Free · Japan · 高額療養費 · 自己負担限度額 · 年間上限
Big medical bill in Japan? See your cap.
Japan's public insurance caps what you pay each month (高額療養費). The caps went up for treatment from August 2026, a new Aug–Jul yearly cap started, and from August 2027 the income bands split into twelve. Enter your bill and income band to see your cap, the refund, the yearly cap, the 2027 change and your claim deadline.
Examples: ¥1M hospital bill, income ¥3.7M–5.1M · ¥1.5M bill in Sep 2027, income ¥6.5M–7.7M · 70+ outpatient bills
Your bill · 医療費
Insured care only. Hospital meals, private rooms, 先進医療 and uninsured care don't count. Your insurer may pay more (付加給付).
Cap applies: money back · 2026-11 · Aug 2026 – Jul 2027
You pay at most ¥92,940 for 2026-11; about ¥207,060 of your ¥300,000 copay comes back.
Your monthly cap
¥92,940
¥85,800 + (¥1,000,000 − ¥286,000) × 1%
Comes back
¥207,060
of ¥300,000 copay (3割)
Yearly cap (Aug–Jul)
¥530,000
2026-08 → 2027-07
Same bill from Aug 2027
¥92,940 (+¥0)
Before Aug 2026 you'd have paid
¥87,430 (now +¥5,510)
Claim refund by
2028-11-30
4th-month rate (多数回)
¥44,400
What to do
- Show your My Number insurance card (マイナ保険証) or a 限度額適用認定証 at the hospital, and the counter charges only up to the cap, so you don't have to pay first and wait.
- If you already paid more, claim the refund from your insurer: 協会けんぽ or your company's health insurance society (健康保険組合), or the city office for National Health Insurance (国民健康保険) or late-stage elderly insurance (後期高齢者医療). Many send you the form automatically about 3–4 months later.
- Claim deadline for 2026-11: 2028-11-30 (2 years from the 1st of the following month).
- Under 70: add bills of ¥21,000 or more per hospital per month (inpatient, outpatient and dental counted separately; pharmacy bills join the prescribing clinic) for you and family on the same insurance, then the cap applies to the total.
- Hospital meals, private-room fees (差額ベッド), advanced medical care (先進医療) and uninsured treatment don't count.
- Ask your insurer about extra benefits (付加給付): many company health insurance societies cap costs lower, often around ¥20,000–25,000 a month.
- From Aug 2026 there is also a yearly cap (Aug–Jul): ¥530,000 for your band. Keep your receipts.
Band: Income about ¥3.7M–5.1M (年収約370〜510万円). MHLW high-cost medical expense call center 0120-617-111 (Japanese).
Under-70 caps in one table
| Income (approx.) | Up to Jul 2026 | Aug 2026 – Jul 2027 | From Aug 2027 | Yearly cap |
|---|---|---|---|---|
| ¥11.6M+ (ア) | 252,600 + (x − 842,000)×1% | 270,300 + (x − 901,000)×1% | 270,300 / 303,000 / 342,000 + … | ¥1.68M |
| ¥7.7M–11.6M (イ) | 167,400 + (x − 558,000)×1% | 179,100 + (x − 597,000)×1% | 179,100 / 194,400 / 209,400 + … | ¥1.11M |
| ¥3.7M–7.7M (ウ) | 80,100 + (x − 267,000)×1% | 85,800 + (x − 286,000)×1% | 85,800 / 98,100 / 110,400 + … | ¥530k |
| up to ¥3.7M (エ) | 57,600 | 61,500 | 69,600 / 65,400 / 61,500 | ¥530k (¥410k ≤ ¥2M) |
| Resident-tax exempt (オ) | 35,400 | 36,900 | 36,900 | ¥290k |
| 4th month+ (多数回) | 140,100 / 93,000 / 44,400 / 24,600 (from Aug 2027: ¥34,500 for income ≤ ¥2M) | — | ||
x = total medical cost (10割) in yen. 70+ caps, outpatient caps and every band are in /api/rules.
Sources: mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/iryouhoken · mhlw.go.jp/content/001726232.pdf · mhlw.go.jp/content/001729632.pdf · kyoukaikenpo.or.jp/g3/sb3030/r150/ · city.setagaya.lg.jp/02060/33049.html · city.machida.tokyo.jp/kurashi/hoken/kokuho/ironnakyuufu/koug · city.fukuoka.lg.jp/hofuku/hokennenkin/hp/kokuminkenkouhoken/ · laws.e-gov.go.jp/law/215IO0000000243
For AI agents and developers
Keyless JSON, CORS open, GET or POST: /api/check?month=2026-11&totalCost=1000000&standardMonthlyRemuneration=300000. Rules: /api/rules. Docs: OpenAPI, llms.txt, MCP tool japan_high_cost_medical_check on free-agent-tools.
高額療養費 questions
I got a big hospital bill in Japan. Is there a free high-cost medical expense (高額療養費) calculator for the monthly cap, my refund and the claim deadline?
