Japan health insurance high-cost medical expense benefit (高額療養費) — income figure used to determine the 15,000 yen monthly category for people aged 70 and over revised to 826,500 yen (effective August 1, 2026)
Source material is a Japanese government announcement (in Japanese); this page is a summary.
From August 1, 2026, when determining whether a person falls under the category for people aged 70 and over with a 15,000 yen monthly cap (健康保険法施行令 Article 42, paragraph 3, item 6) of Japan's health insurance high-cost medical expense benefit, the amount applied to people receiving public pensions and similar payments changes from 806,700 yen to 826,500 yen. It applies from care received in or after August 2026, and the insurer certification that caps the amount payable at the counter can be applied for in advance, from June 25, 2026, before the effective date.
Key facts
| Effective date | August 1, 2026 (令和8年政令第219号 「健康保険法施行令等の一部を改正する政令」, promulgated June 25, 2026) |
|---|---|
| Amended provision | 健康保険法施行令 Article 42, paragraph 3, item 6 — care from the month after the month in which the person turns 70; the category whose high-cost medical expense calculation threshold is 15,000 yen |
| Amount that changes | Amount applied in place of the amount specified in Article 35, paragraph 4 of the Income Tax Act when calculating gross income for people receiving public pensions and similar payments: 806,700 yen → 826,500 yen |
| Application | From the calculation threshold for cases where the month of care falls in or after August 2026. Care in or before July 2026, and the age-70-and-over long-term care combined (介護合算) calculation threshold where the base date falls in a month in or before July 2026, remain under the former rules (supplementary provisions, Article 3) |
| Cap at the counter (where insurer certification has been obtained) | 15,000 yen combined per household for those aged 70 and over / 7,500 yen for care subject to the special rule in the month a person turns 75 / 8,000 yen per person for outpatient care (Article 43, paragraph 1, item 2(ヘ), item 3(ヘ), item 4(ロ)) |
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Effective August 1, 2026, Article 42, paragraph 3, item 6 of Japan's Health Insurance Act Enforcement Order (健康保険法施行令) is amended. That item defines the category whose high-cost medical expense calculation threshold is 15,000 yen per month, covering people receiving care from the month after the month in which they turn 70 where the insured person and all of their dependents have no income amounts based on gross income or forest income for municipal inhabitant tax purposes under the Local Tax Act and no separately calculated income amounts. The amendment changes, for people receiving public pensions and similar payments, the amount applied in that determination in place of the amount specified in Article 35, paragraph 4 of the Income Tax Act — from 806,700 yen to 826,500 yen. The existing treatment where employment income is included is retained: it is counted as that employment income minus 100,000 yen (0 yen if the result is below 0 yen). Under Article 3 of the supplementary provisions, the amendment applies from the high-cost medical expense calculation threshold for cases where the month of care falls in or after August 2026; care in or before July 2026 remains under the former rules. Under Article 2 of the supplementary provisions, an insurer's certification that a person falls under this category can be obtained in advance — before the effective date — from the promulgation date of June 25, 2026.
Summaries below are factual notes based on government announcements and primary sources — not evaluations or opinions.
Summaries reflect national-level programs. Municipal (city/ward/town) programs may differ — confirm with the official desk before applying.
FAQ
How can I check whether I fall under this 15,000 yen category?
This category covers care from the month after the month in which you turn 70, where the insured person and all of their dependents have no income amounts based on gross income or forest income for municipal inhabitant tax purposes and no separately calculated income amounts. Cases where, in the month the care was received, the person qualifies as a person requiring protection (要保護者) as specified by Ministry of Health, Labour and Welfare ordinance are also included. If you receive public pensions or similar payments, the calculation for care in or after August 2026 applies 826,500 yen. The actual determination and certification are made by the insurer you are enrolled with (協会けんぽ or a 健康保険組合), so check with your insurer whether it applies to you.
Can I apply in advance, before receiving care in August?
Under Article 2 of the supplementary provisions, an insurer's certification that a person falls under Article 42, paragraph 3, item 6 as amended may also be obtained before the effective date (August 1, 2026), following the rules in Article 43, paragraph 1, item 2(ヘ), item 3(ヘ) and item 4(ロ). Those enabling provisions took effect on the promulgation date, June 25, 2026. Once you have this certification, the amount you must pay at the medical institution's counter is limited to the applicable calculation threshold.
What happens to care I received up to July 2026?
Under Article 3 of the supplementary provisions, the high-cost medical expense calculation threshold for cases where the month of care falls in or before July 2026, and the age-70-and-over long-term care combined (介護合算) calculation threshold where the base date falls in a month in or before July 2026, remain under the former rules. In other words, the determination applying the former amount (806,700 yen) stays in place.