Japan's Ministry of Health, Labour and Welfare (MHLW) has proposed raising the annual cap on the medical portion of National Health Insurance (kokumin kenko hoken, NHI) premiums by ¥30,000, from ¥930,000 to ¥960,000, in FY2027 (April 2027–March 2028). It presented the plan to the Medical Insurance Committee of the Social Security Council on 11 November 2026[MHLW]. The ¥170,000 cap on the long-term care portion, paid by people aged 40 to 64, stays the same. This is the sixth year in a row that the cap has been raised. The official amount will be set by an amendment to the cabinet order.
Households that already pay the cap will see their premiums go up. As a rough guide, that means a single person with an annual income of about ¥11.7 million or more, at the national average rates. The increase is at most ¥30,000 a year (¥2,500 a month).
The FY2027 cap: ¥960,000 for the medical portion, ¥1.13 million including long-term care
NHI premiums are split into four portions, and each portion has its own cap (the assessment cap, fuka gendogaku). Under this plan, only the medical portion changes.
| Portion | FY2026 (current) | FY2027 (plan) |
|---|---|---|
| Medical portion (basic portion + late-stage elderly support portion) | ¥930,000 | ¥960,000 |
| of which: basic portion | ¥670,000 | ¥690,000 |
| of which: late-stage elderly support portion | ¥260,000 | ¥270,000 |
| Long-term care portion (households with members aged 40–64) | ¥170,000 | ¥170,000 (unchanged) |
| Medical + long-term care | ¥1.10 million | ¥1.13 million |
| Child and child-rearing support portion | ¥30,000 | To be decided in the year-end budget process |
| Total | ¥1.13 million | ¥1.16 million (if the child portion stays at ¥30,000) |
*The FY2026 amounts are from the Order for Enforcement of the National Health Insurance Act. The FY2027 figures are the plan the MHLW presented to the Medical Insurance Committee on 11 November 2026[MHLW].
In the MHLW's materials, the medical and long-term care portions together come to ¥1.13 million. This does not include the child and child-rearing support portion (kodomo kosodate shienkin), which was added in FY2026. If the child portion stays at ¥30,000, the total is ¥1.16 million. Because the cap on FY2026 premium notices is also ¥1.13 million, I felt the ¥1.13 million figure on its own could easily be mistaken for "no change". The MHLW says the cap for the child portion will be set based on the year-end budget process, when the total amount of the support levy is decided[MHLW]. How the child portion works is explained in How much the child and child-rearing support levy costs.
Who pays more: households earning about ¥11.7 million or more, by up to ¥30,000 a year
The MHLW estimates that 1.73% of households will reach the medical-portion cap in FY2027. The income at which the cap is reached is about ¥11.7 million or more for a single-person household at the national average rates[MHLW]. Without the increase, the figures would be 1.87% and about ¥11.4 million.
| Household situation | Effect on the FY2027 medical portion |
|---|---|
| Medical portion already at the cap (¥930,000) | Up ¥30,000 a year (¥2,500 a month) |
| Just under the cap (calculated amount between ¥930,000 and ¥960,000) | You pay the calculated amount; the increase is less than ¥30,000 |
| Calculated premium below ¥930,000 | No increase from the higher cap (rate revisions can still change the premium) |
The cap applies per household, not per person. Even if both spouses have high incomes, the household has only one medical-portion cap. Rates differ by municipality, so the income at which you hit the cap also depends on where you live. In municipalities using the three- or two-factor method (with no asset-based levy), the estimate shows the cap being reached from a salary of about ¥11 million[MHLW].
Premiums are based on the previous year's income. In a year when you report gains from selling land, buildings or shares in your tax return, those gains are also counted[Shinjuku City]. As with a year of strong business profits, a household that is normally below the cap can reach it in the following fiscal year.
You can check the premium formula itself in How National Health Insurance premiums are calculated, and the differences between municipalities in NHI premium rankings.
