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.

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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.

Income Level	Annual Income Estimate	Monthly Payment Cap (Approx.)
Low Income	0 ～ 2,600,000 yen	35,400 yen
Lower-Middle Income	2,600,000 ～ 5,000,000 yen	57,600 yen
Average Income	5,000,000 ～ 9,000,000 yen	87,430 yen
Higher Income	9,000,000 ～ 11,600,000 yen	140,100 yen + (cost – 467,000) × 1%
Very High Income	11,600,000 yen or more	252,600 yen + (cost – 842,000) × 1%