In August 2026, Japan raised the caps under its High-Cost Medical Care Benefit (kogaku ryoyohi), and the "monthly ceiling on medical bills" became a hot topic. So what happens in a world where no such ceiling exists at all? In the United States, roughly 1 in 12 adults carries medical debt, and one estimate puts total medical debt at no less than $220 billion (about 33 trillion yen). A one-day hospital stay for appendicitis can top $10,000 — this article uses primary sources to break down the structure in which "you can go bankrupt even with insurance," the value of Japan's High-Cost Medical Care Benefit that this comparison reveals, and how Japanese travelers and expatriates can prepare for U.S. medical costs.
U.S. Medical Costs: The Reality in Numbers
| Item | Figure |
|---|---|
| Total medical debt | At least $220 billion (analysis by KFF, the Kaiser Family Foundation, based on 2021 federal survey data) |
| People carrying medical debt | About 20 million (debt over $250; roughly 1 in 12 adults). Of these, 3 million owe more than $10,000 |
| Appendicitis surgery (1-day hospital stay) | Reported bills of over $10,000 (about 1.5 million yen) (Consulate-General of Japan in New York) |
| Hospitalization costs | Can reach $10,000-$20,000 per day (Ministry of Foreign Affairs of Japan, medical conditions in New York) |
In Japan, appendicitis surgery and hospitalization cost around 100,000-plus yen even at the standard 30% copayment, and with the High-Cost Medical Care Benefit, the monthly cap for a person with average income is around 90,000 yen. The same illness deals damage to household finances that differs by an order of magnitude — that is the theme of this article.
Why It Happens: No Public Universal Coverage
The United States has no public health insurance covering all citizens like Japan's. Health insurance is, in principle, something "employers provide as a benefit," and public programs are limited to Medicare for the elderly, Medicaid for low-income people, and a few others. Obamacare (the ACA) reduced the number of uninsured, but tens of millions of people still lack coverage today.
And crucially, out-of-pocket costs are heavy even for the insured.
- Deductibles: plans commonly require you to pay everything yourself up to several thousand dollars a year before insurance kicks in at all
- High out-of-pocket maximums: under ACA standards, the annual out-of-pocket limit for 2026 plans is $10,600 for an individual (about 1.6 million yen) and $21,200 for a family. That is a different order of magnitude from Japan's roughly 90,000 yen per month under the High-Cost Medical Care Benefit — and this is the story for "fortunate plans that even have a cap"
- Out-of-network billing: if you are treated at a hospital or by a doctor outside your plan's network, even the cap does not apply — accidents happen where the emergency transport destination just happened to be out of network
- Premiums themselves are high: employer-provided family coverage exceeding $20,000 a year is not unusual, and losing your job means losing your insurance at the same time
The Result: Medical Bills Trigger Household Collapse
- A 2019 study in the American Journal of Public Health reported that about 2 in 3 bankruptcy filers cited "medical bills or income loss due to illness" as a reason (on the other hand, some economics research finds that bankruptcies with medical bills as the "direct cause" are far fewer, and the magnitude is disputed)
- Even short of bankruptcy, people forgo care. Surveys repeatedly report that a substantial share of U.S. adults have given up treatment or medication because of cost
- Medical debt damaging credit scores and affecting mortgages and auto loans has also become a recognized secondary harm, and moves to exclude medical debt from credit reports are advancing at the state and federal levels
The frightening part: this happens even in a country "with insurance"
Most people carrying medical debt are not uninsured — they are insured. As long as the three holes of deductibles, out-of-pocket maximums, and out-of-network billing remain, "having insurance" does not equal "being safe" — that is the lesson the U.S. has learned over the past 20 years.