Why the cap is raised: "to hold down the burden on middle-income households"
When medical costs grow and more premium revenue is needed, raising only the rates while keeping the cap fixed would leave high-income households, whose premiums are already capped, paying the same, and put the whole increase on middle-income households. To avoid this, the MHLW raises the cap a little each fiscal year so that the share of households paying the cap moves toward 1.5%[MHLW]. The idea mirrors the rule in employees' health insurance, which keeps the share of people in the top grade between 0.5% and 1.5%.
The effect on middle-income households is small, however. In the MHLW's FY2027 estimate, the medical portion for a household earning ¥4 million would be ¥330,000 (up 5.5% from the previous year) if the cap were left unchanged, and ¥328,000 (up 4.9%) with the increase[MHLW]. The difference is about ¥2,000 a year. Raising the cap slightly softens the increase for middle-income households, but I was surprised that it does not stop it.
Low-income households get a 70%, 50% or 20% reduction of the per-capita levy (kintowari). The income limits are summarized in Who qualifies for the NHI 70%, 50% and 20% reductions.
The medical and long-term care caps have risen ¥140,000 in six years
The medical portion cap goes from ¥820,000 in FY2021 to ¥960,000 under the FY2027 plan. Including the long-term care portion, the cap rises from ¥990,000 to ¥1.13 million, an increase of ¥140,000 over six years.
Over the past 20 years, the largest one-year increase was ¥40,000. This ¥30,000 rise is the next largest, the same as in FY2022 and FY2025.
Formal decision by a cabinet order amendment in early 2027; the new cap appears on June 2027 notices
- 11 November 2026 (done): The MHLW presented its plan to the Medical Insurance Committee of the Social Security Council[MHLW]. After hearing the committee's views, the government decides. The child portion cap is set after the year-end budget process.
- Around January–February 2027: The Order for Enforcement of the National Health Insurance Act is amended. The order for FY2026 was promulgated on 15 January 2026[e-Gov].
- 1 April 2027: The change takes effect. The amount in the cabinet order is a ceiling that must not be exceeded; the actual cap is set by each municipality in its own ordinance. Some municipalities keep their cap below the national amount.
- Around June 2027: Your city, town or village sends the notice of your FY2027 premium. Premiums are calculated from your income for January–December 2026.
If your June 2026 notice shows a ¥930,000 medical portion, you are affected
You can check whether this affects you on the premium notice you received around June 2026. If the medical portion (the basic portion plus the late-stage elderly support portion) equals your municipality's cap, your FY2027 premium will rise by up to ¥30,000.
Sole proprietors who are at the cap sometimes consider setting up a company, paying themselves a director's salary, and moving to the company's health insurance. However, employee pension premiums are added on top, and rules against using companies with no real business to escape NHI are getting stricter. The thinking behind this is in Rules against escaping NHI and micro-corporations, and you can estimate the gains and losses with the micro-corporation simulator.
Summary
- The MHLW has proposed raising the cap on the NHI medical portion by ¥30,000, from ¥930,000 to ¥960,000, in FY2027.
- The ¥170,000 long-term care portion is unchanged, and the total including the child portion is expected to be ¥1.16 million (if the child portion stays at ¥30,000).
- Households at the cap pay more: a single person earning about ¥11.7 million or more at national average rates, by up to ¥30,000 a year.
- The formal decision comes with a cabinet order amendment in early 2027, and the new amount will show on premium notices around June 2027.
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References (sources)
- MHLW: On the assessment caps for National Health Insurance premiums (taxes) (220th meeting of the Medical Insurance Committee, Social Security Council, Document 2, 11 November 2026) (in Japanese)
- MHLW: On the assessment caps for National Health Insurance premiums (taxes) (205th meeting of the Medical Insurance Committee, Social Security Council, Document 3, 27 November 2025) (in Japanese)
- e-Gov: Order for Enforcement of the National Health Insurance Act (Article 29-7) (in Japanese)
- Shinjuku City: How the income-based NHI premium is calculated (in Japanese)
This article is general information based on MHLW materials and laws as of 14 November 2026. The FY2027 cap is the plan the MHLW presented to the Medical Insurance Committee, and the official amount will be set by an amendment to the cabinet order. Actual caps and premiums differ by municipality, so please check with the National Health Insurance desk at your city, town or village office.