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NHIS Copayment Ceiling Refund Calculator 2026

If the covered out-of-pocket copayments you paid in one year exceed the ceiling for your income decile, the National Health Insurance Service (NHIS) refunds the excess. Check your estimated refund right away.

KRW
3. Long stay in a long-term care hospital If you were hospitalized in a long-term care hospital for more than 120 days in a year, a higher separate ceiling applies.
Estimated refund (post-settlement refund basis)
₩770,000
About 31% of what you paid would be refunded
Annual out-of-pocket copayments (covered)Amount you entered₩2,500,000
Ceiling appliedDeciles 4–5 · Standard ceiling₩1,730,000
Estimated refundOut-of-pocket copayments − ceiling (settled around August of the following year)₩770,000

Advance payment at hospital

If the out-of-pocket copayments you paid at the same hospital exceed that year's highest ceiling (₩8,430,000 in 2026), the hospital claims the excess directly from the NHIS so you do not pay more. Long-term care hospitals are excluded.

Post-settlement refund

Amounts paid across multiple hospitals and pharmacies are added up over one year and compared with your ceiling. The NHIS settles and refunds the amount around August of the following year, once income and premiums are confirmed. This calculator uses the post-settlement refund basis.

Please check before calculating. This calculator is an estimation tool that simplifies how the system works. Your actual refund is determined by the NHIS after it totals treatment records from all medical institutions and confirms your personal ceiling. Out-of-pocket copayments do not include non-covered services, selectively covered services, amounts paid in full by the patient, implants, inpatient charges for premium rooms (2- or 3-bed rooms), the patient share for chuna manual therapy, or outpatient treatment for minor conditions at tertiary general hospitals. Amounts already settled at a hospital through advance payment at hospital are deducted from the refund, and from October 8, 2026, if you have unpaid health insurance premiums, they may be deducted from the excess amount.
Understanding the Copayment Ceiling System from the beginning →

Ceiling source: National Health Insurance Service (NHIS), "2026 Copayment Ceiling Amounts Notice" (January 6, 2026; applicable January 1–December 31, 2026), and press releases from the Ministry of Health and Welfare and the NHIS (August 2026). System information follows the NHIS website's explanation of the Copayment Ceiling System. Last verified: October 20, 2026.

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Frequently asked questions

Q. When do I receive my NHIS Copayment Ceiling refund?
For a post-settlement refund, the NHIS confirms income and premiums in the year after treatment and settles the amount, so payment is usually made around August of the following year. If you have registered a consent account for payment, the money is deposited automatically without a separate application.

Q. How can I check my income decile?
Your income decile is determined by your household's average annual health insurance premium. You can check your premium on the NHIS website or app to estimate your decile band, and for your exact personal ceiling it is best to contact the NHIS (1577-1000).

Q. Are non-covered medical costs included in the refund calculation?
No. Non-covered services, selectively covered services, amounts paid in full by the patient, implants, and inpatient charges for premium rooms (2- or 3-bed rooms) are excluded from the ceiling calculation, so you should enter only covered out-of-pocket copayments in this calculator.

Q. Does the ceiling change if I stay in a long-term care hospital for a long time?
Yes. If you are hospitalized in a long-term care hospital for more than 120 days in a year, a separate, higher ceiling applies instead of the standard ceiling (₩1,430,000 for decile 1 to ₩10,960,000 for decile 10 in 2026).