Comparison with Japan: The High-Cost Medical Care Benefit as a "Bankruptcy Prevention Device"
| United States | Japan | |
|---|---|---|
| Public insurance | Limited to the elderly, low-income people, etc. | Universal coverage (10-30% copayment at the counter) |
| Monthly out-of-pocket cap | Depends on the plan. $10,600 per year (individual) under ACA standards | High-Cost Medical Care Benefit caps costs by income at tens of thousands of yen or more per month (revised in August 2026) |
| If your income stops | Losing your job means losing your insurance | Injury and Sickness Allowance (about two-thirds of salary, up to 18 months in total) |
| Bankruptcy caused by medical bills | Medical bills rank among the top reasons for bankruptcy | Bankruptcy from medical bills alone is exceptional |
The August 2026 revision raised Japan's caps, but the system still ensures that "medical bills cannot consume most of your monthly income." How to use it is covered in our guide to the High-Cost Medical Care Benefit and our article on the Eligibility Certificate for Ceiling Amounts and the My Number insurance card. When you feel dissatisfied with the system, comparing it with a "world without one" is the best yardstick for judgment.
Cases That Affect Japanese People: Preparing for Travel and Expat Assignments
- For U.S. travel, choose insurance by its medical treatment coverage amount: given that hospitalization runs $10,000 a day, treatment coverage that is unlimited (or at least 100 million yen) is the safe zone. Coverage of a few million yen can be blown through in a few days of intensive care
- Check the limits on credit card travel insurance: built-in treatment coverage is often only around 500,000-3,000,000 yen — clearly insufficient in the U.S. Top it up with separate overseas travel insurance before departure
- Expatriates should check three points in their company's insurance plan: (1) the deductible, (2) the annual out-of-pocket maximum, and (3) the network (affiliated hospitals). All the more so if family members accompany you
- Japan's High-Cost Medical Care Benefit is unavailable once you move abroad: if you remove your resident registration and leave National Health Insurance or employee health insurance, you cannot use Japan's system. Confirm how your social insurance will be handled with your company before an overseas posting
What to Do Today
What to do today
- Check the insurance for your next overseas trip (the medical treatment coverage amount, and whether credit card coverage alone is enough)
- Check your own bracket under the High-Cost Medical Care Benefit (your monthly cap) on your insurer's website or from the standard monthly remuneration on your pay slip
- If you are a company employee, share the existence of the Injury and Sickness Allowance (about two-thirds of salary) with your family — just knowing that "Japan also has a breakwater for lost income" helps you avoid over-buying private medical insurance
FAQ
Q. Are medical bills really the No. 1 cause of personal bankruptcy in America?
A. A 2019 study found that about 2 in 3 bankruptcy filers cited medical bills or income loss due to illness as a reason, while other research finds that bankruptcies with medical bills as the sole direct cause are far fewer, so the proportion is disputed. That said, the recognition that medical debt is one of the major drivers of household financial distress is shared across party lines.
Q. Didn't Obamacare solve the problem?
A. The number of uninsured fell sharply, but the structure that makes costs "heavy even with insurance" — high deductibles, high out-of-pocket maximums, and out-of-network billing — remains. Most people carrying medical debt are insured.
Q. Japan's High-Cost Medical Care Benefit caps were also raised in August 2026. Isn't Japan heading in the same direction?
A. Raising the caps does increase the burden, but the mechanism itself — a monthly ceiling tied to income — has been maintained. That is worlds apart from the U.S. structure, where the cap is equivalent to about 1.6 million yen per year and some bills escape the cap entirely.
Q. How much coverage do I need to feel safe on a U.S. trip?
A. Unlimited medical treatment coverage, or at least 100 million yen, is the guideline. Hospitalization can run $10,000-$20,000 a day, and when intensive care or medical evacuation is involved, bills in the tens of millions of yen have been reported. Credit card travel insurance alone falls short in most cases.
References (Sources)
Note: U.S. dollar amounts are converted at 1 USD = 150 JPY as approximations. Figures from medical debt and bankruptcy research vary by methodology, and the article notes the sources and the existence of debate. This article is provided for informational purposes as a comparison of systems and does not advocate for or against any particular policy.