Outpatient Visits Beyond 300 a Year Cost 90 Percent Out of Pocket From the 301st -- Effective January 2027, 65 Visits Earlier Than the Current 365 Threshold

This is not a new system; the threshold just drops by 65 visits

The system that raises the copayment rate according to annual outpatient visits has been in force since July 1, 2024. At the time the government said that from the 366th outpatient visit in a year, the copayment rate would rise from an average of 20 percent to 90 percent. Now the Ministry of Health and Welfare has had an amendment to the Enforcement Decree of the National Health Insurance Act approved at a Cabinet meeting, and from January 1, 2027 the 90 percent rate applies from the 301st visit. The amendment was announced for public comment on March 25 this year, with comments accepted until May 4.

How much changes from the 301st visit

The 20 percent figure is an average that varies with the type of institution and the treatment. To make it concrete, here is a hypothetical calculation only: on an outpatient visit with a total bill of 10,000 won, a 20 percent rate means you pay 2,000 won, while a 90 percent rate means you pay 9,000 won. That is 4.5 times as much for the same visit. This amount is for illustration, and the real burden depends on the bill and the type of institution. The higher rate applies after the 300th visit; up to 300 visits, nothing changes.

300 visits a year is close to six a week

The ministry described 300 visits a year as using a medical institution about six times a week. The statistics the government cited are these.

• Outpatient visits per person per year were 17.9 in 2024, about 2.7 times the OECD average of 6.6.
• In 2025, 7,765 people out of roughly 48.4 million used outpatient care more than 300 times.
• The heaviest user was reported at 1,775 visits in one year.

These numbers do not apply to most insured people; even 20 visits a year is nowhere near 300.

The 365 threshold was lowered because its effect showed up only at the extreme

In National Health Insurance Service data reported by Money Today in April, the number of people with more than 365 outpatient visits a year was 1,468, down 36 percent from the year before. By contrast, the group using care 200 to 300 times a year fell by only 2 to 9 percent. If the threshold sits at 365, the range below it is barely affected, which reads as the background to lowering the line. In the same report, experts pointed to a lack of medical justification and suggested either lowering the threshold further to 200 visits or tightening oversight of institutions that encourage unnecessary visits. Assessments of the system are still divided.

Who is exempt, and how to ask for an exception

People who unavoidably need frequent care stay outside the 90 percent rule, as before. The range reported is children, pregnant women, people with severe disabilities, and people with severe, rare or intractable diseases. Even if you are not on that list, you can obtain an exception through review by the National Health Insurance Service if medical necessity is recognized. Exactly which conditions count is set by the decree and the Service's detailed lists, so anyone who may qualify should confirm directly with the Service (1577-1000) using their own diagnosis code rather than relying on a press summary.

How visits are counted: what is confirmed and what is not

When the system was introduced in 2024, the government's explanation was that days of prescribed medication and days of hospital stay are excluded, that only outpatient visits are counted, and that the count runs from January 1 to December 31. In the reports I checked, it is not stated whether the 300-visit amendment works the same way. The same goes for whether pharmacy dispensing counts and how the system links to the out-of-pocket ceiling. I do not state these as fact; please check the Service's guidance before the rule takes effect. One preparation is settled: a medical-history confirmation system that lets institutions see a patient's visits to other institutions will start operating on December 24 this year, beginning with CT and MRI.

Other systems to check in a year with high medical bills

If treatment has dragged on and bills have grown, check whether there is money you can get back regardless of visit count. The refund when your annual out-of-pocket spending exceeds an income-based ceiling is covered in health insurance refunds and the out-of-pocket ceiling, and the application deadline is in the post on the ceiling refund deadline. For support after a single very large bill, see the criteria for catastrophic medical expense support, and for a stay in a nursing hospital, health insurance coverage of nursing hospital caregiving costs.

Order of steps before it takes effect

Unless you are close to 300 visits a year, nothing changes for you. If you might be affected, go in this order. First, ask the Service how many outpatient visits you have had so far this year (confirm the lookup method in the Service's guidance before the rule takes effect). Second, ask the Service whether you are exempt, using your diagnosis code. Third, if you are not exempt, discuss with your doctor whether overlapping visits to several institutions for the same symptom can be reduced. Fourth, the count has restarted each January 1 under the 2024 system, so visits in 2027 start accumulating from your first visit of the new year. This post is general information compiled from press reports and government announcements and does not replace medical or legal advice; please confirm individual cases with the National Health Insurance Service and your treating clinicians.