Run by “regional alliances”

The Medical Care System for the Advanced Elderly is run by “a regional alliance for the medical care of the advanced elderly”. Each regional alliance is established for an individual prefecture. All municipalities in a prefecture belong to one regional alliance. While the regional alliances make decisions on insurance premiums and payments for medical care costs, municipal offices handle tasks such as collecting insurance premiums.

Insurance premiums determined by each prefecture

The amount of insurance premiums is determined by ordinances of each prefecture. The cost to each member is determined based on the number of people in the household (benefits portion) and income (ability portion). Lower-income members have various ways to reduce their premiums.

All members are considered insured persons

All members of the Medical Care System for the Advanced Elderly are considered insured persons and pay insurance premiums. There is no system corresponding to the system for “dependents” under the health insurance system.

Same insurance benefits as under the health insurance system

The Medical Care System for the Advanced Elderly provides the same insurance benefits as other medical insurance systems (e.g., health insurance). The copayment of medical care costs is 10% or 20% (30% for persons earning income at the same levels as active workers).

• *Persons earning income at the same levels as active workers: Under the Medical Care System for the Advanced Elderly, this refers to persons whose taxable income is 1.45 million yen or more.
• *Persons to whom the 20% copayment applies: Persons whose taxable income is 280,000 yen or more and whose pension income + total amount of other income is 2 million yen or more for a single-person household or 3.2 million yen or more for a multi-person household (not including persons earning income at the same levels as active workers).

When you join the Medical Care System for the Advanced Elderly, you will lose your eligibility as an insured person (or dependent) under the health insurance system.

Since the Medical Care System for the Advanced Elderly is completely independent of other medical care insurance systems, you will lose your eligibility as an insured person or dependent under your previous health insurance program after you join.

Note that when an insured person under the health insurance system switches to the Medical Care System for the Advanced Elderly after reaching the age of 75, his or her dependents will also lose their status as dependents. (See the table below.)

Eligibility status before and after joining the Medical Care System for the Advanced Elderly