> ## Content Index > Fetch the complete content index at: https://www.medi-hi.com/llms.txt > Use this file to discover other available public pages before exploring further. # Insurance Coverage for Menopausal Herbal Medicine: Criteria & Costs - URL: https://www.medi-hi.com/en/info/medical_menopause_km_insurance-en/ - Published: 2026-10-16T01:11:18.000Z - Updated: 2026-10-16T03:18:41.000Z - Author: medihi - Tags: 갱년기, #info, #in_루나, #in_이현숙, #yjain, #in_의료진감수, #in_마루, #lang-en POINT ## In This Article Even if you’re considering an herbal medicine prescription for menopausal symptoms, you may hesitate to seek care because of the cost. The Stage 2 Pilot Program for National Health Insurance coverage of decoction-type herbal medicines (cheop-yak, 첩약) does not automatically apply just because you have a “menopause” diagnosis. You need to check the eligible conditions, participating institutions, and the number of covered days together. In this post, we summarize the coverage criteria and costs for menopause herbal medicine insurance, along with what to confirm when choosing treatment. ## 1\. When can menopause herbal medicine be covered by insurance? Menopause itself is not a covered indication under the Stage 2 Pilot Program for National Health Insurance coverage of decoction-type herbal medicines. However, if you have an eligible pilot-program condition in addition to menopause, and that condition is diagnosed as the primary diagnosis, and you receive an herbal decoction prescription for the purpose of treating that condition, insurance coverage may be considered. So when assessing coverage, it is more important to confirm whether the prescription is intended to treat an eligible covered condition than whether you “have menopausal symptoms.” Customized herbal decoctions aimed at relieving menopausal symptoms may be non-covered (out-of-pocket), separate from these criteria. --- ## 2\. What should you check before expecting insurance coverage? ![An infographic displaying the 6 major covered conditions for herbal decoction insurance, including facial palsy, stroke sequelae, dysmenorrhea, lumbar herniated disc, allergic rhinitis, and functional dyspepsia](https://www.medi-hi.com/content/images/2026/10/medical_menopause_km_insurance_01.gif) Even if a prescription falls under a covered category, you still need to confirm whether the clinic/hospital participates in the pilot program, the patient copayment rate, and the annual limit on covered days to estimate your actual cost. ✅Criteria to check before coverage applies - **Eligible conditions:** facial nerve palsy, post-stroke sequelae, dysmenorrhea, lumbar disc herniation, allergic rhinitis, functional dyspepsia - **Participating institutions:** Confirm whether the facility participates in the Stage 2 herbal decoction pilot program. - **Copayment rate & covered days:** 30% at Korean medicine clinics, 40% at Korean medicine hospitals, and 50% at general hospitals, with coverage up to a maximum of 20 days per condition per patient per year. Checking these criteria together helps you understand both whether coverage is possible and what your expected out-of-pocket cost may be. --- ## 3\. How strong is the research evidence for menopause herbal medicine? Some clinical studies have reported that herbal medicine may help lower certain adverse-reaction scores in menopausal patients and may provide supportive relief for symptoms such as hot flashes or emotional instability. Studies examining formulas such as Gyejibokryeong-hwan (桂枝茯苓丸) or Gamisoyo-san (加味逍遙散) have also observed changes in menopausal symptoms. Systematic reviews that compile multiple clinical trials note that study durations and sample sizes vary, making it difficult to draw a single definitive conclusion about the size of the effect. For this reason, it is appropriate to view herbal medicine as one possible option that may be used alongside lifestyle management or other treatments, taking into account individual symptoms, preferences, and underlying conditions. If you have liver or kidney disease, or if you take medications such as anticoagulants, you should check for potential drug interactions. Sharing a list of current medications with your clinician before dispensing can help create a safer treatment plan. --- ## 4\. What criteria are used to choose menopause herbal medicine? ![An illustration highlighting essential criteria to consider when choosing herbal medicine for menopause](https://www.medi-hi.com/content/images/2026/10/medical_menopause_km_insurance_02.png) It is best to choose menopause herbal medicine after reviewing the type and severity of symptoms, your usual health status, and any medications you are currently taking. Even within