Medical Expense Calculator

Medical Expense Calculator helps estimate Korea-related medical expense, copay, refund, special-case, and uncovered-cost assumptions in English.

Medical expense inputs

Medical expense result

Health insurance paid

₩1,750,000

35% of total bill

Covered copay

₩1,750,000

Eligible for the ceiling test

Ceiling refund

₩0

Ceiling ₩2,980,000

Private insurance refund

₩2,450,000

Estimated by generation

Tax credit estimate

₩157,500

Rate 15%

Final burden

₩642,500

12.9% burden rate

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Korean medical expense actual burden calculator

This page translates the Korean guide for actual medical burden after health insurance, out-of-pocket ceiling refund, private indemnity insurance, and medical-expense tax credit.

Four-step refund structure

The Korean guide explains that the hospital bill is not the same as the final burden. First, Korean National Health Insurance pays the covered portion except for the statutory copay. Second, the annual out-of-pocket ceiling can refund covered copays above the income-decile ceiling. Third, private indemnity insurance may reimburse remaining covered and non-covered amounts. Fourth, medical-expense tax credit can reduce year-end tax.

The calculator keeps covered and non-covered amounts separate. Non-covered items are not counted for the NHIS out-of-pocket ceiling, but they can still matter for private insurance and the year-end medical expense tax credit.

2026 copay and ceiling assumptions

Outpatient copay rates in the source are 60 percent at tertiary hospitals, 50 percent at general hospitals, 40 percent at hospitals, and 30 percent at clinics and pharmacies. Inpatient copay is generally 20 percent, but severe disease under special case treatment uses 5 percent in the model.

The 2026 annual ceiling table in the Korean guide uses KRW 870,000 for the 1st income decile, KRW 1,080,000 for deciles 2 to 3, KRW 1,560,000 for deciles 4 to 5, KRW 2,980,000 for deciles 6 to 7, KRW 4,080,000 for decile 8, KRW 5,230,000 for decile 9, and KRW 10,500,000 for decile 10.

Medical expense tax credit

The Korean page preserves the year-end settlement rule that medical expenses above 3 percent of total salary are eligible for credit. General medical expenses use a 15 percent credit rate with a normal KRW 7,000,000 limit. Infertility treatment uses 30 percent. Premature infant and congenital anomaly medical expenses use 20 percent.

Private insurance proceeds must be subtracted before calculating the tax-credit base. Since the 2019 tax law change, reimbursed private insurance amounts are excluded from eligible medical expenses, so the same won cannot be claimed twice.

Private insurance generation comparison

The Korean model separates private indemnity insurance generations. Generation 1 to 3 is modeled as 90 percent cover for covered copay and 80 percent for non-covered expenses. Generation 4 and Generation 5 are modeled as 80 percent for covered copay and 70 percent for non-covered expenses, with a KRW 2,000,000 annual self-burden cap in the source constants.

Because non-covered care can dominate the bill, the final burden depends heavily on private insurance generation and actual policy exclusions. The calculator provides an estimate, but claim review, policy terms, and receipts should be checked before assuming a refund.