Could you be losing out? Changes coming to the High-Cost Medical Expense Benefit System

💰 Will medical expenses increase or decrease?
An easy-to-understand guide to the changes in the High-Cost Medical Expense Benefit System!
🏥 Cancer treatment
🩺 Dialysis
🧬 Treatment for intractable diseases
🚑 Long-term hospitalization
For those receiving such treatments, monthly medical expenses can be a significant burden.
The system that supports household finances during such times is
🏥 the "High-Cost Medical Expense Benefit System."
Regarding this system,from August 2026and
from August 2027major revisions are planned.
🌟 From August 2026
📌 Increase in the monthly out-of-pocket maximum
📌 Establishment of an annual maximum

🌟 From August 2027
📌 Subdivision of income brackets (subdivided into 13 categories)

In this revision starting from August 2026,
📌 The monthly out-of-pocket maximum will be adjusted
📌 On the other hand, an "annual maximum" will be newly established for those continuing long-term treatment
➡ Consideration will also be given to those whose medical expenses continue over a long period

Here, I will briefly explain the contents of the High-Cost Medical Expense Benefit System revision😊

Reference: Ministry of Health, Labour and Welfare
To all users of the High-Cost Medical Expense Benefit System

Source: Ministry of Health, Labour and Welfare
Regarding the review of the High-Cost Medical Expense Benefit System (PDF)

💡 What is the High-Cost Medical Expense Benefit System?
When you visit a hospital due to illness or injury, you pay a portion of the medical expenses yourself.
However,
🏥 Cancer treatment
🩺 Dialysis
🧬 Treatment for intractable diseases
🚑 Long-term hospitalization
can sometimes result in high medical costs.
That is why the
🏥 High-Cost Medical Expense Benefit System was established.
Since you can receive a refund for medical expenses that exceed a certain amount, it can help lighten the burden on your household finances.

🤔 Why is the system being reviewed?
In Japan, the population is aging, and
📈 medical expenses are increasing year by year.
Also,
🧬 expensive new drugs
🏥 advanced treatments
are increasing.
On the other hand,
👨‍⚕️ long-term patients
👵 the elderly
👨‍👩‍👧‍👦 families with high medical expenses
must continue to be supported.
Therefore, the government has decided to review the system in order to:
⚖️ maintain the system for the future
🏥 protect long-term patients
💰 consider low-income individuals

📅 Changes from August 2026
*Below, we use the example of those with an annual income of 3.7 million to 7.7 million yen.
📌 Increase in out-of-pocket maximum
For example, for those with an annual income of approximately 3.7 million to 7.7 million yen (under 69 years old):
💰 Currently
Monthly maximum: 80,100 yen + 1%
⬇
💰 From August 2026 onwards
Monthly maximum: 85,800 yen + 1%
will be the new amount.

🌟 The biggest point this time!
An "annual maximum" will be newly established
The system until now only had
📅 a monthly maximum.
However,
💭 some people do not reach the maximum every month
💭 but have significant medical expenses over the course of a year.
Therefore, a new
📅 "annual maximum"
will be introduced.
Once your annual out-of-pocket expenses reach a certain amount,
✨ no further medical expense burden will be required.

💰 How much is the annual maximum?
The annual maximum varies depending on income.
👨 Annual income of approx. 11.6 million yen or more
📅 Annual maximum
💰 1.68 million yen

👨 Annual income of approx. 7.7 million to 11.6 million yen
📅 Annual maximum
💰 1.11 million yen

👨 Annual income of approx. 3.7 million to 7.7 million yen
📅 Annual maximum
💰 530,000 yen

👨 Annual income of approx. 2 million to 3.7 million yen
📅 Annual maximum
💰 530,000 yen

👨 Annual income of less than approx. 2 million yen
📅 Annual maximum
💰 410,000 yen

👨 Resident tax exempt (under 70 years old)
📅 Annual maximum
💰 290,000 yen

🏥 What happens to the "multiple-time" provision?
The High-Cost Medical Expense Benefit System has a provision called
📌 "multiple-time eligibility."
This is a system where,
📅 if you have been eligible for high-cost medical benefits 4 or more times in a year,
the burden from the 4th time onwards is reduced.
For example, for those with an annual income of approx. 3.7 million to 7.7 million yen (from August 2026 onwards):
💰 1st to 3rd time
Monthly maximum: 85,800 yen + 1%
⬇
💰 4th time onwards
44,400 yen
will be the amount.
Even with this revision,
✅ the multiple-time eligibility provision will be maintained.
Consideration for those receiving long-term treatment will continue.

📅 Changes from August 2027
From August 2027, income brackets will befurther subdivided (15 levels)will be implemented.

📊 For example, for those currently in the 3.7 million to 7.7 million yen bracket,
from August 2026, the monthly maximum is 85,100 yen + 1%, but
from August 2027, it will be subdivided as follows:
👨 Annual income approx. 3.7 million to 5.1 million yen: Monthly maximum 85,100 yen + 1%
👨 Annual income approx. 5.1 million to 6.5 million yen: Monthly maximum 98,100 yen + 1%
👨 Annual income approx. 6.5 million to 7.7 million yen: Monthly maximum 110,400 yen + 1%
It will be divided in detail like this.
This will create a mechanism that aims for:
💰 increased burden for those with higher incomes
⚖️ a more equitable burden

👛 Consideration for low-income individuals
This revision also includes considerations for those who would be significantly impacted.
Support is provided for those who are heavily affected by the cost of living.
🏠 Peace of mind for households exempt from residence tax
For households exempt from residence tax,
📅 an annual cap will be set for outpatient medical expenses.
As a result,
💡 "I'm worried about medical costs because I go to the hospital every month"
this system ensures that even for those people, the annual burden will not increase significantly compared to the current level.

👨‍👩‍👧‍👦 For those with an annual income of less than 2 million yen
There is a system in place to reduce out-of-pocket expenses if you repeatedly face high medical costs due to illness or injury.
With this revision,
👨‍👩‍👧‍👦 for those with an annual income of less than 2 million yen,
💰 we plan to further lower those out-of-pocket expenses.
Consideration for those who are prone to heavy medical cost burdens has been included.

📝 Summary
The revisions to the High-Cost Medical Expense Benefit System include:
✅ Review of the out-of-pocket maximum
✅ Establishment of an annual cap
✅ Subdivision of income brackets
✅ Consideration for low-income individuals
While some will see an increase in their burden due to these revisions,
🏥 cancer treatment,
🏥 treatment for intractable diseases,
🏥 and long-term hospitalization
may result in reduced burdens for those receiving long-term care.
Medical costs are a familiar issue for everyone.
Please take this opportunity to check the details of the system for yourself and your family.😊

🌟 Information from KATUJIMU Administrative Scrivener and Social Insurance Labor Consultant Office
At KATUJIMU, we handle:
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📌 Labor and social insurance procedures
📌 Drafting of various regulations
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and more.
Please feel free to contact us.

　KATUJIMU Administrative Scrivener and Social Insurance Labor Consultant Office

⚠️ Notes
This article is based on laws and published materials available at the time of creation.
The content may change due to future legal revisions or other factors.
Our office assumes no responsibility for any problems that may arise from the content of this article. Please verify the information yourself and use it responsibly.