High-Cost Medical Expense Benefit: Limits & How to Claim [2026]
- This is a system that refunds the part of your monthly out-of-pocket medical costs that exceeds an income-based ceiling.
- Members of National Health Insurance or Social Insurance are covered, so foreign residents can use it if enrolled.
- The out-of-pocket ceiling varies by income bracket (see the table in the article for reference figures).
- You apply to receive the refund (the application method is explained in the article).
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, from treatment in August 2026)
The monthly out-of-pocket ceiling increased starting with treatment in August 2026 (treatment through July 2026 is billed at the lower previous rates below this table).
| Annual income (approx.) | Monthly ceiling | Annual cap |
|---|---|---|
| ¥11.6M+ | ¥270,300 + (cost − ¥901,000) × 1% | ¥1.68M |
| ¥7.7M–11.6M | ¥179,100 + (cost − ¥597,000) × 1% | ¥1.11M |
| ¥3.7M–7.7M | ¥85,800 + (cost − ¥286,000) × 1% | ¥530,000 |
| up to ¥3.7M | ¥61,500 | ¥530,000 |
| Residence-tax exempt | ¥36,900 | ¥290,000 |
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)
Even when sudden hospitalization or surgery makes costs high, it helps to know how to get emergency care.
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.
Note that dental care is also covered by public health insurance and qualifies for the High-Cost Medical Expense Benefit (self-pay dental treatments are excluded). If extended treatment or long-term recovery is involved, those aged 40 and over may also be eligible for support under Long-Term Care Insurance — reviewing both the medical and care cost sides can help you plan ahead.
💰 Want free advice on insurance and money from a professional? PR
If a high medical bill has you thinking about how to prepare for future costs, public coverage plus private insurance, or your household budget, this free consultation service connects you with a financial planner (FP) to review insurance and household finances (Hoken Story). The consultation is free, funded by referral fees from partner insurance companies/agencies. Consultations are conducted in Japanese. What can be covered depends on your situation and requests.
Get a free insurance & money consultation →
Sources
- MHLW (High-Cost Medical Expense Benefit)
- MHLW (comparison table of old/new ceilings)
- Japan Health Insurance Association, "High-Cost Medical Expense Benefit"
* Rules may change. Please check official sites for the latest information.
Ask our AI Concierge
Chat with our AI about this topic.
More helpful info for life in Japan
Browse all guides →