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

Published 2026.06.06 ・ Updated 2026.10.11 | Operated by MRI Co., Ltd. | Written & verified by Zainichi Life Navi Editorial Team (Editorial Policy)
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📌 Key points
  • 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).
PRPaying for everyday life in Japan: a card to consider
エポスカードEPOS CardEPOS卡Thẻ EPOS年会費無料・店頭受取で最短即日No annual fee · Same-day at Marui (fastest case)年会费免费·丸井店铺最短当日Miễn phí thường niên · Nhanh nhất trong ngày tại Marui
年会費が無料（標準カード）で、マルイ店舗で受け取る場合は最短即日発行に対応しています。発行の可否はカード会社の審査により決まります。No annual fee (standard card), and same-day issuance is available when you pick up the card at a Marui store. Whether a card is issued is decided by the card company's screening.年会费免费（标准卡），在丸井店铺领取时最短可当日发卡。能否发卡由发卡公司的审查决定。Miễn phí thường niên (thẻ tiêu chuẩn), nhận thẻ tại cửa hàng Marui có thể được phát hành nhanh nhất trong ngày. Việc có phát hành thẻ hay không do công ty thẻ xét duyệt quyết định.

※カードの発行には審査があり、在留資格・在留期間により発行できない場合があります。条件は公式サイトでご確認ください。* Issuance is subject to screening and may not be available depending on your residence status/period. Check the official site for conditions.※发卡需审查，可能因在留资格·在留期间无法发行。条件请见官方网站。* Việc phát hành cần xét duyệt và có thể không được tùy tư cách/thời gian lưu trú. Xem điều kiện trên trang chính thức.

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 ceilingAnnual 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
💡 Multiple-month reduction (unchanged — not raised)If you hit the ceiling 3+ times in the past 12 months, the ceiling drops further from the 4th time (this amount was not increased in the August 2026 revision): ¥140,100 for the top bracket / ¥93,000 for ¥7.7M–11.6M / ¥44,400 for the two middle-and-lower brackets / ¥24,600 for the residence-tax-exempt bracket. This matters for anyone in ongoing long-term treatment.
⚠️ A new annual cap was addedAlongside the August 2026 increase, an annual cap was newly introduced (the year runs from August through the following July). Once your cumulative out-of-pocket high-cost-medical payments for the year reach the cap, any further out-of-pocket amount is refunded by your insurer. A further breakdown of income brackets is planned for August 2027. Check MHLW or your insurer for the latest figures.

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.

Sources

* Rules may change. Please check official sites for the latest information.

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