Japan will raise the caps on out-of-pocket medical expenses as part of changes in its high-cost medical care benefit system from August that are designed to curb ballooning national medical costs.
The ceilings on monthly out-of-pocket medical expenses will be raised next month and again in August 2027. The total margin of increases will be between 4% and 38%, depending on a patient¡¯s annual income.
Under the high-cost medical care benefit system, patients excluding members of households exempt from resident tax are divided into four categories based on income levels.
In principle, the ceilings are set at levels calculated by adding a fixed amount based on the annual income to a variable amount, which is 1% of the patient¡¯s total medical costs minus a certain sum. Expenses exceeding the caps will be covered by public medical insurance.
The current fixed amount is about ?80,000 for middle-income patients with annual incomes of ?3.7 million to ?7.7 million. This amount will rise to about ?86,000 next month.
Following this change, for example, a 40-year-old patient with an annual income of ?7 million whose total medical care costs reached ?1 million in a month will see the out-of-pocket expense capped at ?92,940.
In August next year, the income categories will be subdivided. In the new category for patients with annual incomes of ?6.5 million to ?7.7 million, the fixed amount will increase by 38% from the current level to about ?110,000.
The system that reduces out-of-pocket payments further if the ceilings are exceeded three times within a year will not be changed. The cap after such reductions will stay at ?44,400 per month for middle-income individuals.
Under the reduction system, annual upper limits on out-of-pocket payments will be introduced next month. For middle-income patients, the annual limit will be ?530,000.
As for the special caps on out-of-pocket payments by outpatients age 70 or over, the monthly ceiling will be raised from the current ?18,000 to ?22,000 in August and to ?28,000 a year later, while the annual ceiling will be raised from the current ?144,000 to ?216,000 next month and kept at that level after that.
The changes to the high-cost medical care benefits will be the first since 2015 for the working generation. The government expects that the country¡¯s total public medical insurance benefits will decrease by ?245 billion per year through the changes, allowing premiums per insured person to drop by ?1,400 annually.
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