes monthly limits for home benefits, and requires full patient payment for benefit cost beyond the limit or outside covered scope. The Enforcement Decree supplies the ordinary 15% home-benefit copay, while the separate reduction notice supports effective rates of 9% and 6% for NHIS-confirmed reduction categories.
These rules are specific to South Korea's long-term-care insurance system and all monetary outputs are in Korean won. They do not apply to Medicare, Medicaid, private long-term-care policies, or another country's home-care funding. Even in Korea, the certificate, individual benefit-use plan, provider record, and final NHIS adjudication take priority over this planning estimate.
2026 monthly home-benefit ceilings
South Korea 2026 monthly home-benefit ceiling by long-term-care grade| LTC grade | Monthly ceiling |
|---|
| Grade 1 | KRW 2,512,900 |
| Grade 2 | KRW 2,331,200 |
| Grade 3 | KRW 1,528,200 |
| Grade 4 | KRW 1,409,700 |
| Grade 5 | KRW 1,208,900 |
2026 home-visit care fee per visit
Official 2026 gross home-visit care fee and standard copay example by duration| Service duration | Gross benefit fee | Illustrative 15% copay |
|---|
| 30 minutes or more | KRW 17,450 | KRW 2,618 |
| 60 minutes or more | KRW 25,320 | KRW 3,798 |
| 90 minutes or more | KRW 34,120 | KRW 5,118 |
| 120 minutes or more | KRW 43,430 | KRW 6,515 |
| 150 minutes or more | KRW 50,640 | KRW 7,596 |
| 180 minutes or more | KRW 57,020 | KRW 8,553 |
| 210 minutes or more | KRW 63,530 | KRW 9,530 |
| 240 minutes or more | KRW 70,080 | KRW 10,512 |
The last column assumes the entire visit remains within the monthly ceiling, uses the standard 15% category, and has no add-on. The calculator rounds the per-visit add-on fee and the aggregate within-ceiling copay to won for planning. Actual NHIS claim adjustments and provider records can produce a difference.
Copay categories
- Standard home-benefit copay: 15%
- After an NHIS-confirmed 40% reduction: 9%
- After an NHIS-confirmed 60% reduction: 6%
- Confirmed statutory exemption within the ceiling: 0%
Provider-confirmed official add-ons
- Service from 22:00 to 06:00: 30%
- Sunday service: 30%
- Paid holiday or Labor Day service: 50%
- Choose one final claim category when conditions overlap
The current 2026 home-visit care text does not contain a 20% add-on for 18:00 to 22:00. Do not copy an evening rule from day/night care or another benefit category into a home-visit schedule. Select an add-on only after the provider confirms how the visit will be claimed.
How the monthly benefit ceiling is allocated
The ceiling tracks gross benefit cost, meaning the NHIS share plus the beneficiary copay. It is not a wallet that decreases only by the amount the family paid. A grade 3 beneficiary with KRW 300,000 of other counted home benefits has KRW 1,228,200 left before home-visit care, even if the household paid only a fraction of that KRW 300,000.
- Enter gross cost for other home benefits counted toward the same ceiling. Obtain this from the NHIS plan or provider statement; do not enter only the patient receipt amount. Exclude a provider add-on or remote-area transport amount that the rules keep outside the ceiling.
- For each covered home-visit schedule, multiply the official duration fee by the one provider-confirmed add-on category and the monthly visit count. Separate ordinary visits, Sunday visits, and paid-holiday visits if their claim categories differ.
- Allocate the ceiling to other home benefits first and home-visit care second. This ordering is used only to explain which entered home visit first crosses the remaining ceiling. The total household cost for the month does not depend on claim order.
- Apply 15%, 9%, 6%, or 0% only to the aggregate cost inside the ceiling. Add every won above the ceiling as full household payment. The calculator separately reports estimated NHIS payment, within-ceiling copay, and full above-ceiling payment.
- Divide the final remaining ceiling by the standard 180-minute fee of KRW 57,020 to obtain a reference count. This is not authorization for extra visits; grade, individual plan, staffing, same-day spacing, and add-ons can change what is allowed.
Calculation flow
Other counted home benefits + gross covered home-visit care → split within and above the monthly ceiling → apply confirmed copay only within the ceiling → add full excess → add separate private-pay contract → subtract the family contribution that can actually be applied.
Worked grade 3 example
Assume grade 3, the standard 15% copay, KRW 300,000 of other counted home benefits, and twenty covered 180-minute visits without an add-on. Covered home-visit care costs KRW 57,020 × 20, or KRW 1,140,400. Combined benefit cost is KRW 1,440,400, which remains below the grade 3 ceiling of KRW 1,528,200. The within-ceiling household copay is KRW 216,060 and the ceiling remaining is KRW 87,800.
Now add a separate private-pay extension used twenty times. The family needs two hours and receives two hours per visit, but the written contract has a three-hour minimum. At an illustrative KRW 18,000 hourly rate, with KRW 3,000 contract travel expense and KRW 5,000 meal cost per visit, the private contract totals KRW 1,240,000. These are synthetic example numbers, not market averages, recommended prices, or regulated NHIS fees.
