Out-of-Pocket Costs for Rare, Severe and Intractable Diseases to Fall From 10% to 5%; Implants to Be Covered Even Without Teeth

The government will gradually lower health insurance out-of-pocket costs for people with rare, severe and intractable diseases from the current 10% to as low as 5%, and will cover dental implants for older adults who have no teeth. A total of 1.97 million people will benefit, with 600 billion to 800 billion won allocated annually.

The Ministry of Health and Welfare announced the measures on the 7th as part of its “First-Phase Health Insurance Coverage Innovation Plan.” The steps are intended to reduce medical costs for people with severe and rare diseases and address new health care needs.

The out-of-pocket rate under the special calculation program for rare, severe and intractable diseases will fall from 10% to 7% in December this year, then to 5% in January 2028. The change takes into account that other conditions covered by the program, including cancer and heart and cerebrovascular diseases, already have a 5% rate.

The ministry estimates that 1.36 million people with rare, severe and intractable diseases will save an average of 220,000 to 360,000 won per person annually. The cost of lowering the out-of-pocket rate is 300 billion won annually at 7% and 500 billion won at 5%.

The government will also simplify the renewal process, which required test results even for diseases that are difficult to cure. The process will be revised in stages through 2027 so that decisions can be based on a clinical diagnosis and, when necessary, treatment history. A total of 312 diseases are covered.

A pilot program to expedite coverage listing for rare disease treatments will also begin in the second half of this year. By streamlining coverage assessments and negotiations, the listing period will be shortened from the current 240 days to 100 days.

Support for severe diabetes will also expand. Coverage for insulin pumps and continuous glucose monitors, previously limited to people with type 1 diabetes, will extend to people with severe type 2 diabetes. People with pancreatic impairment will receive 90% of the standard amount, regardless of type.

The standard coverage amount for insulin pumps for people ages 19 to 34 will also rise from 1.7 million won to 4.5 million won. The measure is intended to ease financial burdens during the period when people are preparing to enter the workforce. Expanding support for severe diabetes will cost 70 billion won annually and reduce costs by 360,000 won per year for people with type 1 diabetes and 4.18 million won for those with severe type 2 diabetes.

At-home care support will be strengthened for people with glycogen storage disease and neurogenic bladder. The government will provide continuous glucose monitoring sensors and other supplies to 344 people with glycogen storage disease, and increase the daily limit for self-catheterization catheters for children with neurogenic bladder from six to eight. The standard amount will also rise from 9,000 won per day to 18,000 won for people younger than 19 and 13,500 won for those 19 and older.

Dental coverage will also expand. Starting in January 2027, older adults with no teeth will be eligible for coverage of dental implants, benefiting about 70,000 people by 2.3 million won per person. Coverage for light-cured composite resin will expand from children up to age 12 to those up to age 13, benefiting about 140,000 people.

The ministry also plans to develop a separate reimbursement plan in the second half of the year for specialized nursing hospitals for people with severe muscular rare diseases. It will announce additional measures, including easing caregiving burdens and covering new treatments currently not covered by insurance, once its review is complete.