South Korea is building out a nationwide home-based care network for long-term care insurance beneficiaries at the same time the public fund paying for that care is projected to exhaust its reserves within four years. That reserve depletion timeline – 2030, according to a peer-reviewed fiscal study published in November 2025 – sits alongside a government announcement that 50 additional medical institutions have joined the network, bringing the total to 463 centers across all 229 cities, counties, and districts nationwide. The intersection of those two trajectories – expanding care infrastructure and a funding base under structural fiscal pressure – represents a significant market condition for insurance professionals operating in Korea’s long-term care space.
The Pilot Project for Long-Term Care Home-based Medical Care Centers deploys teams of physicians, nurses, and social workers to the homes of long-term care insurance (LTCI) beneficiaries, delivering medical services on-site and connecting patients with other community support they require. Every person served is an LTCI beneficiary. The program operates entirely within Korea’s public long-term care insurance framework, administered by the National Health Insurance Service (NHIS).
The model targets older adults whose mobility constraints make conventional clinic or hospital visits difficult or impossible, with the explicit goal of keeping them out of hospitals and residential care facilities. The ministry ran the latest open call from April 21 to May 22, 2026. Full city, county, and district coverage was first achieved in February 2026, one month before the integrated care system came fully into effect in March 2026.
The ministry revised the program’s medical institution-public health center collaboration model in this round, with the stated aim of bringing more institutions into areas with limited healthcare access. Eligibility, previously confined to counties, was extended to cities classified as medically underserved. Staffing requirements were also adjusted: nurses on these teams had previously been required to hold an affiliation with a public health center. That requirement has been removed, allowing nurses based at the medical institution itself to fill the role. Public health centers, previously limited to working with a single medical institution each, may now partner with up to two. Fourteen of the 50 newly designated centers were placed under this revised framework.
Taken together, the practical effect of these rule changes is that LTCI beneficiaries in areas previously outside the program’s reach are now entering the home-based care system. For insurers, that geographic expansion means claims exposure shifting into regions where demand has been suppressed by access constraints rather than by lower underlying need – a distinction that may not yet be fully reflected in existing pricing models.
Lim Eul-gi, Director General for Senior Policy at the ministry, described the program’s function within the broader care system. “Long-term care home-based medical care centers are an essential part of the healthcare infrastructure that helps older adults with limited mobility age in place, in familiar home settings. We remain committed to expanding the necessary infrastructure to meet the growing demand for home-based medical care and to continuously improving the quality of these services,” Lim said. What the official framing does not address is how that infrastructure will be financed as the fund underpinning it moves toward deficit. The fiscal picture is considerably more strained than the ministry’s language suggests.
A study published in Health Economics Review in November 2025, using actual NHIS financial data and Statistics Korea population projections, found that NHI expenditures are projected to surpass revenues starting in 2025, with accumulated reserves expected to be depleted by 2030, and annual deficits growing from KRW 21.8 trillion in 2032 to KRW 123.3 trillion in 2042. The study isolated the specific contribution of demographic change to those figures. Compared to a scenario where population structure remains constant at 2023 levels, demographic shifts are projected to decrease NHI revenues by KRW 8.5 trillion (4.5%) and increase expenditures by KRW 30.8 trillion (17.8%) in 2032 – with the annual fiscal burden attributable to demographic change alone estimated at KRW 39.4 trillion in 2032, rising to KRW 152.5 trillion in 2042.
The NHI and LTCI are structurally linked. Under the Korean system, the LTCI contribution is calculated as a fixed percentage of the NHI contribution amount, meaning the two levies move together. NHI contributions currently stand at 7.19% of monthly wages for employee-insured workers as of 2026, according to the NHIS. Any fiscal deterioration in the NHI system therefore flows directly into the long-term care fund – the same fund that reimburses services delivered across the 463-center network.
Approximately 10.84 million people – 21.21% of South Korea’s total population of about 51.11 million – were aged 65 or older in 2025, according to the Ministry of the Interior and Safety cited by Korea Herald. The country crossed the United Nations’ super-aged threshold of 20% in 2024. The Health Economics Review study projects the proportion of those aged 65 and over will rise from 18.2% in 2023 to 35.5% by 2042, with the old-age dependency ratio rising from 24.4 to 62.6 over the same period – meaning the ratio of elderly dependents to working-age contributors will more than double within two decades, placing compounding pressure on the contribution base that funds both NHI and LTCI.
The geographic distribution of that aging population has direct consequences for how long-term care risk is concentrated across Korea’s insurance market. Outside the capital area, where seniors account for 18.82% of residents, the figure reaches 23.69% in the rest of the country. Eleven provinces and cities, including Seoul for the first time, recorded senior populations above the 20% threshold in 2025. For insurers, this uneven distribution has implications for portfolio exposure by region, pricing assumptions, and the adequacy of care networks in areas where both demand and supply constraints are most acute.
Household composition adds a further layer of demand pressure. Of the 10.27 million single-person households recorded in 2025, 21.6% – roughly 2.21 million – were headed by someone aged 70 or older, with a further 18.9% in their 60s. People living alone are less likely to have informal caregiving support, which historically drives higher formal care utilization and increases the frequency and duration of LTCI claims.
The supplementary budget secured by the MOHW for 2026 offers a further signal that existing funding frameworks are not keeping pace with demand. The ministry secured KRW 346.1 billion (approximately US$233 million) under the first supplementary budget for 2026, passed by the National Assembly on April 10, to ease cost pressures on low-income households and vulnerable groups amid inflation tied to the Middle East conflict. A portion was directed toward healthcare access in underserved areas, including retraining for public officials in primary care roles and the placement of substitute nursing staff at local health subcenters.
The final figure exceeded the government’s original proposal of KRW 326.3 billion (approximately US$219 million) by KRW 19.8 billion (approximately US$13 million), lifting the MOHW’s total 2026 expenditure to KRW 137.8410 trillion (approximately US$92.8 billion). That the government found it necessary to supplement an already substantial health and welfare budget mid-year reflects the scale of the gap between what the existing system provides and what a super-aged population requires.
The 463-center network, the fiscal sustainability projections, and the demographic data collectively describe a system pivoting toward home-based community care while the public fund supporting it faces structural pressure. The policy levers available to the government – contribution rate adjustments, benefit restructuring, or an expanded role for private supplementary coverage – each carry different implications for insurers.
For those with existing long-term care books of business, the shift away from institutional settings raises questions about how benefit triggers, care grade assessments, and claims duration will evolve as the home-based model becomes the default rather than the exception. For those considering product development, the gap between rising demand and a public fund with reserves projected to run out by 2030 is the indicator most worth tracking – because how the NHIS chooses to close that gap will determine the regulatory and competitive shape of Korea’s long-term care insurance market for the decade ahead.