Worked monthly cost example for grade 3 covered care and a private-pay extension| Item | Formula | Result |
|---|
| Covered home-visit care | KRW 57,020 × 20 | KRW 1,140,400 |
| Combined gross benefit cost | KRW 300,000 + KRW 1,140,400 | KRW 1,440,400 |
| Within-ceiling copay | KRW 1,440,400 × 15% | KRW 216,060 |
| Private time-based labor | 60 billable hours × KRW 18,000 | KRW 1,080,000 |
| Contract travel expense | KRW 3,000 × 20 | KRW 60,000 |
| Contract meal cost | KRW 5,000 × 20 | KRW 100,000 |
| Household cost before contribution | KRW 216,060 + KRW 1,240,000 | KRW 1,456,060 |
| Primary caregiver funding need | KRW 1,456,060 - KRW 200,000 | KRW 1,256,060 |
The contract delivers 40 hours but bills 60 because of the minimum, so 20 extra billable hours appear in the result. Adding the covered-benefit household cost to the private contract produces KRW 1,456,060 before family sharing. If another family member contributes KRW 200,000, the primary caregiver must prepare KRW 1,256,060.
If other benefits rise to KRW 400,000 and the covered 180-minute schedule rises to twenty-two visits, gross benefit cost becomes KRW 1,654,440. The amount above the grade 3 ceiling is KRW 126,240, paid in full. Standard copay within the ceiling is KRW 229,230, so the covered-benefit household cost is KRW 355,470 before any private contract.
Four different time measures in a private-pay quote
An hourly price by itself does not describe a private home-care contract. The family's care need, the provider's delivered time, the minimum billable time, and the final billed time can all differ. Entering each measure reveals both a care gap and a billing gap. If contracted service time is zero, this calculator sets billable time to zero even when a minimum is entered; it does not invent a charge for an unused visit.
Care needed
Enter how many hours per visit cannot safely be left uncovered, based on meals, toileting, movement, supervision, or another concrete family need.
Contracted service delivered
Enter the hours the private worker or provider agrees to deliver. Monthly delivered hours equal this number multiplied by the visit count.
Minimum billable time
If two hours of service are billed as at least three, enter three. Ask whether late arrival, early departure, cancellation, or replacement staffing changes the minimum.
Billable time
The calculator uses the greater of delivered time and the minimum, multiplied by visits. The difference above delivered time is shown as extra hours billed by the minimum.
Read every charge outside the hourly rate
- Enter a private surcharge only when it appears in the separate written quote. Do not automatically copy the official 30% or 50% NHIS add-on into the private contract.
- Enter a per-visit travel expense only when the separate contract identifies it. NHIS remote-area transport is paid under its own rule and is not a beneficiary charge, so ask whether the requested amount duplicates that payment.
- Enter meal cost only when the contract identifies who receives the meal and how it is priced. Keep the parent's ordinary groceries outside this line so quotes remain comparable.
- Use other monthly cost for a written fixed charge such as administration or a platform fee. If there is a deposit or one-time enrollment fee, agree on a monthly allocation period before entering it.
Separate schedule groups reveal where the money goes
Weekdays versus Sundays
Enter sixteen ordinary 180-minute visits and four Sunday visits as two covered groups. Apply the 30% category only to the Sunday group after provider confirmation, avoiding an overestimate across all twenty visits.
Evening versus weekend private terms
If weekday extensions have a three-hour minimum but weekend work has a four-hour minimum and surcharge, create two private groups. Their line totals show which term drives the budget.
Apply family sharing last
First combine within-ceiling copay, full excess, and private-pay cost. Then subtract the fixed contribution agreed by other family members, producing the primary caregiver's actual funding need.
Do not hide an unmet care gap
Twenty visits needing three hours each require 60 hours. A contract delivering two hours each supplies 40, leaving 20 unmet hours even if its price fits the budget.
Step-by-step use
- Select the beneficiary's LTC grade and NHIS-confirmed copay category. Changing the grade resets the ceiling to the statutory 2026 amount; edit the ceiling only if the current benefit plan confirms a different usable figure.
- Enter gross cost for every other home benefit counted in the same month. Ask for the NHIS-plus-patient total rather than copying only the cash receipt.
- Add covered home-visit groups by duration and provider-confirmed add-on. Keep ordinary, night, Sunday, and paid-holiday visits separate and order them as planned so the first above-ceiling visit is useful in consultation.
- Add separate private-pay groups. Enter care needed, contracted delivery, minimum billable time, hourly rate, private surcharge, travel, meals, and fixed costs exactly as quoted.
- Review household covered-benefit cost, private cost, minimum-billing gap, and unmet care hours together. A low price is not a complete plan when supervision remains uncovered.
- Enter the fixed monthly contribution expected from other relatives. Print the result and take the schedule-level breakdown to NHIS and the provider for confirmation before changing services or signing.
