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.

• * We recommend using a Myna health insurance card. Doing so eliminates the need to present an elderly benefits card.

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.

• *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.

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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.