This article was written by the NIPPON VISA & LIFE editorial team based on information from public organizations such as the national government and local governments. Rules and fees may differ depending on the city, ward, town or village where you live.
Japan’s public medical insurance has the High-Cost Medical Expense Benefit (kogaku ryoyohi seido), which sets a limit on the medical costs you pay yourself in one month. The amount over the limit is paid back to you later by your insurer (the organization that runs the medical insurance you belong to). If you use your My Number health insurance card (My Number card registered for use as a health insurance card), the amount you pay at the counter is also kept down to the limit.
The Short Answer: What to Do When Your Medical Costs Get High
- Check which medical insurance you belong to (your company’s health insurance or National Health Insurance) and who your insurer is
- If you are planning a hospital stay or surgery, use your My Number health insurance card at the reception of the medical institution (or get a “Limit Application Certificate” (gendogaku tekiyo ninteisho) in advance)
- If you paid more than the limit at the counter, make an application for the High-Cost Medical Expense Benefit to your insurer
- You can apply for up to 2 years from the 1st day of the month after the month you received treatment
An overview of how to use hospitals is in When You Are Sick or Injured in Japan: The Basics of Hospitals, Ambulances, Medicine, Medical Insurance and Where to Get Advice, and the My Number health insurance card and eligibility certificate (shikaku kakuninsho) you show at reception are explained in How to See a Doctor in Japan: Choosing Between Hospitals and Clinics, What to Show at Reception, the Medical Questionnaire, Payment and Medicine.
What Is the High-Cost Medical Expense Benefit?
At the counter of a hospital or pharmacy, you usually pay part of the medical cost (30% for people under 70, and 20% for children who have not yet started elementary school). If your medical costs get high because of a hospital stay or surgery, even 30% can be a large amount.
The High-Cost Medical Expense Benefit is a system that pays back the amount over the limit when what you pay yourself in one month (from the 1st day to the last day of the month) exceeds the limit. The limit is decided by your age and income.
(Sources: Ministry of Health, Labour and Welfare (MHLW) “To Everyone Using the High-Cost Medical Expense Benefit”, MHLW “About the Revision of the High-Cost Medical Expense Benefit”)
Example: When Medical Costs Are 1,000,000 Yen
This is an example from the Ministry of Health, Labour and Welfare. It is for a person under 70 with an annual income of about 3,700,000 yen to about 5,100,000 yen (paying 30%) who received 1,000,000 yen of medical care in one month.
| Item | Amount |
|---|---|
| Total medical costs (100%) | 1,000,000 yen |
| 30% paid at the counter | 300,000 yen |
| Limit on what you pay yourself | 85,800 yen + (1,000,000 yen − 286,000 yen) × 1% = 92,940 yen |
| High-Cost Medical Expense Benefit paid back | 207,060 yen (300,000 yen − 92,940 yen) |
(Source: “Outline of the High-Cost Medical Expense Benefit” in MHLW “To Everyone Using the High-Cost Medical Expense Benefit”)
Monthly Limits (Under Age 70, August 2026 to July 2027)
The limits were revised for treatment from August 2026. The limits for people under 70 are as follows.
| Income category (approximate annual income) | Company health insurance (standard monthly remuneration) | National Health Insurance (income under the former proviso method) | Monthly limit | Multiple-time limit | Annual limit |
|---|---|---|---|---|---|
| About 11,600,000 yen or more | 830,000 yen or more | Over 9,010,000 yen | 270,300 yen + (medical costs − 901,000 yen) × 1% | 140,100 yen | 1,680,000 yen |
| About 7,700,000 yen to about 11,600,000 yen | 530,000 yen to 790,000 yen | 6,000,000 yen to 9,010,000 yen | 179,100 yen + (medical costs − 597,000 yen) × 1% | 93,000 yen | 1,110,000 yen |
| About 3,700,000 yen to about 7,700,000 yen | 280,000 yen to 500,000 yen | 2,100,000 yen to 6,000,000 yen | 85,800 yen + (medical costs − 286,000 yen) × 1% | 44,400 yen | 530,000 yen |
| Up to about 3,700,000 yen | 260,000 yen or less | 2,100,000 yen or less | 61,500 yen | 44,400 yen | 530,000 yen |
| Exempt from resident tax | — | — | 36,900 yen | 24,600 yen | 290,000 yen |
- “Medical costs” means the total medical costs (100%) before insurance is applied.
