When a parent suddenly became unable to move around easily, the family began considering admission to a nursing home. Upon hearing the fees at the first places they looked into, their initial thought was reportedly, "Can we keep affording this cost?" Even if the children shared the burden, the monthly expenses were still heavy, and there were even reports of quiet tensions among siblings over who would pay how much.

The turning point came when one family member called the National Health Insurance Service (NHIS). They only then learned that families do not pay the full cost of nursing home fees; rather, a substantial portion is covered by the Service through the long-term care insurance system for the elderly.

Long-Term Care Grade Assessment: The First Step to Using Benefits

If the parent had already received a long-term care grade assessment, the application itself would not have been difficult, but the family reportedly realized too late that they had not even gone through the grade application process because they were unaware of it. The counselor explained that one must first receive a grade assessment before using either facility benefits or home-based benefits.

They explained that once a grade is assigned, whether using a facility such as a nursing home or receiving home visit care, the percentage of benefit costs paid by the individual is fixed, with the remainder covered by the Service.

However, two points require separate attention. Facility admission and home-based care are subject to different co-payment rates, and non-covered costs such as meal fees, snack fees, and grooming fees must be paid separately regardless of which option is chosen, as they are not included in benefit items.

Reduction System That Lowers Co-Payment Rates Based on Income and Assets

What surprised the family even more was that a separate reduction system exists that lowers the individual co-payment rate depending on income and asset levels. Those in lower health insurance premium brackets see their rates decrease in stages, and among basic livelihood security recipients, those receiving medical benefits are entirely exempt from co-payments.

It was also explained that not receiving application guidance does not mean exclusion from eligibility. Even without notification, individuals can directly contact the Service to confirm whether they qualify for reductions and apply—a point that would have been overlooked had they not known.

The family then proceeded step by step from the grade application to confirming reduction eligibility, and reportedly felt the burden lessen compared to their initial worries.

Non-Covered Items and Amounts to Check Before Admission

However, the fact that the composition and amounts of non-covered items vary by facility remained a variable. The family's conclusion was that without checking in advance which non-covered items the nursing home in question charges and at what amounts, the total billed amount could feel higher than expected even if benefit payments decrease.

The points to check going forward can be summarized as follows:

• Whether a long-term care grade assessment has been received and the grade renewal timing
• Eligibility for reductions based on income and asset criteria
• The list and amounts of non-covered items at facilities under consideration for admission

While the Service sometimes determines reductions ex officio and notifies individuals, it is safer not to assume and to directly inquire and confirm, in case no notification was received. As related fee schedules and co-payment rate standards may change with annual notice revisions, it is necessary to reconfirm the latest standards through the National Health Insurance Service before applying.

[This article was written for the general purpose of providing policy information related to long-term care insurance for the elderly. Actual grade assessments, co-payment rates, reduction eligibility, and support details may vary depending on an individual's income and asset status and the timing of system revisions. For accurate guidance, please check through official channels such as the National Health Insurance Service. AI assisted in part.]