"If I get cancer, how much will the medical bills be?" The answer is greatly changed by the High-Cost Medical Expense Benefit. Public health insurance has a monthly cap on out-of-pocket costs — about ¥90,000 a month for those earning ¥3.7–7.7 million a year. Even if medical costs reach ¥1 million, you pay only up to the ceiling, not the ¥300,000 that a 30% out-of-pocket share would be. This system, which sparked a major debate in 2025 over "freezing the increase," actually began its increase with treatment from August 2026. Here we summarize the ceilings now in force, the newly created annual ceiling, and how to use the system.
- Monthly ceiling: For an annual income of ¥3.7–7.7 million (category "u"), ¥85,800 + 1% (about ¥93,000 with ¥1 million in medical costs). Even with ¥1 million in medical costs, you pay only up to the ceiling, not ¥300,000 at the counter.
- Procedure: With a My Number health insurance card, no advance procedure is needed and your counter payment is capped at the ceiling (the eligibility certificate for the ceiling amount can also be used).
- Even lighter: Household aggregation (combining family members' costs of ¥21,000 or more) and the multiple-time provision (from the 4th time, ¥44,400 for category "u" — left unchanged by the revision).
- Already raised in August 2026: Category "u" went from ¥80,100 to ¥85,800. In exchange, an annual ceiling (¥530,000 for categories "u" and "e", among others) was newly created[Japan Health Insurance Association].
- Not covered: Extra-bed charges, the technology fees for advanced medical treatment, meals during hospitalization, and free (non-insured) treatment are outside the ceiling. This is where private medical insurance should be considered.
List of out-of-pocket ceilings (under age 70, for treatment from August 2026)
These are the ceilings currently in force, revised on August 1, 2026. The monthly ceilings were raised, and in exchange an annual ceiling (August through the following July) was newly created[Japan Health Insurance Association].
| Category | Rough annual income | Monthly ceiling | Multiple-time provision (from 4th) | Annual ceiling (new) |
|---|---|---|---|---|
| a | about ¥11.6 million and up | ¥270,300 + (medical costs − ¥901,000) × 1% | ¥140,100 | ¥1,680,000 |
| i | about ¥7.7–11.6 million | ¥179,100 + (medical costs − ¥597,000) × 1% | ¥93,000 | ¥1,110,000 |
| u | about ¥3.7–7.7 million | ¥85,800 + (medical costs − ¥286,000) × 1% | ¥44,400 | ¥530,000 |
| e | up to about ¥3.7 million | ¥61,500 | ¥44,400 | ¥530,000* |
| o | residence-tax exempt | ¥36,900 | ¥24,600 | ¥290,000 |
* Within category "e", those confirmed to have a standard monthly remuneration of ¥150,000 or less get an annual ceiling of ¥410,000. The annual ceiling is judged over the year "from August through the following July," and the excess is reimbursed later by your insurer (for the time being, operated on the individual's application basis).
Show the pre-revision ceilings (for treatment through July 2026)
| Category | Monthly ceiling (through July 2026) | Multiple-time provision |
|---|---|---|
| a | ¥252,600 + (medical costs − ¥842,000) × 1% | ¥140,100 |
| i | ¥167,400 + (medical costs − ¥558,000) × 1% | ¥93,000 |
| u | ¥80,100 + (medical costs − ¥267,000) × 1% | ¥44,400 |
| e | ¥57,600 | ¥44,400 |
| o | ¥35,400 | ¥24,600 |
Treatment through July 31, 2026 is calculated with these amounts (there was no annual ceiling). Refer to this table if you are applying retroactively for a past month.
Example: for a category "u" person in a month with ¥1 million in medical costs (30% at the counter = ¥300,000) → the ceiling is 85,800 + (1 million − 286,000) × 1% = ¥92,940. The difference of about ¥210,000 comes back as the High-Cost Medical Expense Benefit (before the revision this was ¥87,430, so the same medical costs now mean about ¥5,500 more. Those aged 70 and over have a separate category table).
What changed in the August 2026 revision (already in effect)
- The increase that had been scheduled for August 2025 was fully frozen due to a public backlash. Afterward, a revised plan was finalized in December 2025, and following the passage of the FY2026 budget it took effect on August 1, 2026 (for August treatment onward)[Japan Health Insurance Association: the revision from August 2026].
- Example: category "u" went from ¥80,100 to ¥85,800 (the base amount for the +1% portion also changed from ¥267,000 to ¥286,000) — an increase of about ¥5,700 a month. The other categories were raised similarly (a ¥270,300; i ¥179,100; e ¥61,500; o ¥36,900). The multiple-time provision (category "u" ¥44,400) was left unchanged.
- Together with the increase, a new "annual ceiling" was created. For people in long-term treatment who do not reach the multiple-time provision, an annual cap on patient burden was established (a ¥1,680,000; i ¥1,110,000; u and e ¥530,000; o ¥290,000; within category "e", those confirmed to have a standard monthly remuneration of ¥150,000 or less get ¥410,000), and the excess is reimbursed by the insurer. The "year" runs from August through the following July, and for the time being it is operated on the individual's application basis.
- As a second stage, a subdivision of income categories is planned for August 2027 (for example, splitting category "u" by income band, with roughly ¥5.1–6.5 million becoming ¥98,100 a month under one proposal). Please check MHLW and insurer materials for the confirmed amounts before it takes effect.
- Because the impact is greater for those in long-term treatment, it has become even more important to make full use of the multiple-time provision, household aggregation, the annual ceiling, and additional benefits (top-ups unique to a health insurance society).
