The non-payment status of refunds under the health insurance out-of-pocket cap system and excessively long waiting periods have been pointed out as problems.

■ 2.26 Million People and 2.8915 Trillion Won in Refunds for 2025 Medical Treatment... 75% from the Bottom 30% Income Bracket

According to data received from the National Health Insurance Service by Rep. Seo Young-seok of the Democratic Party of Korea on the National Assembly's Health and Welfare Committee, 2.26 million people are eligible for refunds for medical treatment in 2025, totaling 2.8915 trillion won. Of these, 870,000 are in the bottom 10% income bracket, and including those in the bottom 30%, they account for 75% of all eligible recipients.

■ Waits of Up to 1 Year and 7 Months for Refunds... 162,420 People Have Not Received Payments

Post-hoc refunds are made in August of the year after the medical treatment, when individual cap amounts are finalized. If hospital fees paid in January 2025 are refunded in August 2026, the wait can be as long as 1 year and 7 months.

Even after payment has been decided, some people have not received their refunds. As of the end of September 2026, 162,420 people had not received refunds decided for payment in 2025, with 75% of them in the bottom 30% income bracket. This figure was tallied separately from the earlier count of refund recipients for 2025 medical treatment.

■ "Advance Payments with Later Settlement and Expanded Automatic Payments Are Needed"

Rep. Seo proposed a system of paying provisional amounts first to those in income brackets 1 to 3 and settling the balance later. He also emphasized the need to expand automatic payments and to establish measures ensuring that those who have not received refunds can obtain them before the three-year statute of limitations expires.

[This article received some AI assistance in its writing. The information provided is for reference purposes, and this newspaper bears no legal or financial responsibility for the use of such information.]