When a hospital stay or surgery is scheduled, the question that matters is "how much will I actually pay at the counter?" Japan's public health insurance puts a monthly ceiling on what you pay out of pocket, so even ¥1 million in medical costs never means paying the ¥300,000 that a 30% share would be. This article answers, in order: ①what your ceiling is ②what changes at age 70 ③how you receive the benefit ④how much August 2026 added. If you only want the number, the table just below is enough.
How much you pay: ceilings by income (under 70)
Find the row for your annual income. The "monthly ceiling" is the most you pay in that month. The next column gives the worked-out figure for a month with ¥1 million of medical costs — ¥300,000 at a 30% share[JHIA].
| Annual income | Monthly ceiling | You pay, on ¥1m of costs | 4th month onward | Annual ceiling |
|---|---|---|---|---|
| Over ¥11.6m | ¥270,300 + 1% of costs over ¥901,000 | ¥271,290 | ¥140,100 | ¥1.68m |
| ¥7.7m–11.6m | ¥179,100 + 1% of costs over ¥597,000 | ¥183,130 | ¥93,000 | ¥1.11m |
| ¥3.7m–7.7m | ¥85,800 + 1% of costs over ¥286,000 | ¥92,940 | ¥44,400 | ¥530,000 |
| Under ¥3.7m | ¥61,500 (flat) | ¥61,500 | ¥44,400 | ¥530,000* |
| Resident-tax exempt | ¥36,900 (flat) | ¥36,900 | ¥24,600 | ¥290,000 |
*Those confirmed to have a standard monthly remuneration of ¥150,000 or less (roughly income under ¥2m) get an annual ceiling of ¥410,000 — but that ¥410,000 is reimbursed only from August 2027 onward. The "4th month onward" column applies when you have already hit the ceiling in three months within the past 12.
To get your own figure directly, use our High-Cost Medical Expense simulator. Enter your income band and the medical cost, and it shows the gap against the 30% share and how much comes back. It also handles household aggregation, the multiple-month reduction, and a health society's top-up benefit, so it lands closer to reality than the table.
Worked example: income ¥5m (ceiling ¥85,800 + 1%)
A month with ¥1m of medical costs (¥300,000 at 30%)
Ceiling = 85,800 + (1,000,000 − 286,000) × 1% = ¥92,940 → about ¥210,000 comes back
A month with ¥300,000 of medical costs (¥90,000 at 30%)
Ceiling = 85,800 + (300,000 − 286,000) × 1% = ¥85,940 → only ¥4,060 comes back
The benefit bites hardest on large bills. At around ¥90,000 of out-of-pocket cost, this income band gets almost nothing back. On the same ¥300,000 of costs, someone earning under ¥3.7m gets ¥28,500 back and a resident-tax-exempt household ¥53,100.
From age 70, read this table instead
People aged 70 and over have their own table, and the ceiling differs between an outpatient-only month and a month that includes a hospital stay. This is the section to read if you are checking a parent's costs[JHIA].
| Category | Outpatient only (per person) | Month including a stay (per household) | Annual ceiling |
|---|---|---|---|
| Working-age level over ¥3.7m | No separate cap (use the right column) | ¥85,800 + 1% to ¥270,300 + 1% | ¥530,000–1.68m |
| General under ¥3.7m | ¥22,000 (up to ¥216,000 a year) | ¥61,500 | ¥530,000 |
| Low income Ⅱ resident-tax exempt | ¥11,000 (up to ¥96,000 a year) | ¥25,700 | ¥290,000 |
| Low income Ⅰ no income | ¥8,000 | ¥15,700 | ¥180,000 |
"Working-age level" covers the three bands with standard monthly remuneration of ¥280,000 or more and uses the same amounts as the under-70 table (an outpatient-only month is also judged on the household figure). "General" means standard monthly remuneration of ¥260,000 or less. Low income Ⅱ is a resident-tax-exempt household; low income Ⅰ is a household with no income. Your own category appears on your insurance card or in your insurer's notice.
