What is the benefit of obtaining an Eligibility Certificate beforehand?

Submitting an Eligibility Certificate (Gendogaku Tekiyou Ninteishou) at the hospital reception restricts your billing to the statutory cap immediately, eliminating the need to wait months for a reimbursement refund.

Can family medical expenses be combined under the same policy?

Yes. Family members covered under the same health insurance policy can pool copays of 21,000 JPY or more incurred within the same calendar month to receive a combined refund.

JapanUpdated for 2026Health

Japan High-Cost Medical Expense Benefit Calculator 2026 (Kougaku Ryouyouhi)

Calculate your statutory monthly maximum out-of-pocket medical bill and insurance refund under Japan's High-Cost Medical Expense Benefit system across statutory income tiers.

Medical & Clinical Social Security & Pension Health & Wellness

Calculated Result

Actual Out-of-Pocket Copay Cap

¥87,430

High-Cost Insurance Refund

¥212,570

Calculator Inputs

Total 100% Medical Costs in Month

Quick select:

Annual Income Tier (Under Age 70)

Actual Out-of-Pocket Copay Cap

¥87,430

High-Cost Insurance Refund

¥212,570

Standard 30% Window Copay

¥300,000

Copay Reduction Rate

70.9%

The statutory cap successfully shields your household from catastrophic medical expenses.

Out-of-Pocket vs Refund Balance

Final Out-of-Pocket Payment

¥87,430(29%)

Statutory System Subsidy

¥212,570(71%)

Calculated under Health Insurance Act Art. 115. Excludes extra bed amenities (Sagaku Bed), meal co-payments, and uninsured advanced treatments.

This calculator is a mathematical model for fitness and nutrition estimation for general awareness only. Estimated results do not constitute medical diagnosis or a substitute for professional healthcare. Always consult a physician or certified nutritionist before starting any new diet or training regimen.

Official Statute: 健康保険法第115条 (高額療養費・所得区分別自己負担限度額算定基準)Last Verified: 2026-09-03

Calculation Methodology

Standard Income Tier (3.7M - 7.7M JPY): Copay Cap = 80,100 JPY + (Total 100% Medical Costs - 267,000 JPY) × 1%.

Frequently Asked Questions

Calculated on a strict calendar-month basis (from the 1st to the last day of each month). Treatments spanning multiple months are assessed independently per calendar month.

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Japan

Japan High-Cost Medical Expense Benefit Calculator 2026 (Kougaku Ryouyouhi)

Calculator Inputs

Out-of-Pocket vs Refund Balance

Calculation Methodology

Frequently Asked Questions

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