Key Facts
• Public health insurance determines patient cost-sharing based on age and income.
• Cost-sharing rates: under 70 years old (30%), 70–74 years old (20% or 30% for high income).
• Seniors 75+ pay 10%, or 30% for high income, and 20% for certain income levels.
• In April 2014, cost-sharing for those turning 70 increased from 10% to 20%.
• October 2022 introduced a 20% rate for seniors 75+ with specific income levels.
• High-cost medical expense system reimburses costs exceeding income-based limits.
• Advanced medical treatments, private room fees, and cosmetic surgery are not covered by insurance.
• Tax deductions apply for medical expenses exceeding a certain threshold.
• Government proposed raising cost-sharing limits, but the summer 2025 increase was postponed.
• Patients can use My Number insurance cards to cap payments at income-based limits.
Summary
Japan’s public health insurance system adjusts patient cost-sharing based on age and income. For those under 70, the rate is 30%, while seniors aged 70–74 pay 20%, or 30% if their income matches working-age levels. For individuals 75 and older, the rate is 10%, with higher-income earners paying 20% or 30%. Changes in 2014 and 2022 increased cost-sharing for certain age groups to address rising medical expenses. The high-cost medical expense system reimburses costs exceeding income-based limits, and tax deductions are available for significant medical expenses. However, advanced treatments and private room fees are not covered. A proposed increase in cost-sharing limits faced criticism and was postponed in 2025. Patients are encouraged to use My Number insurance cards for streamlined payment caps.
