Japan’s High-Cost Medical Expense Program: What Foreigners Need to Know

Japan is known for having one of the most affordable and efficient healthcare systems in the world, but even here, medical bills can get expensive—especially if you need surgery, hospitalization, or emergency care. The good news? Japan has a fantastic safety net called the High-Cost Medical Expense Benefit. It helps reduce your out-of-pocket medical bills when they become too expensive within a single month.

If you’re a foreign resident living in Japan, this guide will help you understand exactly how the system works, who can use it, how much you can expect to pay, and how to apply when needed.

What Is the High-Cost Medical Expense Benefit?

Japan’s High-Cost Medical Expense Benefit (高額療養費制度, Kōgaku Ryōyōhi Seido) is a system that limits the maximum amount you pay for approved medical treatments each month.

If your monthly medical expenses go over that limit, the government reimburses the amount that exceeds it.

This cap varies depending on:

• Your income level
• Your age
• The type of health insurance you have (National Health Insurance or Employee Health Insurance)

This system is one of the reasons healthcare in Japan remains affordable even for major surgeries and hospital stays.

Are Foreign Residents Eligible?

Yes! If you are enrolled in National Health Insurance (NHI) or Employee Health Insurance (EHI), then you automatically qualify—regardless of nationality.

Meaning:

• New residents
• International students
• Long-term workers
• Permanent residents

…all can use this system as long as they are insured.

Tourists, however, are not eligible.

How Do You Join the Japanese Health Insurance System?

You’re required by law to join if you stay in Japan for more than 3 months.

1. National Health Insurance (NHI)

For:

• Students
• Freelancers
• Part-time workers
• Unemployed residents

Where to apply:

• Your city or ward office

What you need:

• Residence Card
• Passport
• My Number (if you have one)
• Address registration

→About National Health Insurance

2. Employee Health Insurance (EHI)

For:

• Full-time company employees

Your company enrolls you automatically.

Once enrolled in either insurance, you’re automatically covered by the high-cost medical expense system.

Why This System Matters (Huge Benefits!)

Here’s why the High-Cost Medical Expense Benefit is a life-saver:

✔ You never pay unlimited medical bills

The government sets a ceiling for your monthly medical expenses.

✔ Helps during surgeries and emergencies

Hospital bills can easily reach hundreds of thousands of yen. This system ensures you only pay the capped amount.

✔ Reduces stress during medical emergencies

You don’t have to worry about going bankrupt because of unexpected medical issues.

✔ Works automatically (after you apply)

Even if you forget at the hospital, you can apply later and still receive the reimbursement.

How Much Will You Actually Pay?

Your monthly maximum depends on your income bracket.

What Costs Are Included?

✔ Doctor visits
✔ Hospitalization
✔ Surgery
✔ Prescriptions
✔ Emergency care
✔ Outpatient treatments

Not included:

✘ Private hospital room fees
✘ Meals during hospitalization
✘ Cosmetic procedures
✘ Non-covered treatments (e.g., LASIK)

How to Apply for the High-Cost Medical Expense Benefit

There are two main ways:

1. Apply Before Treatment

If you know the medical cost will be high (e.g., planned surgery):

Apply for the Eligibility Certificate for Ceiling Amount Application (限度額適用認定証).

Where to apply:

• City hall (NHI)
• Employer/insurance provider (EHI)

Required documents:

• Health insurance card
• ID
• My Number
• Application form

Give the certificate to the hospital.
Your bills will automatically be reduced—no reimbursement later.

2. Apply After Treatment

If you didn’t apply before:

You pay the full amount at first.
Later, you receive a reimbursement.

Process:

1. Wait for the insurance provider to send you a notice
2. Fill the form
3. Attach receipts
4. Receive refund to your bank account

Processing time: 2–3 months.

Easy-to-Understand Cost Calculation

Let’s say you are an average-income resident.

Additional Support: “Multiple-month Reduction”

If your high medical expenses continue for 3 months or more within a year:

→ Your cap becomes even lower.

This helps people undergoing long-term treatments.

What You Need When Applying

• Application form
• Health insurance card
• Receipts from hospital
• Bank account details
• My Number ID

Don’t throw away your receipts!

Tips for Foreign Residents

• Keep all receipts and paperwork
• Ask the hospital’s billing office—they’re used to helping foreigners
• Always bring your insurance card
• Apply for the eligibility certificate before major surgery
• If unsure, city hall staff can explain everything (many speak English)

Reference Links 1: Ministry of Health, Labour and Welfare
Reference Links 2: Japan Health Insurance Association

Thanks for reading!