menopause, the pattern of discomfort can differ—such as hot flashes, sweating, sleep disruption, and emotional changes—so a Korean medicine doctor’s evaluation helps determine the direction of the prescription based on your current symptoms. Herbal medicine can be one approach to personalized management in that it may be tailored to individual symptoms and constitution. However, a specific formula cannot be assumed to work to the same degree for everyone, so it is important to monitor symptom changes after treatment and adjust the prescription as needed. If you have underlying conditions or take multiple medications, inform your clinician of your current medications and confirm possible interactions. Building a treatment plan based on this information can help you use herbal medicine more safely. --- ## 5\. What should you check first about the cost of Korean medicine treatment? ![An infographic showing step-by-step cost verification procedures before menopausal Korean medicine treatment](https://www.medi-hi.com/content/images/2026/10/medical_menopause_km_diagnosis_03.png) To reduce the cost of herbal decoctions, it is important to confirm whether the facility participates in the pilot program and to review the terms of your private indemnity insurance (silson boheom, 실손보험) before treatment. Indemnity insurance applies different reimbursement criteria for covered Korean medicine outpatient care depending on when you enrolled and the policy terms. **✅ Pre-treatment cost-check sequence** - Use the Health Insurance Review & Assessment Service (HIRA) to look up whether the facility participates in the Stage 2 herbal decoction pilot program. - Call your insurer’s customer service line to confirm whether the covered outpatient copayment for Korean medicine is eligible for reimbursement. - After the visit, obtain a receipt showing your copayment and a prescription/dispensing statement, then submit them to your insurer. You should confirm both National Health Insurance coverage and the reimbursement scope of your indemnity insurance to estimate your final out-of-pocket cost. --- ## 6\. Frequently Asked Questions (FAQ) #### Q. Can I receive National Health Insurance coverage for herbal decoctions based on a menopause diagnosis alone? A standalone diagnosis of menopause or menopausal syndrome is not included as a covered indication in the pilot program. If the purpose is not to treat one of the six government-designated eligible conditions, a customized herbal decoction is billed entirely as non-covered (out-of-pocket). #### Q. Which conditions qualify for covered herbal decoction prescriptions? One of the six eligible conditions listed in the guidelines—such as functional dyspepsia or lumbar disc herniation—must be the primary diagnosis. You must also be treated at a participating institution and remain within the annual covered-day limit to receive benefits. #### Q. How do costs differ between covered herbal decoctions and non-covered herbal decoctions? For non-covered herbal decoctions, you pay the full amount set by the medical institution. For covered herbal decoctions, the statutory copayment rate applies—at Korean medicine clinics, you pay 30% of the total cost. #### Q. Can menopause herbal medicine be claimed through indemnity insurance? Whether indemnity insurance pays depends on your enrollment timing and policy terms. In some cases, the covered copayment may be eligible, so it is best to confirm claimable items with your insurer before treatment. [ RECOMMENDED READ Acupuncture for Menopause: Korean Medicine Care for Hot Flashes & Palpitations Experiencing hot flashes and palpitations? Discover why internal medical checks for heart or thyroid health matter and how menopausal acupuncture can help. ➔ ](https://www.medi-hi.com/en/info/medical%5Fmenopause%5Fkm%5Facupuncture-en/) This health content has been reviewed by medical professionals, compiled from authoritative domestic and international sources, and is regularly updated in accordance with the latest clinical guidelines. Last Reviewed: Oct 16, 2026 Last Updated: Oct 16, 2026 ### Sources - Ministry of Health and Welfare · Health Insurance Review & Assessment Service (HIRA), Stage 2 Guidelines for the Pilot Program on National Health Insurance Coverage of Decoction-Type Herbal Medicines (2024). - The Society of Korean Medicine, Korean Medicine Clinical Practice Guidelines for Menopausal Syndrome (2021). - Cochrane Database of Systematic Reviews, Chinese herbal medicine for menopausal symptoms(2016). ※ The copyright for all content on this blog belongs to medihi. Unauthorized copying, distribution, or derivative use is strictly prohibited, and violations may result in legal action without prior notice.