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Measures for reducing cost burdens for persons aged 70-74

The copayment rates and cost-sharing maximum amounts for medical care for persons aged 70–74 are lower than for persons less than 70 years of age.

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Copayment rate for medical care costs

The copayment rate for medical care costs for elderly persons aged 70-74 is lower than for younger persons. Persons aged 70-74 must present their elderly benefits cards when undergoing examinations.

The copayment rate for individuals aged 70–74

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.

Caution:

Those falling in the category of the same income level as active workers II or active workers I must submit a Certificate of Application of Maximum Copayment Amount to avoid paying more than the cost-sharing maximum amount at a hospital.
If you expect to incur high medical care costs, apply to the Society to obtain a certificate in advance.


  • * Those falling in the category of the same income level as active workers III or ordinary income need not apply for a certificate. They can simply present their elderly benefits cards to avoid paying more than the cost-sharing maximum amount.
Category Cost-sharing maximum amount
Per person
(Outpatient)
Per household
(Outpatient and inpatient)
Persons earning income at levels comparable to active workers
(Elderly benefits card copayment rate: 30%)
The same income level as active workersⅢ
(Standard monthly remuneration830,000 yen or more)
252,600 yen+
(medical care costs-842,000 yen)×1%
[Frequent qualification of expenditures 140,100 yen]
The same income level as active workersⅡ
(Standard monthly remuneration 530,000 yen - 790,000 yen)
167,400 yen+
(medical care costs-558,000 yen)×1%
[Frequent qualification of expenditures 93,000 yen]
The same income level as active workersⅠ
(Standard monthly remuneration280,000 yen - 500,000 yen)
80,100 yen+
(medical care costs-267,000 yen)×1%
[Frequent qualification of expenditures 44,400 yen]
Normal
(Elderly benefits card copayment rate: 20%)
Standard monthly remuneration
260,000 yen or less
18,000 yen
<Annual maximum (August of the previous year to July): 144,000 yen>
57,600 yen
[Frequent qualification of expenditures 44,400 yen]
  • *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.
  • *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.Those falling in the category of the same income level as active workers will be treated as such, even if they are exempt from paying municipal tax.
  • *Even persons earning income at levels comparable to active workers will be grouped in the Normal category if their annual income is less than a certain base amount (3.83 million yen for an elderly person living alone, 5.2 million yen for multiple elderly persons living in the same household) and their patient cost-sharing rate shown on their medical care certificates for the elderly is 20% due to a request for application of the base income amount.
  • *Those whose cost-sharing amount exceeds the annual maximum of 144,000 yen must apply to the .
    (This benefit is not paid automatically.)

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.

Column

Persons earning income at the same levels as active workers

Elderly persons earning income at the same levels as active workers are referred to as “persons earning income at the same levels as active workers.” The copayment for such individuals is 30%.
For health-insurance purposes, this refers to persons whose standard monthly remuneration is 280,000 yen or more. However, persons meeting either of the descriptions below may apply to the Health Insurance Society to be treated as persons with normal income levels.

  • Those in a household consisting of two or more elderly persons with a combined annual income of less than 5.2 million yen (or elderly persons living alone whose annual income is less than 3.83 million yen)
  • Those for which the judgment criteria for annual income have changed from those for a multi-person household to those for a single-person household because a dependent becomes an insured person under the Medical Care System for the Advanced Elderly and who are therefore judged to qualify as persons earning income at the same levels as active workers

Persons in the earlier stage of old age

Elderly persons aged 65 through 74 are referred to as “persons in the earlier stage of old age.” Since most persons in the earlier stage of old age are covered by National Health Insurance, a system of financial adjustment between health insurance systems has been introduced whereby health insurance associations and other insurers with low percentages of persons in the earlier stage of old age will cover the cost of benefits for persons in the earlier stage of old age.

There is no frequently asked questions and answers that have been registered.

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