Market scope note: This article covers information from both Korea and the United States. Each piece of information is labeled 🇰🇷 Korea or 🇺🇸 U.S. in the body to indicate which country it applies to.
The first bill a family encounters after beginning to care for a parent is usually more complicated than expected. Many families feel the actual amount is higher than they anticipated after hearing phrases like "15% cost-sharing" or "20% cost-sharing." That gap most often comes from two things. One is the structure of cost-sharing rates that apply only to covered benefit items. The other is that the family has not yet applied for the reduction programs that can lower that percentage itself.
🇰🇷 Korea Let's start with the basic structure of Korea's 노인장기요양보험 (National Long-Term Care Insurance). For home-based benefits such as visiting care and day and night care, the individual pays 15% of the benefit cost; for facility-based benefits such as nursing homes, the share is 20%. As of 2026, the monthly benefit limit for home-based care at Grade 1 is approximately 2,510,000 won, and if visiting care is used to the maximum within that limit, the out-of-pocket amount comes to roughly 370,000 won. For facility-based benefits, the daily rate for Grade 1 is multiplied by the number of days of admission and then 20% is applied, resulting in approximately 500,000 to 560,000 won per month depending on the grade. However, these amounts apply only to covered benefit costs; non-covered items such as meal ingredient fees, premium room charges, and haircut and grooming fees must be paid in full by the individual, separate from the cost-sharing rate. At nursing homes, meal and snack costs range from approximately 250,000 to 450,000 won per month and vary by facility, so actual monthly spending must be planned as the total of the covered benefit out-of-pocket amount plus these non-covered costs.
🇰🇷 Korea So how can this cost-sharing be reduced? There are reduction programs based on income and asset levels. As of 2026, recipients of 생계급여 or 의료급여 (livelihood or medical benefits) under the 국민기초생활보장법 (National Basic Livelihood Security Act) are fully exempt from out-of-pocket costs for covered benefits. Other 의료급여 (medical benefit) recipients receive a 60% reduction, paying only 6% for home-based benefits and 8% for facility-based benefits. Those whose 건강보험료 (health insurance premium) ranking falls in the bottom 25% or below (Reduction Tier 1) pay 9% for home-based and 12% for facility-based benefits, while those in the bottom 50% or below (Reduction Tier 2) pay 12% for home-based and 16% for facility-based benefits. Eligibility is often confirmed and applied automatically by the 건강보험공단 (National Health Insurance Service), but it is safer to check your specific eligibility directly with the 국민건강보험공단 (National Health Insurance Service) at 1577-1000. Also keep in mind that for home-based benefits, any amount exceeding the monthly benefit limit is paid entirely out of pocket.
🇺🇸 U.S. A similar structure exists for Medicare beneficiaries in the United States. The Medicare Savings Program (MSP) is a state-administered program that helps beneficiaries with incomes below a certain level reduce their Part B premiums, deductibles, and cost-sharing. As of 2026, the QMB (Qualified Medicare Beneficiary) tier, which offers the broadest benefits, covers Part A and B premiums, deductibles, copays, and more; the monthly income limit is $1,350 for an individual and $1,824 for a couple. SLMB pays the Part B premium of $202.90 per month on the beneficiary's behalf and applies to individuals with monthly income up to $1,616 and couples up to $2,184. Some states apply income limits higher than the federal standards or have eliminated asset tests entirely, so it is important not to give up based on the federal standards alone.
🇺🇸 U.S. Separate assistance is also available for prescription drug costs. Extra Help (Low Income Subsidy, LIS) eliminates Medicare Part D prescription drug insurance premiums and deductibles and reduces the out-of-pocket cost per prescription to a maximum of $5.10 for generic drugs and $12.65 for brand-name drugs. Under the Inflation Reduction Act (IRA), partial subsidies were eliminated starting in 2024, so as of 2026 all eligible applicants receive the same full benefit. The 2026 eligibility criteria for an individual are annual income of approximately $23,940 or below and assets of $18,090 or below. Once annual out-of-pocket costs reach $2,100, all subsequent prescriptions are free for the rest of the year.
There is one point emphasized equally in both Korea and the United States. These benefits do not automatically disappear from your bill — they require eligibility confirmation and an application. And because income and asset criteria are adjusted every year, it is worth checking again this year even if you did not qualify last year. In both countries, there are still many families paying the full amount simply because they are unaware of these reduction and assistance programs.
Sources: 국민건강보험공단 노인장기요양보험 (National Health Insurance Service Long-Term Care Insurance, longtermcare.or.kr), 보건복지부 고시 (Ministry of Health and Welfare Notification, 2026 Long-Term Care Fee Standards), Medicare Rights Center 2026 MSP Guide, CMS (Centers for Medicare and Medicaid Services) Extra Help/LIS 2026 standards, Social Security Administration Extra Help information (ssa.gov).
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.