Market scope note: This article draws on sources from both Korea and the United States. Each piece of information is labeled 🇰🇷 Korea or 🇺🇸 U.S. in the text to indicate which country it applies to.
Every new year brings incremental changes to health insurance rules. But 2026 is different. Both Korea and the United States have made meaningful reforms aimed at reducing the real cost of medical care for older adults, and the scope of those changes is significant. If you are caring for an aging parent, understanding what has changed this year can make a practical difference.
🇰🇷 Korea The most notable change is the extension of 건강보험 (National Health Insurance) coverage to nursing-care costs at long-term care hospitals (요양병원). Until now, these costs were entirely excluded from health insurance, meaning families had to cover 100% out of pocket. One-on-one private nursing care could run roughly 3.7 million won per month, and even shared nursing arrangements typically cost between 600,000 and 900,000 won a month. Private nursing expenses borne by households were estimated at 10 trillion won as of 2022 — a substantial burden.
🇰🇷 Korea The 보건복지부 (Ministry of Health and Welfare) announced a pilot program, set to begin in the first half of 2027, that would apply 건강보험 coverage to nursing-care costs at medically oriented long-term care hospitals, bringing patients' out-of-pocket share down from the current 100% to approximately 30%. Priority coverage is being considered for patients with high medical and nursing needs, those with serious or rare conditions, patients with dementia or Parkinson's disease, and 장기요양 (long-term care) Grade 1 and Grade 2 inpatients. The program will expand gradually, starting with hospitals of 100 beds or more that directly employ their own nursing-care staff. Because this change significantly reduces the financial burden, it is worth checking whether the long-term care hospital where your parent is staying will participate.
🇰🇷 Korea Home-based care benefits are also expanding. The monthly benefit ceiling for 장기요양 재가급여 (long-term care home-care benefits) has been raised — from 2,310,000 won to 2,510,000 won for Grade 1, and from 2,080,000 won to 2,330,000 won for Grade 2. In addition, 재택의료센터 (home medical care centers) have increased from 192 to 250 locations, and the number of people served by 노인맞춤돌봄서비스 (Customized Care Services for Older Adults) has expanded from 550,000 to 576,000. Older parents who have difficulty getting around now have greater access to in-home visits from doctors and nurses, as well as everyday care services.
🇺🇸 U.S. In the United States, starting in 2026, the annual out-of-pocket cap for Medicare Part D prescription drug costs is set at $2,100. This is a slight increase from the 2025 cap of $2,000, but it represents a major improvement compared to the years when no cap existed at all. Once this amount is reached, beneficiaries pay nothing more for covered prescription drugs for the rest of that calendar year. In the past, older adults who needed expensive medications sometimes paid $10,000 to $15,000 a year in drug costs.
🇺🇸 U.S. Drug price reductions have also begun in earnest. Under the 인플레이션 감축법 (Inflation Reduction Act, IRA), new negotiated prices for 10 drugs took effect on January 1, 2026. The list includes medications commonly used by cardiovascular and diabetes patients, such as Eliquis, Jardiance, and Xarelto, with discounts ranging from 38% to 79% compared to previous prices. CMS estimates that these negotiations will save approximately $6 billion in Medicare spending and reduce out-of-pocket costs for roughly 8.8 million beneficiaries by about $1.5 billion.
🇺🇸 U.S. The standard monthly premium for Medicare Part B has risen to $202.90 in 2026, surpassing $200 for the first time, and the annual deductible has increased to $283. The Part A inpatient hospital deductible has also increased to $1,736. With premiums rising, carefully comparing the provider networks and formularies of Medicare Advantage plans has become even more important for managing out-of-pocket spending. A new special enrollment period has also been introduced: if a provider's information is listed incorrectly when enrolling in a Medicare Advantage plan, the enrollee may switch plans within 3 months of joining.
Sources: 대한민국 정책브리핑 (보건복지부, December 2025), 서울신문·경향신문 (요양병원 간병비 급여화, July 2026), KFF (Medicare Drug Price Negotiation, updated March 2026), CMS (Medicare Part D Negotiated Prices Fact Sheet, August 2024), Elder Law Answers (How Medicare Changes in 2026 Will Affect Older Adults), U.S. News (Medicare Part D 2026), CoveredUSA (Medicare Part D OOP Cap 2026).
Note: This article was compiled by AI from the sources cited above. We strive for accuracy, but for decisions about your specific situation, please confirm the latest guidance from a professional or the relevant agency.