- “Standard monthly remuneration” is the monthly salary amount used as the basis for deciding premiums in company health insurance. “Income under the former proviso method” (kyu tadashigaki shotoku) is the income amount used in National Health Insurance. If you do not know your category, ask your insurer.
- For people confirmed to have an annual income of up to about 2,000,000 yen (standard monthly remuneration of 150,000 yen or less in company health insurance, or 860,000 yen or less in National Health Insurance), an annual limit of 410,000 yen is applied, and the refund will be paid from August 2027 onward.
- For people aged 70 or older, the limits are set separately (there is also a limit for outpatient care only).
(Source: MHLW “About the Revision of the High-Cost Medical Expense Benefit” page 4, “Patient Cost-Sharing Ratios and High-Cost Medical Expense Limits (August 2026 to July 2027)”)
What Is the Multiple-Time Limit?
If you received the High-Cost Medical Expense Benefit in 3 or more months within the last 12 months, the limit becomes even lower from the 4th month. This is called the “multiple-time limit” (tasukai gaito) (the “Multiple-time limit” column in the table above).
According to the Japan Health Insurance Association (Kyokai Kenpo), the count is not carried over when your insurer changes, or when a person who was insured as the main member becomes a family member (dependent). For example, if you change companies and your health insurance changes, the count may start again.
(Sources: MHLW “To Everyone Using the High-Cost Medical Expense Benefit”, Kyokai Kenpo “When You Have Paid High Medical Costs”)
Annual Limit (A New Limit from August 2026)
From August 2026, in addition to the monthly limit, a limit for one year (annual limit) was created. One year here means from August to July of the following year. When the total of what you pay yourself each month reaches the annual limit, the amount you paid over it is paid back by your insurer.
According to Kyokai Kenpo, applications for the annual limit are planned to start in August 2027.
(Sources: MHLW “To Everyone Using the High-Cost Medical Expense Benefit”, Kyokai Kenpo “When You Have Paid High Medical Costs”)
There Will Also Be Changes from August 2027
The Ministry of Health, Labour and Welfare says it plans to divide the income categories more finely from August 2027. Because the limits will change, people receiving medical care around that time should check the information from their insurer.
(Source: MHLW “To Everyone Using the High-Cost Medical Expense Benefit”)
How What You Pay Yourself Is Counted
According to Kyokai Kenpo, what you pay yourself in one month is counted as follows.
- It is counted for each medical institution
- Even at the same medical institution, “medical inpatient care”, “medical outpatient care”, “dental inpatient care” and “dental outpatient care” are each counted separately
- What you paid at a pharmacy with a prescription from a hospital is added to the amount of the medical institution that issued the prescription
You Can Combine Your Family’s Costs (Household Combination)
When family members see a doctor in the same month, or when one person sees doctors at several medical institutions, you can combine what you paid yourself in the calculation (household combination, setai gassan). For people under 70, only amounts of 21,000 yen or more paid at one medical institution (for each category above) can be combined. In the case of Kyokai Kenpo, the “household” that can be combined is the insured person (hihokensha) and the family members covered by that health insurance (dependents, hifuyosha).
(Source: Kyokai Kenpo “When You Have Paid High Medical Costs”)
What Is Not Covered
According to Kyokai Kenpo, the following are not covered by the High-Cost Medical Expense Benefit.
- Meals during a hospital stay (the part you pay yourself for inpatient meal costs and inpatient living costs)
- The extra amount for treatment combined with services not covered by insurance (hoken-gai heiyo ryoyohi)
How to Keep the Amount You Pay at the Counter Down to the Limit
The High-Cost Medical Expense Benefit is usually paid back after you first pay at the counter. According to the Ministry of Health, Labour and Welfare, for both outpatient care and hospital stays, you can keep the amount you pay at the counter down to the monthly limit in the following ways.
