Japan to Raise Caps on Out-of-Pocket Medical Expenses

Tokyo, July 18 (Jiji Press)–Japan will raise the caps on medical expenses borne by patients 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 in August 2027. The total margin of increases will reach 4 pct to 38 pct, varying depending on the 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 incomes. 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 pct 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 yen for middle-income patients with annual incomes of 3.7 million yen to 7.7 million yen. This amount will rise to about 86,000 yen next month. Following this change, for example, a 40-year-old patient with an annual income of 7 million yen whose total medical care costs reached 1 million yen in a month will see the out-of-pocket expense capped at 92,940 yen. In August next year, the income categories will be subdivided. In the new category for patients with annual incomes of 6.5 million yen to 7.7 million yen, the fixed amount will increase by 38 pct from the current level to about 110,000 yen. Japan will keep unchanged the system that reduces the out-of-pocket payments further if the ceilings are exceeded three times within a year. The cap after such reduction will stay at 44,400 yen per month for middle-income individuals. To 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 yen. As for the special caps on out-of-pocket payments by outpatients aged 70 or over, the monthly ceiling will be raised from the current 18,000 yen to 22,000 yen in August and to 28,000 yen a year later, while the annual ceiling will be raised from the current 144,000 yen to 216,000 yen next month and kept at the 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 yen per year through the changes, allowing premiums per insured person to drop by 1,400 yen annually. END [Copyright The Jiji Press, Ltd.]