Copayment rate for medical care costs

The copayment rate for medical care costs for elderly persons aged 70-74 is 10% (30% for persons earning income at the same levels as active workers). Such persons must present their elderly benefits cards when undergoing examinations.

• *While the copayment rate for individuals aged 70-74 (other than those earning income at the same levels as active workers) has officially increased to 20%, the rate remains at 10% for the time being due to a freeze on implementation of this increase.

Cost-sharing maximum amounts for high-cost medical care

Cost-sharing maximum amounts for elderly persons aged 70-74 are lower than for persons less than 70 years of age.
A per-person cost-sharing maximum amount for outpatient care and a combined cost-sharing maximum amount for total outpatient and inpatient cost-sharing amounts per household apply in cases in which more than one member is covered under the same medical insurance plan within one household.
For high-cost medical care for which the total amount paid per household exceeds the cost-sharing maximum amount, you will be refunded the excess amount at a later date.

• *When an eligible person qualifies for high-cost medical care benefits for at least three months of a 12-month period, starting with the fourth month, the cost-sharing maximum amount is reduced to the amount for cases of frequent qualification of expenditures.
• *Despite plans to increase the cost-sharing maximum amount for persons aged 70?74 with normal income levels to the amounts shown in brackets, a freeze on this increase is currently in place.
• *During the month of an individual’s 75th birthday, he or she will be an insured person under both health insurance and the Medical Care System for the Advanced Elderly. For this reason, the cost-sharing maximum amount for that month will be halved on an exceptional basis. (This exception does not apply to individuals whose birthday falls on the first of the month.)
• *See here for information on the cost-sharing maximum amount for persons with low income.

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• When you incur high medical care costs

Annual High-Cost Medical Care Benefits for outpatient care (annual total of outpatient costs) for those aged 70 or older

Insured persons and dependents aged 70 or older whose total copayments for outpatient care during the one year period (from August 1 of the previous year to July 31) exceeded 144,000 yen are eligible to be reimbursed for the excess amount as High-Cost Medical Care Benefits.

• * This benefit is available only to those whose income category is "general" or "low income" as of the basis date (July 31, or the day before the date of death in the event of the death of the insured person).
• * Calculations of High-Cost Medical Care Benefits exclude copayments paid during a period in which the insured person belonged to the “same income level as active workers” category.
• * This benefit applies to outpatient care received August 1, 2017 or later.