- Use your My Number health insurance card (a My Number card registered for use as a health insurance card) at the counter
- Get a Limit Application Certificate (gendogaku tekiyo ninteisho) from your insurer in advance and show it at the counter
According to Kyokai Kenpo, if you use your My Number health insurance card (at medical institutions, etc. that have introduced online eligibility checks), you do not need to apply for a Limit Application Certificate. However, people in low-income categories, such as those exempt from resident tax, need to apply for a “Limit Application and Standard Charge Reduction Certificate” (gendogaku tekiyo hyojun futangaku gengaku ninteisho) even if they use their My Number health insurance card.
Where to apply for a Limit Application Certificate depends on the medical insurance you belong to.
| Medical insurance you belong to | Where to apply |
|---|---|
| Company health insurance (Kyokai Kenpo or a health insurance society) | The Kyokai Kenpo prefectural branch, or your health insurance society |
| National Health Insurance | Your city, ward, town or village (the National Health Insurance counter) |
| Medical care system for people aged 75 and over (kouki koreisha iryo seido) | Your city, ward, town or village |
According to Kyokai Kenpo, the Limit Application Certificate can be used from the 1st day of the month in which the application was received. It is not issued for months before the month you applied, so apply early once a hospital stay or similar has been decided.
(Sources: MHLW “To Everyone Using the High-Cost Medical Expense Benefit”, Kyokai Kenpo “Limit Application Certificate”)
How to Apply for the Refund
If you paid more than the limit at the counter, make an “application for payment of the High-Cost Medical Expense Benefit” to your insurer.
- Check who your insurer is. If you use a My Number health insurance card, you can check on Mynaportal. If you do not, you can check on your eligibility certificate (shikaku kakuninsho)
- Submit your insurer’s application form (for Kyokai Kenpo, the “Health Insurance High-Cost Medical Expense Benefit Payment Application Form”. By mail or online application)
- If you are in National Health Insurance, ask at the National Health Insurance counter of your city, ward, town or village
According to Kyokai Kenpo, the right to receive the High-Cost Medical Expense Benefit expires 2 years from the 1st day of the month after the month you received treatment. You can also apply for older months as long as it is within 2 years.
Kyokai Kenpo also has a “High-Cost Medical Expense Loan Program” (kogaku iryohi kashitsuke seido) that lends you money interest-free, up to 80% of the expected benefit amount, until the High-Cost Medical Expense Benefit is paid.
(Sources: MHLW “To Everyone Using the High-Cost Medical Expense Benefit”, Kyokai Kenpo “Health Insurance High-Cost Medical Expense Benefit Payment Application Form”, Kyokai Kenpo “When You Have Paid High Medical Costs”)
Common Questions
Can I Use It If I Do Not Have Health Insurance?
The High-Cost Medical Expense Benefit is a system of public medical insurance (company health insurance, National Health Insurance, etc.). The refund is paid by the insurer of the medical insurance you belong to. For the types of medical insurance and how to join, please read When You Are Sick or Injured in Japan: The Basics of Hospitals, Ambulances, Medicine, Medical Insurance and Where to Get Advice.
What If My Hospital Stay Covers 2 Months?
The limit is calculated for each month (from the 1st day to the last day of the month). A hospital stay that continues into the next month is calculated separately for each month.
I Do Not Know Which Limit Category I Am In
If you are in company health insurance, ask your employer or your insurer (the Kyokai Kenpo branch or your health insurance society). If you are in National Health Insurance, ask at the National Health Insurance counter of your city, ward, town or village.
I Am Worried About Asking in Japanese
Some cities, wards, towns and villages have counters where you can get advice in foreign languages. Search for “(name of your city, ward, town or village) 外国人 相談” (foreign residents consultation), or ask at your city, ward, town or village office. Where to get advice when you have trouble with hospitals is listed in When You Are Sick or Injured in Japan: The Basics of Hospitals, Ambulances, Medicine, Medical Insurance and Where to Get Advice.
Primary Sources Used for This Article
- MHLW “To Everyone Using the High-Cost Medical Expense Benefit”
- MHLW “About the Revision of the High-Cost Medical Expense Benefit” (for treatment from August 2026)
- Japan Health Insurance Association (Kyokai Kenpo) “When You Have Paid High Medical Costs”
- Japan Health Insurance Association (Kyokai Kenpo) “Limit Application Certificate”
- Japan Health Insurance Association (Kyokai Kenpo) “Health Insurance High-Cost Medical Expense Benefit Payment Application Form”
This article is a translation of the original Japanese version.
