Medical bills for older adults approach half of all health care spending

Health care costs covered by Korea’s national insurance system for those aged 65 and older have risen nearly 40 percent over the past four years, exceeding 50 trillion won ($38 billion) in 2023 and accounting for nearly half of the country’s total insured medical spending, government data showed on Wednesday.

According to figures submitted to Rep. Kim Mi-ae of the National Assembly’s Health and Welfare Committee, combined co-payments and insurance reimbursements for older adults rose from 37.47 trillion won in 2020 to 52.12 trillion won last year — a 39.1 percent increase.

The sharp rise in costs underscores a looming public health challenge for a nation with one of the world’s fastest-aging populations. As the number of older citizens grows, the data points to an urgent need for sustainable long-term care policies to keep the national health insurance system from coming under severe strain.

Korea has seen a striking demographic shift over the past two decades, with the share of the population aged 65 and older rising from 9.1 percent in 2005 to 20.3 percent at present, according to official data from Statistics Korea. The country became a “super-aged society” — defined as one in which more than 20 percent of the population is 65 or older — a threshold it crossed last year. The speed of this transformation is among the fastest in the world, outpacing aging trends in countries like Japan, Germany and France.

In the first half of 2025, medical expenses for older adults reached 27.98 trillion won — already more than half of the total for 2024 — raising the likelihood that this year’s spending will break another record.

Per capita health care spending for older adults also rose steadily, from 4.74 million won in 2020 to 5.37 million won in 2023.

Older adults now account for a growing share of Korea’s health care expenditures, rising from 43.1 percent of the total in 2020 to 44.8 percent in 2023 and 46 percent in the first half of 2025. Experts warn that this demographic shift poses long-term challenges to the country’s welfare infrastructure.

Kim expressed deep concern over the mounting burden on Korea’s national health insurance system, warning that the rapidly aging population could significantly undermine its long-term financial sustainability unless proactive measures are taken.

“With nearly half of all health care spending going to older adults, it’s clear that population aging is already placing serious pressure on the system,” she said. “Without structural reform, the health insurance fund will struggle to stay afloat and meet future demands.”

According to the health ministry’s second comprehensive health insurance plan for 2024-28, the fund’s annual surplus of 463.3 billion won is projected to shift into a deficit beginning in 2026. The cumulative reserve, expected to remain near 30 trillion won through 2027, is forecast to decline to 28.42 trillion won by 2028 — enough to cover just 2.7 months of payments at current spending levels.