A Long-Term Care Grade Takes 30 Days From Application to Decision — Procedure and the 15/20% Co-Payment

You can apply before turning 65

Long-term care insurance is a separate scheme from health insurance, though the premium is collected alongside the health insurance contribution. Eligibility runs along two tracks.

• Age 65 or over — you may apply regardless of the type of illness
• Under 65 — you may still apply if you have a geriatric disease specified by Presidential Decree, such as dementia or cerebrovascular disease

Many people do not know about the second track. Someone who had a stroke in their early sixties, for instance, may give up after looking only at the age line and lose several years to it.

There is a misunderstanding in the other direction as well. Difficulty moving around does not automatically produce a grade. The assessment is not made from a diagnosis but from a score for how much help a person needs to get through daily life alone.

The application does not have to be made by the person themselves

Applications go to the National Health Insurance Service. You can apply at a branch office, by post, or by fax; the website and app are available for applicants aged 65 or over, or for renewals.

If the person is in no state to handle it, a family member or relative can apply on their behalf. What you need is the application form and identification, and a doctor's opinion is not a document you must submit when applying. For those 65 and over, it can be filed any time before the material goes to the grading committee. Applications are often delayed by a trip to the hospital for that opinion first — reversing the order is faster.

An assessor comes to the home — 90 items

Once you apply, a Service employee visits in person to assess. The long-term care assessment form consists of 90 items, of which 65 items across physical function, cognitive function, behavioural change, nursing care and rehabilitation feed into the grade calculation.

There is one mistake families make repeatedly during this visit. The older person tries harder than usual in front of the assessor. The tension of having a guest in the house often produces movements they cannot normally manage.

That is why it is better for a family member to be present on the day. What has to be described is the ordinary state including bad days, not a good day — and things a daytime visit cannot show, such as wandering at night or repeating the same question, need to be written down beforehand to be reflected accurately.

Thirty days to a decision, and 30 more if extended

After the assessment, the grading committee deliberates on the basis of the assessment report and the doctor's opinion. The statutory period is within 30 days of the date the application was submitted, and where a detailed examination is unavoidably required it may be extended once, within a further 30 days.

So a decision arrives within two months at the outside. If a hospital discharge date is already set, the realistic move is to count backwards from it and apply in advance.

Five grades, plus a cognitive support grade

The outcome is grades 1 through 5 or a cognitive support grade; where the threshold is not met, the result is "outside the grades." The lower the number, the more help the person needs.

What the grade determines is the type of service available and the monthly ceiling — not the quality of care. For 2026, the monthly ceiling for home care is 2,512,900 won at grade 1 and 2,331,200 won at grade 2. The Ministry of Health and Welfare has said the 2026 ceilings for the severe grades (1 and 2) rise by more than 200,000 won, taking grade 1 from 41 to 44 three-hour home visits a month.

A result outside the grades is not the end of it either. Local governments run separate schemes such as customised care services for older adults, which the community service centre can explain. If dementia is suspected, reading dementia symptoms by stage in advance makes it easier to describe the situation during the assessment.

What you actually pay — 15% at home, 20% in a facility

Using long-term care benefits does not mean paying the full cost; you pay only the co-payment rate.

• Home care benefits (home visit care, bathing, day and night care) — 15% of the benefit cost
• Facility benefits (nursing home admission) — 20% of the benefit cost
• Basic livelihood security recipients pay nothing, and a separate co-payment reduction scheme exists based on income and property

There is a reason a nursing home invoice does not stop at "20%," though. Non-covered items such as food ingredients, haircuts and the premium on an upgraded room are paid in full regardless of the co-payment rate. When you take a consultation, ask for covered and non-covered amounts separately, or the quotes cannot be compared.

For reference, the 2026 long-term care premium rate is 0.9448% of income (13.14% of the health insurance contribution), averaging about 18,362 won a month per household. It is a policy you are already paying for. Its coverage is entirely different from indemnity medical insurance, so having indemnity medical insurance does not replace it.

In order

• ① Is the person 65 or over, or do they have a geriatric disease?
• ② Apply to the Service (1577-1000) — the doctor's opinion can follow later
• ③ Set the assessment date and have a family member present, with the usual condition written down
• ④ Receive the decision and the standard care plan within 30 days
• ⑤ Contract with a provider — ask for covered and non-covered costs separately
• ⑥ If outside the grades, ask the community centre about customised care services for older adults

If medical bills have already mounted, it is worth checking health insurance refunds and the out-of-pocket ceiling as well. Whether someone is due for a screening can be checked in the national health checkup guide.

This article summarises the Act on Long-Term Care Insurance for Older Adults and public guidance from the National Health Insurance Service and the Ministry of Health and Welfare, confirmed in August 2026. Grading outcomes and eligibility for co-payment reductions depend on an individual's condition, income and property, and confirmed amounts must be checked with the Service. This article explains a scheme and its costs; it does not replace diagnosis or treatment decisions.