[How much does hospitalization cost?] Averages, breakdowns, and the High-Cost Medical Expense Benefit System | Realistic costs for a 1-month hospital stay

When you are scheduled for hospitalization,
one thing you might be just as concerned about as the treatment itself is the "hospitalization cost."

"How much will it actually cost?"
"Will I get a huge bill later?"
Many people enter their hospital stay with these kinds of anxieties.

In reality, hospitalization costs include not just medical fees,
but also accumulate small expenses like meal costs and room charges.
Especially with long-term hospitalizations, not seeing the full picture can add to your mental burden.

On the other hand, knowing about public systems like the High-Cost Medical Expense Benefit System correctly
can significantly change your actual out-of-pocket expenses.

In this article, we will organize the estimates and breakdowns of hospitalization costs,
as well as the systems you should know about, as clearly as possible.

How much does hospitalization cost? First, let's organize the big picture

Hospitalization costs are broadly composed of the following four categories:
• Medical expenses (covered by insurance)
• Difference in bed charges (private rooms, small-group rooms, etc.)
• Meal costs (hospitalization meal therapy expenses)
• Miscellaneous expenses and living costs

*Miscellaneous and living costs may include, in addition to daily necessities,
"document preparation fees" for medical certificates and various certifications.
These are often not covered by insurance, and are items that people frequently feel "cost more than expected" after hospitalization.

Just by knowing this breakdown,
your perspective on hospitalization costs will change significantly.

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Hospitalization cost breakdown ① Medical expenses (insurance coverage)

These are the costs for the treatment itself, such as examinations, medication, IV drips, and surgery.
Health insurance is applied, and the typical out-of-pocket ratio is as follows:

• 69 years old or younger: 30%
• 70–74 years old: 20% (subject to income conditions)
• 75 years old or older: 10–20%
And, essential to consider when thinking about hospitalization costs

is the High-Cost Medical Expense Benefit System.
For medical expenses that exceed a certain amount,

there is a monthly cap on out-of-pocket expenses.
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Hospitalization cost breakdown ② Difference in bed charges (private rooms, small-group rooms)

This is the cost incurred if you request a private room or a 2-person room.
• Large room (4–6 person room): Generally free
• 2-person room: Several thousand yen/day
• Private room: Approx. 5,000 to 50,000 yen/day

*Difference in bed charges are not covered by health insurance
*This is an item where cost differences tend to become large during long-term hospitalizations

How you balance "comfort" and "cost"
is an important decision point that affects the overall hospitalization cost.

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Hospitalization cost breakdown ③ Meal costs (hospitalization meal therapy expenses)

The estimated out-of-pocket cost after the April 2025 revision is as follows:
• Per meal: From approx. 510 yen
• Total for 3 meals a day: Approx. 1,400 to 1,600 yen

*There are reduction measures depending on income bracket and system
*Billed separately from medical expenses

During long-term hospitalizations,
many people feel that "even if medical expenses are kept down, meal costs add up."

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Hospitalization cost breakdown ④ Miscellaneous expenses and living costs

In addition to medical expenses, daily expenses also occur.
• Shopping at the hospital store
• Daily necessities and consumables
• TV card and Wi-Fi fees
• Transportation costs for family and gifts

Even if each is a small amount,
they add up to an amount that cannot be ignored.

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Average hospitalization cost estimates | What happens if you use the High-Cost Medical Expense Benefit System?

Many people worry that "hospitalization will cost hundreds of thousands of yen,"
but the perspective changes when you consider the High-Cost Medical Expense Benefit System.
Estimates for those 69 or younger with average income

In reality, there are not many cases where "1 month of hospitalization = 800,000 yen out-of-pocket."
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What is the High-Cost Medical Expense Benefit System? A mechanism to keep hospitalization costs down

The High-Cost Medical Expense Benefit System is a system where
if the medical expenses paid in one month (the same calendar month) exceed a certain amount,
the excess amount is refunded.
• In principle, an application is required
　*However, some hospitals can handle this with a My Number health insurance card
• Out-of-pocket expenses can be reduced by submitting a Certificate of Maximum Amount Application in advance
• Applies to both inpatient and outpatient care

Once your hospitalization is decided,
this is a system you should check as soon as possible.


MHLW | To all those using the High-Cost Medical Expense Benefit System

https://www.mhlw.go.jp/content/000333280.pdf

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Can the Certificate of Maximum Amount Application be handled with a My Number health insurance card?

In recent years, by using a "My Number health insurance card,"
a system has been established where the maximum amount for the High-Cost Medical Expense Benefit System is applied automatically.

Basic concept when using a My Number health insurance card

If the medical institution or pharmacy supports the My Number health insurance card,
in principle, there is no need to apply for a "Certificate of Maximum Amount Application" in advance.

Through online eligibility verification,
• Income category
• Maximum out-of-pocket amount

can be confirmed by the medical institution,
so your payment at the counter is limited to the maximum out-of-pocket amount from the start.

This has the following benefits:
• No need to temporarily pay high medical expenses out of pocket
• Reduces the hassle of applying for a refund of high-cost medical expenses at a later date

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However, there are some points to be aware of

The My Number health insurance card cannot be used in all cases.
In the following situations, you may still need a traditional Certificate of Maximum Amount Application:
• The medical institution or pharmacy does not support the My Number health insurance card
• You have not consented to the use of the My Number health insurance card
• Online verification is not possible due to system trouble, etc.
• If you want to "ensure the maximum amount is applied" before hospitalization

Especially for hospitalization,
it is important to check in advance whether the hospital supports the My Number health insurance card.

