[Don't miss out] What is the High-Cost Medical Expense Benefit? A system that helps when medical costs become expensive

Thank you for your hard work today as well.😌

I'm PeakEnd, a physical therapist working in a hospital who shares information on "money" and "careers" for medical professionals.👨‍⚕️

This might be sudden, but
what would you do if you needed to be hospitalized or have surgery tomorrow?🤔
"I'm worried because medical costs seem high..."
"I can't pay hundreds of thousands of yen..."
I'm sure many of you feel that way.😵‍💫

Actually, in Japan,
👉 there is a system called the High-Cost Medical Expense Benefit.
✨

It is a system that reduces your out-of-pocket expenses when medical costs become high.

This time, I will explain the
*High-Cost Medical Expense Benefit*
—which even medical professionals are surprisingly not good at explaining—as clearly as possible.✍

Please be sure to read until the end.😂

🏥 What is the High-Cost Medical Expense Benefit?

The High-Cost Medical Expense Benefit is
👉 a system where, if your monthly medical expenses are high, the amount exceeding a certain limit is refunded to you.
✨

For example,
✔ Hospitalization
✔ Surgery
✔ Cancer drug treatment
even if medical costs become high due to things like these,
there is an upper limit to your out-of-pocket expenses.✨

Therefore,
it can be said that this is a system to prevent situations where
"medical costs cost hundreds of thousands of yen and I can't live..."😊

💰 How much will the burden be reduced?

This is the part everyone is most curious about, right?🤔
For example,
for those with an annual income of approximately 3.7 million to 7.7 million yen,
the monthly out-of-pocket limit is
👉 about 80,000 to 90,000 yen.

Suppose
the total medical cost was 1 million yen;
with a 30% co-pay, it would normally be 300,000 yen.💸
However, if you use the High-Cost Medical Expense Benefit,
the actual burden is reduced to about 80,000 to 90,000 yen.✨
※The upper limit varies depending on age and income.

📄 What is the Certificate of Maximum Amount Application?

Previously,
there were many cases where you would pay high medical costs at the hospital first,
and receive a refund later.
However, now,
by utilizing the 👉 Certificate of Maximum Amount Application
(or using maximum amount information via your My Number health insurance card),
it is often the case that you only need to pay up to the out-of-pocket limit from the start.✨

In other words,
the need to "temporarily prepare hundreds of thousands of yen"
has decreased.😊

Since the system changes often,
when hospitalization or surgery is decided,
it is reassuring to check early.💡

⚠️ There are also costs that are not covered

This is surprisingly not well known.😳

The High-Cost Medical Expense Benefit System applies to
👉 the out-of-pocket portion of insurance-covered medical care
.

Therefore,
❌ the difference in room charges (such as for private rooms)
❌ meal costs
❌ partial costs for advanced medical care
❌ costs for pajamas and daily necessities
are not covered ⚠️

Since patients and their families often ask about this,
it is a key point for healthcare professionals to know 😊

👨‍⚕️ Key points for healthcare professionals to know

When working in a hospital, patients sometimes ask,
"How much will the medical costs be?"
🤔

Of course,
you need to confirm the exact amount with the administrative staff, but
👉 just letting them know that the High-Cost Medical Expense Benefit System exists
can provide them with peace of mind 😌

Also,
there are people who, not knowing about the system,
think, "I don't want to receive treatment because I'm worried about the money."
😵‍💫

In such cases,
just being able to explain, "There is a system to reduce your burden 😊,"
can be a significant form of support ✨

✅ Summary

✔ The High-Cost Medical Expense Benefit System is a system to reduce the burden when medical costs become high
✔ There is a cap on monthly out-of-pocket expenses
✔ The cap varies depending on annual income
✔ It is convenient to use a Certificate of Maximum Amount Application or a My Number health insurance card
✔ Room charge differences and meal costs are not covered
✔ A system that healthcare professionals should also know

🌱 Conclusion

Illness and injury can happen to anyone at any time 💦

At such times,
👉 whether or not you know about the High-Cost Medical Expense Benefit System
can make a big difference in your peace of mind 😌

Even working in a hospital, I personally
often meet patients who do not fully understand the system 💦

I hope you will take this opportunity to remember it,
and use it for yourself, your family, and your patients ✨

Thank you for reading to the end 😊
If you liked this article, please give it a "Like" 😂

※ This article was created based on public information from the Ministry of Health, Labour and Welfare and the Japan Health Insurance Association (Kyokai Kenpo). As the details of the system may change, please check for the latest information when using it.