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)

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.