Under National Health Insurance and the medical system for the latter-stage elderly, income categories and eligibility certificates for the ceiling amount are switched every August 1 based on the previous year's income. In 2026 the revision of the ceilings themselves landed on top of that, so "the same hospital stay costs more than last month" can genuinely happen. See Eligibility certificates for the ceiling amount and the My Number health insurance card for the August checklist.
How to use it (in fact, almost no procedure is now needed)
- See a doctor with a My Number health insurance card: through online eligibility verification, your ceiling information is linked, and your counter payment is capped at the ceiling with no advance procedure.
- If you do not use a My Number health insurance card: obtain an "eligibility certificate for the ceiling amount" from your insurer in advance and present it. Even after the fact, if you apply, the amount exceeding the ceiling is refunded about three months later (statute of limitations: 2 years).
- Household aggregation: out-of-pocket costs of family members on the same medical insurance (for those under 70, items of ¥21,000 or more per person) are combined to judge against the ceiling. Note that when a dual-income couple has separate insurance, the costs cannot be combined.
- The month-straddling trap: the ceiling is "per calendar month." A hospital stay that straddles the end of a month incurs the ceiling for two months, so if you can choose the timing of a planned admission, starting from the beginning of the month is advantageous.
What is not covered, and the relationship with other systems
- Where to file an after-the-fact application: your insurer. Company employees file with their health insurance society or the Japan Health Insurance Association; the self-employed and those after retirement file at their municipality's National Health Insurance counter (this is stated on the insurance card / eligibility confirmation document).
- Not covered: extra-bed charges (private-room fees), meal costs during hospitalization (¥550 per meal, revised June 2026), the technology fees for advanced medical treatment, and free (non-insured) treatment. Because these have no upper limit, one way to frame it is that this is precisely what private medical insurance should cover.
- Difference from the medical expense deduction: the High-Cost Medical Expense Benefit is a "refund from insurance," while the medical expense deduction is a "reduction of tax." You can use both, but in calculating the medical expense deduction you must subtract the amount returned via the High-Cost Medical Expense Benefit.
- If you take time off work due to illness, also consider injury and sickness allowance (2/3 of salary). In a year when your income falls, you may become eligible for the spousal deduction.
- The High-Cost Medical Expense Benefit can likewise be used with National Health Insurance for the self-employed and freelancers (no additional benefits, though).
Do this today
- Check your income category and monthly out-of-pocket ceiling on Mynaportal or the like
- Register to use your My Number health insurance card (counter payments above the ceiling become in principle unnecessary)
- Look back through your medical expense notices for any month within the past 2 years that exceeded the ceiling
More actions: the Take-Home Boost Checklist.
FAQ
If medical costs come to ¥1 million, what is the actual burden?
For an annual income of ¥3.7–7.7 million (category "u"), the monthly ceiling is ¥85,800 + (¥1 million − ¥286,000) × 1% = ¥92,940 (for treatment from August 2026; through July it was ¥87,430). Extra-bed charges and meal costs are separate.
What changed from August 2026?
The out-of-pocket ceilings were raised. Category "u" went from ¥80,100 to ¥85,800 (the +1% base also changed from ¥267,000 to ¥286,000), an increase of about ¥5,700 a month. Meanwhile the multiple-time provision (category "u" ¥44,400) was left unchanged, and an annual ceiling was newly created for those in long-term treatment (a ¥1,680,000; i ¥1,110,000; u and e ¥530,000; o ¥290,000; ¥410,000 within category "e" for a standard monthly remuneration of ¥150,000 or less). A subdivision of income categories is planned for August 2027.
How does the new "annual ceiling" work?
Your out-of-pocket costs from August through the following July are totalled, and anything above the annual ceiling for your category (¥530,000 for category "u") is refunded later. It was created for people whose monthly costs never reach the ceiling but whose treatment continues for a long time. For the time being it is not automatic but runs on the individual's application, so keep your receipts and ask your insurer how to apply.
Is an advance procedure required?
If you see a doctor with a My Number health insurance card, in principle it is not needed, and your counter payment is automatically capped at the ceiling. If you do not use one, obtain the eligibility certificate for the ceiling amount in advance, or file an after-the-fact application and receive a refund about three months later (statute of limitations: 2 years).
Does this mean cancer insurance or medical insurance is unnecessary?
It cannot be said flatly. Thanks to public insurance, out-of-pocket treatment costs are held to around ¥80,000–90,000 a month, but extra-bed charges, advanced medical treatment, income loss from a prolonged illness, and meal costs are not covered. It is reasonable to consider it not as covering "the part above the ceiling" but as a design to fill "the part not covered and the loss of income."
Data sources
- Ceilings and annual ceiling in force from August 2026: Japan Health Insurance Association — The High-Cost Medical Expense Benefit is revised from August 2026 (in Japanese)
- Background and design of the review: Ministry of Health, Labour and Welfare — Social Security Council Health Insurance Committee / Expert Committee on the State of the High-Cost Medical Expense Benefit, materials (December 25, 2025) (in Japanese)
- Basics of the system (household aggregation, multiple-time provision, how to apply): Ministry of Health, Labour and Welfare — On the review of the High-Cost Medical Expense Benefit (Health Insurance Committee materials) (in Japanese) and MHLW "To everyone using the High-Cost Medical Expense Benefit"
* The categories for those aged 70 and over, additional benefits of health insurance societies, and municipal medical cost subsidies differ from the table in this article. How to apply for the annual ceiling varies by insurer, so please check with the insurer you belong to.