High-Cost Medical Expense Benefit Calculator (2026)

How the cap works

Your limit depends on your income bracket and is counted per calendar month. In the middle bracket it is ¥85,800 plus 1% of the total cost above ¥286,000 (from August 2026). For example, a ¥1,000,000 hospital bill would cost ¥300,000 at 30%, but your limit is ¥92,940, so ¥207,060 is covered by the benefit.

• If you reach the limit 3 times in 12 months, a lower limit applies from the 4th time.
• From August 2026, a yearly cap also applies to the total you pay from August to the following July.
• Hospital meals, private rooms and treatments not covered by insurance do not count toward the limit.

Paying only up to the limit at the hospital

If you use your My Number Card as your health insurance card and agree to share your limit information at the hospital, you are charged only up to your limit at the counter. Otherwise, you pay the full 30% and claim the difference back from your insurer later, or apply in advance for a limit certificate (gendogaku tekiyō ninteishō).

Assumptions

• You are under 70 and pay 30%. Limits are those from August 2026 to July 2027.
• Bills from different hospitals in the same month can be combined only when each is ¥21,000 or more; this calculator treats the amount as one bill.
• The same cap applies with employee health insurance and National Health Insurance. For a lower tax bill on high medical costs, you can also claim the medical expense deduction in a tax return.

Choosing health insurance after leaving a job? See health insurance after leaving your job.