Official add-ons and private surcharges are different
An official add-on changes the gross NHIS benefit fee under the notice and therefore can consume the monthly ceiling. A private surcharge changes the separately negotiated contract price and does not become an insured benefit. The calculator keeps two distinct inputs and never transfers a rate from one ledger to the other.
Comparison of an official home-visit care add-on and a private contract surcharge| Question | Covered home-visit care | Private-pay extension |
|---|
| Source | MOHW notice and service record | Separate written contract |
| Base price | Official 2026 duration fee | Provider quote |
| Extra rate | Provider-confirmed statutory category | Written private surcharge |
| Monthly ceiling | Counts unless specifically excluded | Kept outside the insured ceiling |
| Reduction or exemption | Applies within ceiling when confirmed | Does not automatically apply |
| Final authority | NHIS and approved provider claim | Contract parties and professional advice if needed |
Pre-contract loss-prevention checklist
Confirm with NHIS and the benefit plan
- Current grade and recognition validity period
- Reduction or exemption category and effective month
- Gross cost of other benefits counted toward the ceiling
- Approved visit duration, count, and same-day spacing
- Eligibility for 210/240-minute visits and claimed add-ons
Confirm in the private contract
- Service time that does not overlap covered benefit hours
- Permitted personal care, household, and outing tasks
- Minimum hours and partial-hour rounding
- Night, weekend, and holiday surcharge plus evidence for expenses
- Same-day cancellation, substitute staffing, accident, and insurance terms
- Payment date, receipt or tax handling, and refund rules
The 2026 severe-beneficiary home-visit add-on for grades 1–2 can pay the provider KRW 2,000, KRW 4,000, or KRW 6,000 depending on service duration. The beneficiary does not bear that add-on and it does not consume the monthly ceiling, so it is excluded here. Official remote-area transport is also excluded because the beneficiary is not charged for it.
Frequently asked questions
Does only my 15% payment reduce the monthly ceiling?
No. Gross benefit cost—the NHIS payment plus patient copay—uses the ceiling. Enter gross other-benefit cost from the benefit plan, not only the amount on a cash receipt.
Is above-ceiling care free for a 0% exempt beneficiary?
No. The 0% category applies to covered cost within the ceiling. Cost above the ceiling and a separate private-pay contract remain full household payment.
Does every home visit after 18:00 receive a 20% add-on?
No. The current 2026 home-visit care provision does not include an 18:00–22:00 category. Confirm 22:00–06:00 night service, Sunday, or paid-holiday status with the provider and select only the final claimed category.
Does the calculator provide a fair private hourly price?
No. It deliberately uses no market-average or recommended private rate. Geography, tasks, staffing relationship, time of day, insurance, and cancellation terms can materially change a quote. Compare written quotes on the same hours and service scope.
Should every requested travel fee be entered?
Enter only an expense stated in the separate private contract after asking what it covers. NHIS remote-area transport is not charged to the beneficiary, so confirm that a private line does not duplicate that official payment.
Can grades 3–4 use 210- or 240-minute visits?
The notice generally associates the 210/240-minute rates with grades 1–2. Grades 3–4 may use a limited special-request route, including a monthly day limit, when requirements are met. This calculator displays the arithmetic but cannot authorize the claim. Grade 5 has separate cognitive-activity and plan restrictions that also require NHIS confirmation.
Why can a provider invoice differ from the estimate?
Actual recorded time, add-on eligibility, NHIS won-level processing, a change in other benefits, cancellation, claim adjustment, or an omitted private charge can create a difference. Compare the schedule breakdown with service records visit by visit and let the final lawful NHIS and provider statements control.
Sources and limits
The calculator uses the National Law Information Center's Long-Term Care Insurance Act, the notice on benefit provision standards and fee calculation, and the copay reduction notice. The 2026 policy direction and severe-beneficiary add-on were cross-checked against Ministry of Health and Welfare and National Health Insurance Service materials. Rules can be amended, so confirm the version in force for the service month.
- Long-Term Care Insurance Act provides the covered-service, monthly-ceiling, and cost-sharing framework.
- MOHW benefit provision and fee notice provides the 2026 duration rates, visit conditions, add-ons, and remote-area transport rule.
- NHIS 2026 system changes summarizes the year's long-term-care rate and severe home-visit changes.
What is outside this calculator
It does not determine grade, reduction eligibility, medical suitability, or provider quality. It excludes 270-minute extensions, 12-hour home-visit care, family-provided covered care, cognitive-activity home visits, and the cognitive-support grade. It does not decide employment, dispatch, tax, insurance, allowed-task, refund, or consumer-law questions in a private contract. Local subsidies, private insurance, medical cost, equipment, housing, and caregiver opportunity cost are also outside the result.
Take a reconciled schedule to the provider
Start with the monthly ceiling and gross other-benefit cost shown on the NHIS plan. Copy the covered visit schedule and every line of the private quote, then flag the full above-ceiling amount, minimum-billing gap, and unmet care hours. Ask the provider to confirm service scope, add-ons, expenses, cancellation, and substitute staffing in writing, and let NHIS or the lawful final invoice control the amount due.