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Practical recommended approach

Once your hospitalization is decided,
• Confirm with the hospital whether the maximum amount can be applied using your My Number health insurance card
• If you are unsure, apply for a Certificate of Maximum Amount Application just in case

By taking this "two-pronged approach,"
you can minimize your financial anxiety.

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Note: Not all expenses are covered

The High-Cost Medical Expense Benefit System (including the use of a My Number health insurance card)
only covers insurance-covered medical treatment.

The following are not covered:
• Difference in bed charges (private room fees, etc.)
• Meal costs
• Document fees
• Daily necessities expenses

It is important to clear up the misunderstanding that "maximum amount = all hospitalization costs will be covered"
in advance.

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Hospitalization costs for designated intractable diseases | Check for subsidy systems

When considering hospitalization costs,
you need to organize both public systems and private insurance.
• High-Cost Medical Expense Benefit System
• Injury and Sickness Allowance (for company employees, etc.)
• Medical insurance (hospitalization/surgery benefits)
• Designated Intractable Disease Medical Expense Subsidy System

If you fall under a designated intractable disease,
there are systems to reduce your financial burden, such as:
• Reduction of the out-of-pocket ratio

• Setting a monthly out-of-pocket cap

This is a point that those who require long-term treatment or re-hospitalization
should definitely check.

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The "medical certificate/document preparation fee" that working people often overlook

When people think of hospitalization costs, they tend to focus on treatment fees and bed difference charges,
but the "document fees for medical certificates, etc." are something that working people are particularly likely to overlook.

Documents for submission to companies, insurance claims, applications for various systems, etc.,
can surprisingly be required multiple times during and after hospitalization.

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Medical certificates and certificates are not covered by insurance (fully out-of-pocket)

The cost of preparing medical certificates and various certificates is, in principle, not covered by health insurance.
Therefore, depending on the content and number of copies, the costs can be higher than expected.

General estimates are as follows:

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Note that one form may not be enough

For example,
• For submission to your company
• Health insurance (injury and sickness allowance)
• Medical insurance, cancer insurance, and mutual aid
• Applications for designated intractable diseases or public systems

It is not uncommon for different formats to be required for each recipient.

If you think, "It's the same information, so one copy will suffice," you may find yourself needing to have additional ones created later.
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Points to check in advance to reduce waste

To keep medical certificate costs down and avoid rework, it is reassuring to check the following points in advance:
• Is there a company-specified format?
• Is a copy acceptable? (Is the original required?)
• Are there multiple medical certificate formats for insurance companies?
• Can it be created after discharge? (Is mail correspondence possible?)

It takes a little effort, but requesting them all at once can sometimes minimize document fees.

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It is safer to consider this separately from "hospitalization costs"

Document fees, such as for medical certificates, are:
• Not covered by the High-Cost Medical Expense Benefit system
• Sometimes eligible for medical expense deductions

Keep this in mind.

When considering hospitalization costs, if you look at it from the perspective of:
"Treatment costs + difference in bed charges + actual expenses like document fees"
you will be less likely to panic when making payments after discharge.

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Common misconceptions and points of caution regarding hospitalization costs

☑︎If I have insurance, will hospitalization cost almost nothing?

→ Difference in bed charges, meal costs, and miscellaneous expenses are out-of-pocket
→ You also need to anticipate expenses other than medical costs.

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☑︎Is the High-Cost Medical Expense Benefit system applied automatically?

→ In principle, it is an application-based system
→ There are cases where high charges may occur temporarily.
→ By using your My Number health insurance card, there is a mechanism where the limit for the High-Cost Medical Expense Benefit system is applied automatically (be sure to check in advance).
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☑︎Will my out-of-pocket expenses keep increasing the longer I am hospitalized?

→ There is a cap on the medical expense portion
→ However, difference in bed charges and meal costs are charged per day.

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What I actually felt | Anxiety about hospitalization costs is eased by "knowing"

What I felt after experiencing hospitalization was that the anxiety of not knowing the system was greater than the "amount of money itself."
Just by understanding the system, your feelings when looking at the bill will be quite different.
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Summary | You can prepare for hospitalization costs in advance

• Hospitalization costs are the total of medical expenses + living expenses
• Out-of-pocket expenses can be significantly reduced with the High-Cost Medical Expense Benefit system
• For designated intractable diseases, checking subsidy systems is important
• Difference in bed charges has a greater impact the longer the hospitalization
• Document fees may also be required

It is difficult to grasp everything accurately regarding hospitalization costs in advance.
However, just by knowing "what costs money" and "what systems can be used," you can definitely reduce your anxiety during hospitalization.

Especially for long-term hospitalization or treatment for designated intractable diseases, the mental peace of mind is completely different between spending time without knowing the system and facing it with an understanding of it.
To focus on treatment, it is important to reduce financial anxiety one step at a time by eliminating the "unknowns."

I hope this provides some peace of mind to those who are about to be hospitalized or those who are currently hospitalized and concerned about costs.
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References/Sources (Reference sources for systems and amounts)
• Taiyo Life Insurance
• Sony Life

• MS Insurance

• National Tax Agency
• Sumitomo Life
(*Compiled based on public information as of 2025)

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