NationalHealth insurance
High-cost Medical Expense Benefit
高額療養費 (kōgaku ryōyōhi)
In short: Refunds the part of your medical bills above a monthly cap based on age and income.If what you pay at hospitals/pharmacies exceeds the cap set by age and income, the excess is paid back.(Source: www.mhlw.go.jp, verified on 2026-10-15)
Validity: Current as of 2026-10-15 (FY2026 / Reiwa 8); source page live on that date. Verified on 2026-10-15. Official source: https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/iryouhoken/juuyou/kougakuiryou/index.html
- Claim deadline and required documents (confirm with insurer / municipal NHI page)
- Residence-status rule — not stated on source; confirm with office.
Who qualifies
- If what you pay at hospitals/pharmacies exceeds the cap set by age and income, the excess is paid back. [official source · verified on 2026-10-15]
Conditions by topic
| Age | Monthly cap depends on age (under 70 / 70+) and income; example: under 70 with income ~¥3.7–5.1M, ¥1M treatment → ~¥93,000. [official source · verified on 2026-10-15] |
|---|---|
| Income | Cap varies by income bracket; brackets are being subdivided from August 2027. [official source · verified on 2026-10-15] |
| Household | Not stated in the sources we checked — confirm with the office. |
| Child age | Not stated in the sources we checked — confirm with the office. |
| Residence in Japan | Not stated in the sources we checked — confirm with the office. |
| Residence in Tokyo / municipality | Not stated in the sources we checked — confirm with the office. |
| Work / insurance type | Not stated in the sources we checked — confirm with the office. |
| Disability | Not stated in the sources we checked — confirm with the office. |
Residence status
Not stated in the official sources we checked — unknown.
Where to apply
- Depends on your insurer: company plan → that insurer; National Health Insurance → your municipal NHI counter. [official source · verified on 2026-10-15]
Find addresses in the office finder.
Deadlines
Not yet verified from an official source.
Documents
Not yet verified from an official source.
Key details
- Example (from August 2026 rules): under 70 with annual income about ¥3.7–5.1 million, a ¥1,000,000 treatment is capped at about ¥93,000 out of pocket. [official source · verified on 2026-10-15]
- "Multiple-month" reduction: if you hit the cap in 3+ months within 12 months, the cap is lower from the 4th month. [official source · verified on 2026-10-15]
- From August 2026 an annual cap (August–July) is introduced; further income-bracket changes from August 2027. [official source · verified on 2026-10-15]
- Using a My Number health insurance card, or obtaining a limit-application certificate in advance, avoids paying above the cap at the counter. [official source · verified on 2026-10-15]
Phone / counter phrases
すみません、高額療養費の手続きについて伺いたいのですが、何を持っていけばよいですか。
Sumimasen, kōgaku ryōyōhi no tetsuzuki ni tsuite ukagaitai no desu ga, nani o motte ikeba yoi desu ka.
Hello. I would like to ask about the procedure for the high-cost medical expense benefit. What documents should I bring?
すみません、もう少しゆっくり話していただけますか。
Sumimasen, mō sukoshi yukkuri hanashite itadakemasu ka.
Sorry, could you please speak a little more slowly?
Generic phrases for practical help, not official wording.