What is the high-cost medical expense limit in Japan?

Last checked: 2026-11-06

If your covered medical costs in one month pass a limit set by your income, public health insurance refunds the part above it. For a middle-income person under 70, the limit from August 2026 is 85,800 yen plus 1% of total costs above 286,000 yen. A new yearly cap of 530,000 yen also applies at that income. The rule is the same for anyone on public health insurance, and MHLW's leaflet for foreign residents lists it as a National Health Insurance benefit.

Limits for ages 69 and under, August 2026 to July 2027

These are Minato City's figures for National Health Insurance. The same amounts appear on the Japan Health Insurance Association page for employees, which sorts people by standard monthly pay. "Total costs" means the full covered cost, before your 30% share.

National Health Insurance income base	Employees' plan: standard monthly pay	Monthly limit	From the 4th time in a year	Yearly cap
Over 9.01 million yen	830,000 yen or more	270,300 yen + 1% of total costs over 901,000 yen	140,100 yen	1,680,000 yen
Over 6 million to 9.01 million yen	530,000 to 790,000 yen	179,100 yen + 1% of total costs over 597,000 yen	93,000 yen	1,100,000 yen, or 1,110,000 yen on the association page
Over 2.1 million to 6 million yen	280,000 to 500,000 yen	85,800 yen + 1% of total costs over 286,000 yen	44,400 yen	530,000 yen
2.1 million yen or less	260,000 yen or less	61,500 yen	44,400 yen	530,000 yen. Some people have 410,000 yen.
Exempt from resident tax	Low income, exempt from resident tax	36,900 yen	24,600 yen	290,000 yen

The income base is not your salary. Ask your municipal office or insurer which row applies to you. MHLW says the system changes again in August 2027.

Worked example: 1,000,000 yen of covered care

This is our own arithmetic for one month at the third row, with a 30% share. It matches MHLW's example of about 93,000 yen.

Step	Amount
Total covered cost	1,000,000 yen
Your 30% share	300,000 yen
Limit: 85,800 + (1,000,000 - 286,000) x 1%	92,940 yen
Amount above the limit	207,060 yen

The yearly cap and repeat months

Yearly cap. This is new from August 2026. It counts from August to the next July. Once you pass it, the insurer can refund the rest.
Repeat months. If you reached the limit in 3 or more of the last 12 months, the limit drops from the 4th time. MHLW says these amounts did not rise in this revision.

What does not count

Extra charges for selected treatment, such as the difference paid for some options.
Hospital meal and living charges.

The Japan Health Insurance Association lists these. For birth costs, see childbirth cost in Japan.

Adding family costs together

The association says that under 70, amounts of 21,000 yen or more at one hospital or clinic can be added together across its members in your household. Each hospital is counted separately, and inpatient, outpatient and dental care are separate. Ask your insurer how this works for your plan.

How to use it

Use your My Number health insurance card, or ask your insurer in advance for a limit certificate.
MHLW says that with one of these, you do not pay above the monthly limit at the counter.
If you paid more than the limit, claim the rest from your insurer. National Health Insurance members go to their municipality.

Our My Number Card guide explains the card. If you are not yet insured, start with National Health Insurance.

What we could not confirm

New arrivals. We did not find how your income row is set if you have no income record in Japan for last year. Ask your municipal office.
The 1,100,000 yen figure. Minato shows 1,100,000 yen and the association shows 1,110,000 yen for the second row. We show both.
The 410,000 yen cap. The sources say it applies to some people in the fourth row, confirmed by the insurer. Ask yours.
Ages 70 and over. Other limits apply, and we leave them out.

This page is general information, not medical or financial advice. Your insurer decides your limit and your refund.