For the general category, outpatient care went from ¥18,000 a month (¥144,000 a year) to ¥22,000 a month (¥216,000 a year) — ¥4,000 more a month, or ¥72,000 a year, for someone who only attends as an outpatient. For resident-tax-exempt households (low income Ⅱ) the outpatient figure rose from ¥8,000 to ¥11,000, but a new annual ceiling of ¥96,000 was added at the same time, so the maximum over a full year is unchanged. The ¥8,000 for low income Ⅰ is held flat[MHLW].
How you receive it: three routes
This is the confusing part of the system, but there are only three options — and the default is now the one where you do nothing.
AUse a My Number health insurance card (no paperwork — recommended)
Online eligibility verification passes your ceiling information to the hospital, so the counter charges you only up to the ceiling from the start. No advance application, no later claim. Because you never front the money, this route puts the least strain on your cash.
BObtain a ceiling-application certificate (if there is time before admission)
If you are not using a My Number card, apply to your insurer for a ceiling-application certificate and present it at the hospital. The effect is the same as route A. Under National Health Insurance and the medical system for the very elderly, your category is reset every 1 August based on the previous year's income, so these certificates expire at the end of July. Renewal is covered in ceiling-application certificates renew in August.
CPay first and claim it back (if you missed the deadline)
Paying the full 30% at the counter costs you nothing in the end. Claim the benefit from your insurer and the amount above the ceiling is transferred to you in roughly three months. The limitation period is two years, so you can go back over the past two years. Claims go to your health insurance society or the Japan Health Insurance Association if you are an employee, or to your municipal National Health Insurance desk if you are self-employed or retired.
How much August 2026 added
The increase originally planned for August 2025 was frozen entirely after a public backlash. A revised plan was agreed in December 2025 and took effect for treatment from August 2026. The differences are below.
| Annual income | To July 2026 | From August 2026 | Difference on ¥1m of costs |
|---|---|---|---|
| Over ¥11.6m | ¥252,600 + 1% | ¥270,300 + 1% | +¥17,110 |
| ¥7.7m–11.6m | ¥167,400 + 1% | ¥179,100 + 1% | +¥11,310 |
| ¥3.7m–7.7m | ¥80,100 + 1% | ¥85,800 + 1% | +¥5,510 |
| Under ¥3.7m | ¥57,600 | ¥61,500 | +¥3,900 |
| Resident-tax exempt | ¥35,400 | ¥36,900 | +¥1,500 |
People in long-term treatment were spared. The "multiple-month" reduction that applies once you have hit the ceiling in three months within the past 12 (¥44,400 for the ¥3.7m–7.7m band) was left unchanged. The increase lands hardest on people who hit the ceiling through a single hospital stay or operation.
Under National Health Insurance and the system for the very elderly, income categories are reset every 1 August using the previous year's income. In 2026 that coincided with a change to the ceilings themselves, so the same treatment can cost different amounts in July and in August. If a figure does not look right, the quickest route is to ask your insurer which category and which ceiling were applied.
The new annual ceiling
An annual ceiling was introduced alongside the increase. It exists for people whose monthly costs never reach the ceiling but whose treatment goes on for a long time — a year of regular outpatient visits that each fall short of the monthly cap previously brought no relief at all.
- The year runs from August to the following July, not January to December.
- Your out-of-pocket costs over that year are totalled, and anything above the annual ceiling (¥530,000 for the ¥3.7m–7.7m band) is refunded by your insurer.
- For now this is not automatic — you have to ask. That makes it the easiest part of the system to miss, so keep your receipts and check the procedure with your insurer.
- The ¥410,000 annual ceiling for those confirmed to earn under about ¥2m (standard monthly remuneration ¥150,000 or less) is reimbursed only from August 2027 onward.
