This is an English translation. Limits were revised in August 2026; the Japanese version and MHLW materials are authoritative.
Japan High-Cost Medical Benefit Simulator (Post-August 2026)
Japan raised the monthly cap in August 2026 and added an annual cap. Enter your medical cost and income band to see the real burden after the benefit, household aggregation, multiple-occurrence relief and health society top-up benefits.
Calculated on your device only. Figures are estimates.
What changed in August 2026
| Band | Income | Before | From Aug 2026 | Annual cap |
|---|---|---|---|---|
| ア | 11.6M yen and over | 252,600+1% | 270,300+1% | 1680k yen |
| イ | 7.7–11.6M yen | 167,400+1% | 179,100+1% | 1110k yen |
| ウ | 3.7–7.7M yen | 80,100+1% | 85,800+1% | 530k yen |
| エ | Under 3.7M yen | 57,600 | 61,500 | 530k yen |
| オ | Residence-tax exempt | 35,400 | 36,900 | 290k yen |
The monthly cap rose, but an annual cap (August to July) was added, which helps people in long treatment. A second stage in August 2027 will split the five bands into thirteen.
Three ways the burden gets lighter
- Household aggregation: combine family costs of 21,000 yen or more on the same insurance.
- Multiple occurrence: after three claims in 12 months, the cap drops from the fourth.
- Top-up benefit: extra cover from large-company health societies, sometimes capping costs near 20,000 yen a month.
The top-up benefit is the blind spot. With the same income and the same bill, someone in a large-company society can pay less than half of what someone on Kyokai Kenpo pays. If your card names a society, check its website.
FAQ
How much did costs rise in August 2026?
For band C (about 3.7–7.7M yen income) the monthly cap rose from 80,100 to 85,800 yen, an increase of 5,700 yen. Band A rose 17,700, B 11,700, D 3,900 and E 1,500 yen.
What is the annual cap?
Added in August 2026, it caps your total from August to the following July. Bands C and D are 530,000 yen, A is 1.68M, B is 1.11M and E is 290,000 yen. Excess is refunded later.
What is a top-up benefit?
Extra cover paid by a health insurance society on top of the statutory benefit, sometimes capping costs at 20,000–25,000 yen a month. Kyokai Kenpo and National Health Insurance do not have it.
Do I need paperwork in advance?
Not with a My Number insurance card — the counter payment is limited automatically. Otherwise obtain a limit-application certificate beforehand.
Are private room fees covered?
No. Private room fees, advanced medical technology fees, hospital meals and non-covered care are outside the cap and paid in full.
Sources
General information only. Confirm exact figures with your insurer.