Japan to revise the ceilings under the High-Cost Medical Expense Benefit — phased rollout planned for August 2026 and August 2027
Source material is a Japanese government announcement (in Japanese); this page is a summary.
Japan's High-Cost Medical Expense Benefit pays back the excess when monthly out-of-pocket medical costs go above a ceiling set by income and age, and a revision of those ceilings is scheduled to take effect in August 2026 and August 2027.
Key facts
| How it works | Pays back the excess when monthly out-of-pocket costs exceed the ceiling |
|---|---|
| How the ceiling is set | By age (with 70 as the dividing line) and income |
| Example | Under 70, annual income roughly 3.7 million to 7.7 million yen, medical costs of 1 million yen → out-of-pocket payment of around 87,000 yen |
| How to use it | Use the My Number health insurance card, or obtain an eligibility certificate for the ceiling amount in advance and show it at the medical institution |
| Planned revision | Takes effect August 2026 and August 2027 — adjusted monthly ceiling, new annual ceiling, reduced burden for annual incomes under 2 million yen |
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The High-Cost Medical Expense Benefit pays back the excess when a person's out-of-pocket medical costs in one month exceed a ceiling set by age (with 70 as the dividing line) and income. For example, a person under 70 with an annual income of roughly 3.7 million to 7.7 million yen who incurs 1 million yen of medical costs has their out-of-pocket payment held to around 87,000 yen. A revision covering adjustments to the monthly ceiling, the introduction of a new annual ceiling, and reduced burdens for low-income people with an annual income under 2 million yen is scheduled to take effect in August 2026 and August 2027.
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 do I use the High-Cost Medical Expense Benefit?
Use your My Number health insurance card, or obtain an eligibility certificate for the ceiling amount in advance and show it at the medical institution. Ask the insurer of the public medical insurance you belong to about the exact procedure.
What changes under this revision?
Along with adjustments to the monthly ceiling, a new annual ceiling capping cumulative out-of-pocket costs over the year is introduced, and reduced burdens for low-income people with an annual income under 2 million yen are planned. It takes effect in two stages, in August 2026 and August 2027.