How much does a doctor visit cost in Korea with National Health Insurance: co-payment rates for clinics, hospitals, inpatient stays and pharmacies
Numbers checked against the official source on 2026-10-19
With Korea's National Health Insurance, you pay a share of each covered bill that depends on the type of facility: at a clinic or a pharmacy 30%, at a hospital 40% (35% in rural eup/myeon areas), at a general hospital 50% (45% in eup/myeon), and at a tertiary general hospital the whole consultation fee plus 60% of the rest. For an inpatient stay the share is 20%. The insurer pays the remainder. Costs for services that insurance does not cover are not part of this rate table.
Law text: National Health Insurance Act Enforcement Decree (국민건강보험법 시행령), Article 19 and Annex 2, shown on the National Law Information Center as "[시행 2026. 10. 1.] [대통령령 제36675호, 2026. 9. 15., 일부개정]" (in force today). Annex 2 is headed "<개정 2026. 2. 19.>". The decree is not a future-dated version. Read on 2026-10-19.
Outpatient co-payment by type of facility
| Facility | Area | Your share of the covered bill (ordinary adult patient) |
|---|---|---|
| Tertiary general hospital (sangyeop jonghap byeongwon) | All areas | The consultation fee in full, plus 60% of the rest of the covered bill |
| General hospital (jonghap byeongwon) | City district (dong) | 50% |
| General hospital | Town or county (eup, myeon) | 45% |
| Hospital, dental hospital, Korean-medicine hospital, nursing hospital, psychiatric hospital | City district (dong) | 40% |
| The same hospitals | Town or county (eup, myeon) | 35% |
| Clinic, dental clinic, Korean-medicine clinic, health medical centre | All areas | 30% |
| Public health centre, sub-centre, health clinic | All areas | 30% |
| Pharmacy (drugs on a doctor's prescription) | All areas | 30% |
Lower rates for pregnant women and babies
| Facility | Pregnant woman, outpatient | Child under 1 year, outpatient |
|---|---|---|
| Tertiary general hospital | 40% of the covered bill | 20% of the covered bill |
| General hospital | 30% | 15% |
| Hospital (and similar) | 20% | 10% |
| Clinic (and similar) | 10% | 5% |
A child aged 1 to under 6 pays 70% of the rate that would otherwise apply at these facilities. The annex also fixes a set amount, defined in a ministerial ordinance, for patients aged 65 or over at a clinic when the bill is below a threshold; that amount is set in the ordinance, not in the decree, so it is not on this page.
Inpatient care, pharmacies and meals
- Inpatient: 20% of the covered bill, plus 50% of the meal charge during the stay.
- Rooms: in a tertiary general hospital, a 2-, 3- or 4-bed ward the patient uses is charged at 50%, 40% or 30% of the room fee; in a general hospital, hospital and similar, a 2- or 3-bed room is charged at 40% or 30% of the room fee.
- Pharmacy: 30% when you fill a prescription written by a doctor or dentist. For certain illnesses set by the Minister of Health and Welfare, a prescription from a tertiary hospital is charged at 50% and from a general hospital at 40%.
- Rounding: for outpatient care amounts under 100 won are left out. For inpatient care amounts under 100 won are also paid.
Example: what you might pay
These are example bills, not price quotes. If the covered part of a clinic bill is 20,000 won, you pay 30% = 6,000 won. If the covered part of a general hospital bill in a city district is 100,000 won, you pay 50% = 50,000 won. If the covered part of a tertiary hospital bill is 100,000 won and the consultation fee within it is 20,000 won, you pay 20,000 + 60% of 80,000 = 68,000 won.
Outpatient co-payment estimator
The estimator applies only the percentages in the table above to a covered bill you enter. It does not cover uncovered services, drug prices, the 65-and-over set amounts, prescription-drug exceptions, inpatient care, special rules for cancer, rare or severe illness, or the annual cap below. Tertiary hospital and children aged 1 to 5 together are not offered because the decree text does not make clear how the 70% applies to the consultation fee.
Annual cap on co-payments
The NHIS English page says an annual co-payment ceiling is set by income level and any amount above it in a fiscal year is paid back by the NHIS. Items outside the cap include uncovered services, full out-of-pocket items, hospital rooms with 2 or 3 beds and childbirth costs. For 2026 the page lists these ceilings, in won, by contribution decile (decile 10 being the highest contribution):
| Stay in hospital | Decile 1 | 2-3 | 4-5 | 6-7 | 8 | 9 | 10 |
|---|---|---|---|---|---|---|---|
| Up to 120 days | 900,000 | 1,120,000 | 1,730,000 | 3,260,000 | 4,460,000 | 5,360,000 | 8,430,000 |
| Over 120 days | 1,430,000 | 1,810,000 | 2,450,000 | 4,040,000 | 5,800,000 | 6,980,000 | 10,960,000 |
Where the sources disagree
| Point | Decree, Annex 2 (in force 2026-10-01) | NHIS English page | What we show |
|---|---|---|---|
| Tertiary hospital outpatient | Consultation fee in full plus 60% of the rest | "60% of total treatment cost and other expenses" | The decree formula. The English page is a simplification. |
| Co-payment ceiling | Not in the decree annex | The ceiling table lists 2026 values (900,000 won for decile 1 up to 120 days), while the sentence "Compensation for Excessive Co-payment" on the same page names 870,000 won within 120 days and 1,340,000 won over 120 days (the 2023 figures) | The 2026 row of the table. The sentence on the same page is older. |
See also the page on National Health Insurance for foreigners for who is covered and what it costs to join. This page is a summary of the legal rates, not medical or legal advice; your actual bill depends on which items are covered, so confirm with the NHIS or the facility.
Checked 2026-10-19.
Official sources
- National Law Information Center — National Health Insurance Act Enforcement Decree, Article 19 — co-payment rates and amounts are in Annex 2; in force 2026-10-01 (checked 2026-10-19)
- National Law Information Center — same decree, Annex 2 (co-payment rates and amounts) — outpatient table by facility, inpatient 20%, pharmacy 30%, children, pregnant women; text layer of the annex viewer (checked 2026-10-19)
- NHIS (National Health Insurance Service) English — Insurance Benefits — English co-payment table and 2026 annual ceiling table (checked 2026-10-19)
Prices change. If an official page shows a different number from this page, the official page wins — and please tell us so we can fix it.