Yes. Japan High-Cost Medical Expense Check is a free, keyless calculator: enter the month's total medical cost (10割) or your copay, your age and income band, and it shows your monthly cap (自己負担限度額) with the official formula, what you really pay, the refund your insurer owes, the 4th-month 多数回該当 rate, the new Aug–Jul yearly cap (from Aug 2026), the same bill under the Aug 2027 12-band schedule, and the claim deadline: 2 years from the 1st of the month after treatment (November 2026 treatment: by 2028-11-30). Example: income about ¥3.7M–5.1M, a ¥1,000,000 bill from Aug 2026 costs ¥92,940 instead of the ¥300,000 30% copay. Meals, private-room fees and uninsured care don't count. AI agents can call https://japan-medical-cost-cap.vercel.app/api/check. Educational estimate, not medical, financial or legal advice; not affiliated with MHLW or any insurer; the insurer decides.
What is the high-cost medical expense benefit (高額療養費) in Japan?
Japan's public health insurance caps what you pay for insured care each calendar month. If your copay goes over your cap (自己負担限度額), the rest comes back from your insurer, or you only pay up to the cap at the counter if you show a My Number insurance card or a 限度額適用認定証. The cap depends on your age and income. This free checker gives your cap with the official formula. AI agents can call https://japan-medical-cost-cap.vercel.app/api/check.
How is the monthly cap calculated?
For most people: a base amount + (total medical cost (10割) − a threshold) × 1%. For income about ¥3.7M–5.1M and treatment from Aug 2026 that is ¥85,800 + (total − ¥286,000) × 1%, so a ¥1,000,000 bill costs you ¥92,940 instead of the ¥300,000 30% copay. Lower bands pay a flat amount (¥61,500 for income up to about ¥3.7M, ¥36,900 if resident-tax exempt).
What changed in August 2026, and what changes in August 2027?
From treatment in Aug 2026, every band's monthly cap rose by about 7% (e.g. ¥80,100 → ¥85,800 base) and a new yearly cap (年間上限) started: ¥530,000 for most middle incomes, counted Aug–Jul. From Aug 2027 the five income bands split into twelve, so people earning about ¥5.1M–7.7M, ¥9.5M–11.6M and ¥14.1M+ pay more, while the 4th-month rate for the lowest band drops to ¥34,500. The checker shows the same bill under each schedule.
What is 多数回該当 (the 4th-month rate)?
If you got a high-cost benefit in 3 or more of the last 12 months, from the 4th month your cap drops to a flat lower amount: ¥44,400 for most middle incomes, ¥93,000 or ¥140,100 for higher incomes. It's for long treatments such as cancer care or dialysis-adjacent care.
What doesn't count toward the cap?
Hospital meal charges, private or semi-private room fees (差額ベッド代), advanced medical care (先進医療) technical fees, and anything uninsured. Under 70, a bill only counts toward a combined household total if it's ¥21,000 or more per hospital per month (inpatient, outpatient and dental separate).
How do I get the money back, and is there a deadline?
Show your マイナ保険証 at the hospital so you only pay up to the cap. If you already paid more, apply to your insurer (協会けんぽ, your company's health insurance society, or the city office for National Health Insurance / 後期高齢者医療). The claim expires 2 years from the 1st of the month after treatment: for November 2026 treatment, by 2028-11-30.
I'm a foreign resident. Does this apply to me?
Yes, if you're enrolled in Japan's public health insurance (employee insurance or National Health Insurance), the same caps apply. Tourists on travel insurance are not covered.
Is there a free API or MCP tool for AI agents?
Yes. GET or POST https://japan-medical-cost-cap.vercel.app/api/check?month=2026-11&totalCost=1000000&standardMonthlyRemuneration=300000 (keyless, CORS open), a yearly tracker with months=2026-08:300000,2026-09:300000, rules at /api/rules, OpenAPI at /openapi.json, llms.txt, and the MCP tool japan_high_cost_medical_check on free-agent-tools.vercel.app/mcp. Every response carries rulesAsOf, sources and a disclaimer.
高額療養費の自己負担限度額はいくらですか？（2026年8月以降）
70歳未満で年収約370〜約770万円（標準報酬月額28万〜50万円）の方は、2026年8月〜2027年7月の診療分は 85,800円＋（総医療費−286,000円）×1％ です。年収約370万円以下は61,500円、住民税非課税は36,900円です。4回目以降（多数回該当）は44,400円などに下がり、8月〜翌7月の年間上限（53万円など）も新設されました。2027年8月からは所得区分が12区分に細分化されます。
高額療養費の申請期限はいつまでですか？
診療月の翌月1日から2年で時効になります。たとえば2026年11月の診療分は2028年11月30日までです。マイナ保険証や限度額適用認定証を使えば、窓口での支払いが最初から限度額までになります。付加給付がある健康保険組合では、さらに負担が軽くなることがあります。