Long-term care insurance has an equivalent scheme, the high-cost long-term care benefit, and combining the two through the annual medical-and-care aggregation can produce a further refund.
Another rise in August 2027 (amounts already set)
The review comes in two stages, and income categories are subdivided in August 2027. The key point: the bottom of each current band is held flat, and the higher you sit, the more you pay. Which side you land on changes the conclusion entirely[MHLW].
| Annual income | From August 2026 | From August 2027 |
|---|---|---|
| Over ¥16.5m | ¥270,300 + 1% | ¥342,000 + 1% |
| ¥14.1m–16.5m | ¥303,000 + 1% | |
| ¥11.6m–14.1m | ¥270,300 + 1% (unchanged) | |
| ¥10.4m–11.6m | ¥179,100 + 1% | ¥209,400 + 1% |
| ¥9.5m–10.4m | ¥194,400 + 1% | |
| ¥7.7m–9.5m | ¥179,100 + 1% (unchanged) | |
| ¥6.5m–7.7m | ¥85,800 + 1% | ¥110,400 + 1% |
| ¥5.1m–6.5m | ¥98,100 + 1% | |
| ¥3.7m–5.1m | ¥85,800 + 1% (unchanged) | |
| ¥2.6m–3.7m | ¥61,500 | ¥69,600 |
| ¥2m–2.6m | ¥65,400 | |
| Under ¥2m | ¥61,500 (unchanged) | |
| Resident-tax exempt (under 70) | ¥36,900 | ¥36,900 (unchanged) |
The band now lumped together as "¥3.7m–7.7m" splits into three. Anyone on ¥6.5m–7.7m moves to ¥110,400 a month (+¥24,600) and those on ¥5.1m–6.5m to ¥98,100 (+¥12,300), while people on ¥3.7m–5.1m stay at ¥85,800. On an unchanged income, this table tells you where you land in August 2027.
Lower incomes get relief instead. For people earning under about ¥2m, the multiple-month figure falls from ¥44,400 to ¥34,500, and the annual ceiling from ¥530,000 to ¥410,000.
Two increases in two years, and yet the mechanism meant to cushion them still requires the patient to ask for the annual ceiling. The ministry's own material states that it will run on an application basis for the time being, which leaves the administrative effort with exactly the long-term patients who need help most. There is little a reader can do about the design, but keeping a year of receipts together and reviewing the previous year each August prevents most of the losses.
Four things people miss
- The ceiling is per calendar month, so a stay across two months costs two ceilings. A stay from 25 October to 5 November is charged up to the ceiling in October and again in November. If you can choose the dates of a planned admission, starting early in a month makes it more likely to fit inside one.
- Household aggregation only works within the same insurance. If family members each have ¥21,000 or more of out-of-pocket cost (under 70) in the same month, those amounts can be added together — but a dual-income couple on two different insurers cannot combine. Missing this makes the arithmetic fail.
- Private-room fees, meals and advanced treatment sit outside the ceiling. The extra charge for a private room, hospital meals (¥550 per meal), the technical fee for advanced medical treatment and fully private care are not covered and come on top. That gap is what private medical insurance is for.
- Check your health society's top-up benefit. Large companies' health insurance societies often cap your real cost at ¥20,000–25,000 a month. Your effective burden depends heavily on which insurer you belong to, so read your society's rules first. The Japan Health Insurance Association and National Health Insurance have no such top-up.
The difference from the medical expense deduction is that this benefit is a refund from your health insurance, while the deduction reduces your tax. You can use both, but the deduction is calculated after subtracting what the benefit refunded. If illness keeps you off work, injury and sickness allowance (about two-thirds of your pay) may also apply. The benefit works the same way under National Health Insurance for the self-employed.
What to do today
- Put your income and a likely medical cost into the High-Cost Medical Expense simulator and note your ceiling. Far calmer than looking it up after an admission is scheduled.
