Living in Japan, unexpected illnesses or injuries can sometimes lead to very high medical bills. Hospitalization or surgery can easily cost several hundred thousand yen. In such cases, the High-Cost Medical Expense Benefit (高額療養費制度 / Kōgaku Ryōyōhi Seido) can provide valuable financial relief.
What is the High-Cost Medical Expense Benefit?
This system ensures that if your monthly out-of-pocket medical expenses (from the 1st to the end of each month) exceed a certain amount, the excess will be refunded later.
For example, if you are hospitalized from January 10 to February 10, the calculation will be divided into:
- January portion (Jan 10 – Jan 31)
- February portion (Feb 1 – Feb 10)
For each month, any costs above your limit will be refunded.
Refund Process
- Pay your out-of-pocket portion at the hospital or clinic.
- Submit the High-Cost Medical Expense Application Form (高額療養費支給申請書).
- After review, the refund will be processed.
Keep in mind that it usually takes three months or more before the refund is issued. If you have cash flow concerns, you may use the Interest-Free Loan System (高額医療費貸付制度) to temporarily cover costs.
How to Reduce Costs in Advance
By presenting a document called the Certificate of Application of the Maximum Amount (限度額適用認定証 / Gendogaku Tekiyō Ninteishō) at the hospital, you only need to pay up to your monthly limit at the counter. This prevents you from having to make a large upfront payment.
If you have registered your My Number Card (マイナンバーカード) as your health insurance card and the hospital supports online verification, you only need to present your card.
If the hospital does not support this, it is best to ask your company’s HR department to handle the application for the Certificate of Application of the Maximum Amount.
When you visit the hospital, you may need to explain or submit documents in Japanese. Even if you know the process, communication at the counter can still be stressful without Japanese skills. That’s why improving your Japanese language ability is just as important as understanding the system. Check out this article for tips on learning Japanese effectively.
Combining Family Medical Expenses
If multiple family members in the same household receive treatment, or if one person visits multiple medical institutions, the expenses can be combined. If the total exceeds the limit, the excess will be refunded.
(Note: For those under 70 years old, only expenses of 21,000 yen or more per visit can be combined.)
How the Monthly Limit is Decided
The monthly limit depends on your income level and age.
- Higher income → higher limit.
- Lower income → lower limit.
You can check the exact amount on your health insurance society or Kyokai Kenpo website.
Special Rule for Repeated Use (多数該当 / Tasū Gaitō)
If you use the system three times within 12 months, your out-of-pocket limit will be further reduced from the fourth time onward.
For example, if you already received refunds three times in a year, then on your fourth hospitalization, your payment will be even lower than usual. This is especially helpful for those who need ongoing treatment or repeated hospital stays.
Summary
When facing high medical expenses in Japan, the High-Cost Medical Expense Benefit can help ease the financial burden.
- Calculated monthly (1st – end of month)
- Refunds take time (usually 3+ months)
- Use the Certificate of Application of the Maximum Amount to reduce upfront costs
- Family medical expenses can be combined
- Repeated use lowers your out-of-pocket limit from the 4th time onward
Knowing this system will give you peace of mind when living in Japan.
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