High-Cost Medical Expense Benefit: Limits & How to Claim [2026]

The High-Cost Medical Expense Benefit refunds the part of your monthly (calendar-month) out-of-pocket medical costs that exceeds an income-based ceiling. Members of National Health Insurance or Social Insurance are covered, including foreign residents who are enrolled.

① How it works

You normally pay 30% at the counter, but if your monthly out-of-pocket cost exceeds the ceiling, the excess is refunded. If you show a "Ceiling-Amount Certificate" (or My Number insurance card) at the facility, your counter payment is capped at the ceiling from the start.

② Monthly ceiling (under 70, current — through treatment in July 2026)

③ How to claim

• In advance: apply for a Ceiling-Amount Certificate from your insurer (municipal NHI / health insurance society / Kyokai Kenpo) and show it at the facility (generally not needed with a My Number insurance card)
• After the fact: if you paid above the ceiling, claim the benefit from your insurer for a refund (deadline: 2 years from the 1st of the month after treatment)

FAQ

Can foreigners use it?Yes, if enrolled in National Health Insurance or Social Insurance.

What should I do before hospitalization?Get a Ceiling-Amount Certificate and show it, or use a My Number insurance card, so your counter payment is capped.

Are costs combined across months?The ceiling is per calendar month (1st to last day). Costs spanning two months are calculated separately.