- Register your My Number card for insurance use. That alone makes the counter charge you only up to the ceiling (route A).
- Find out whether your health society has a top-up benefit. If it does, your ceiling is lower still. Search your society's site or rules for "additional benefit" or "partial cost refund".
More actions are collected in our take-home pay action list.
Frequently asked questions
If medical costs come to ¥1 million, how much do I pay at the counter?
On an income of ¥3.7m–7.7m, ¥92,940 (¥85,800 plus 1% of the costs above ¥286,000). With a My Number insurance card or a ceiling-application certificate, that is all you pay at the counter. Under ¥3.7m it is ¥61,500, and ¥36,900 for a resident-tax-exempt household. Private-room fees, meals and advanced-treatment fees are extra.
I already paid the full 30%. Is it too late?
No. Claim the benefit from your insurer and the amount above the ceiling is transferred in roughly three months. The limitation period is two years, so any month in the past two years in which you exceeded the ceiling can still be claimed. Employees claim from their health insurance society or the Japan Health Insurance Association; the self-employed and retired from their municipal National Health Insurance desk.
What is the ceiling for a parent aged 70 or over?
From 70, the ceiling differs between outpatient-only months and months including a hospital stay. In the general category (income under about ¥3.7m) it is ¥22,000 a month for outpatient care and ¥61,500 for a month including a stay; for a resident-tax-exempt household (low income Ⅱ) ¥11,000 and ¥25,700; for a household with no income (low income Ⅰ) ¥8,000 and ¥15,700. Those on working-age-level income of ¥3.7m or more use the same amounts as the under-70 table.
How much did my costs rise in August 2026?
On an income of ¥3.7m–7.7m with ¥1 million of medical costs, from ¥87,430 to ¥92,940 — about ¥5,510 more. It is about ¥17,110 for incomes over ¥11.6m, ¥3,900 for incomes under ¥3.7m and ¥1,500 for resident-tax-exempt households. The multiple-month figure for people in long-term treatment was left unchanged, so the fourth and later months within 12 cost no more than before.
How does the new annual ceiling work?
Your out-of-pocket costs from August to the following July are totalled, and anything above the annual ceiling (¥530,000 for the ¥3.7m–7.7m band) is refunded by your insurer. It was created for people whose monthly costs never reach the ceiling but whose treatment continues for a long time. For now it runs on an application basis rather than automatically, so keep your receipts and ask your insurer how to claim.
Given this benefit, do I still need private medical insurance?
It depends. Treatment costs are held to roughly ¥80,000–90,000 a month, but private-room fees, hospital meals, advanced-treatment fees and fully private care fall outside, and lost income while you cannot work is not covered either. The rational approach is to insure the gap and the income loss rather than the part above the ceiling. Employees, who also have sickness allowance, need less cover than the self-employed.
Sources
- Japan Health Insurance Association — the High-Cost Medical Expense Benefit is revised from August 2026 (ceilings, annual ceiling and multiple-month figures in force from August 2026; Japanese)
- Japan Health Insurance Association — High-Cost Medical Expense Benefit (ceilings for those aged 70 and over) (source for the over-70 table here; Japanese)
- Ministry of Health, Labour and Welfare — on the revision of the High-Cost Medical Expense Benefit (reference material) (the table setting current, August 2026 and August 2027 amounts side by side; source for the 2027 subdivision; Japanese)
- Ministry of Health, Labour and Welfare — for people using the High-Cost Medical Expense Benefit (the basics, household aggregation, multiple-month reduction and how to claim; Japanese)
- Work out your own figure: High-Cost Medical Expense simulator (this site; handles household aggregation and top-up benefits)
Health society top-up benefits and municipal medical subsidies (for children, designated intractable diseases, self-reliance support medical care and so on) apply separately from the tables here. Procedures for the annual ceiling differ by insurer. This article is general information; confirm your own eligibility and amounts with your insurer.
