Market scope note: This article covers both Korean and U.S. information. Each item is labeled 🇰🇷 Korea or 🇺🇸 U.S. in the text to indicate which country it applies to.
Many family caregivers are caught off guard when they receive the first bill after a parent begins long-term care services. Some assume that because benefits are in place, everything is covered. In reality, services are divided into covered (급여) and non-covered (비급여) items, and co-payment rates vary by program. Understanding the structure before the bill arrives lets you plan properly instead of being caught by surprise.
🇰🇷 Korea Korea's 노인장기요양보험 (National Long-Term Care Insurance) divides services broadly into 재가급여 (home-based benefits) — which cover in-home care visits, bathing assistance, and day/night care, among others — and 시설급여 (facility-based benefits), which apply when a parent moves into a care facility (요양원). As of 2026, the standard co-payment rate for 재가급여 is 15% of the service cost, and for 시설급여 it is 20%. The 국민건강보험공단 (National Health Insurance Service) covers the remainder, and the individual pays only that percentage.
🇰🇷 Korea Monthly benefit caps are set by care grade for 재가급여. Based on 2026 figures, the cap is 2,512,900 won per month for Grade 1, 2,331,200 won for Grade 2, 1,528,200 won for Grade 3, and 1,409,700 won for Grade 4. Applying the 15% co-payment rate, a Grade 1 recipient who uses the full monthly allowance would pay approximately 377,000 won per month. The caps were raised by more than 200,000 won compared to the previous year for Grade 1 and Grade 2 recipients with severe care needs, and Grade 1 recipients can now use in-home care visits of 3 hours each up to 44 times per month. One important point: any costs that exceed the monthly cap are paid entirely out of pocket, with no contribution from the 공단.
🇰🇷 Korea A reduction program exists for people whose income and assets fall below certain thresholds. Recipients of 기초생활수급 (basic livelihood assistance, medical aid recipients) pay 0 won in co-payments. Those in the 차상위계층 (near-poverty tier) have their co-payment rate for 재가급여 reduced to either 6% or 9%. For 시설급여 (care facility), eligible recipients see their co-payment rate lowered to 8% (a 60% reduction) or 12% (a 40% reduction). Non-covered items such as food ingredient costs and hair and beauty services fall outside the benefit scope; it is strongly advisable to review the facility's list of non-covered items and their prices before admission. Reduction applications can be made through a local branch of the 국민건강보험공단, and if you are unsure whether you qualify, it is worth making an inquiry.
🇺🇸 U.S. If your parent in the United States is enrolled in Medicare, prescription drug costs are partially covered under Medicare Part D. Beginning in 2026, the annual out-of-pocket cap for Part D prescription costs is set at $2,100. Once that amount is reached, the plan covers 100% of the cost of covered medications for the rest of the calendar year. This cap represents a significant reduction from the $8,000 cap in 2024, brought about through the Inflation Reduction Act (IRA), and provides meaningful financial protection for seniors who take high-cost specialty medications. There is no separate application required to reach the cap; the plan automatically tracks spending.
🇺🇸 U.S. Medicare beneficiaries with limited income may apply for Extra Help (also called the Low Income Subsidy, or LIS). Based on 2026 figures, individuals with a monthly income of approximately $2,015 or less (or couples with approximately $2,725 or less) may be reviewed for eligibility. If approved, Part D premiums and deductibles are significantly reduced, and the co-payment per prescription is capped at a small amount (up to approximately $12.65 for brand-name medications). Medicaid recipients, SSI (Supplemental Security Income) recipients, and those enrolled in Medicare Savings Programs (QMB, SLMB, and similar) are automatically eligible and do not need to apply separately. If you are unsure whether your parent qualifies, you can contact the SSA (Social Security Administration) website at ssa.gov/extrahelp or call 1-800-772-1213.
In both countries, many benefits are available only to those who apply for them. More families than you might expect end up paying more than necessary simply because they did not know a reduction was available, or because the paperwork seemed complicated. Taking a moment to review your parent's income and asset situation and reaching out to the relevant agency can make a real difference in your monthly costs. 시에라 케어 어드바이저 (Sierra Care Advisor) is here to support Korean-American family caregivers through the process of checking eligibility and completing applications.
Sources: 국민건강보험공단 (National Health Insurance Service) 노인장기요양보험 official notice (2026 benefit rates and monthly caps); 보건복지부 (Ministry of Health and Welfare) press release (November 2025); National Council on Aging (NCOA), "2026 Medicare Out-of-Pocket Costs Guide"; GoodRx, "2026 Medicare Part D Out-of-Pocket Cap"; Medicare Interactive, "Extra Help Basics"; SmartMatch Insurance Agency, "2026 Medicare Extra Help Income Limits"; angelsitter.co.kr, 2026 in-home care visit and short-term care rates and co-payment data.
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.