Measures for reducing cost burdens for persons with low income
Measures are available to reduce financial burdens for persons who find it difficult to pay medical care costs due to low income.
Less than 70 years of age
Cost-Sharing Maximum Amounts for High-Cost Medical Care Benefits
- * Persons with low income refer to insured persons and dependents exempted from municipal tax or to insured persons and dependents who do not require public assistance if they are approved as eligible for measures for reducing cost burdens for persons with low income.
- * Those whose standard monthly remuneration is 530,000 yen or more do not fall in the category of persons with low income, even if they are exempt from paying municipal tax.
- * To be placed in one of the low-income categories, you must apply in advance for a maximum copayment/reduced standard copayment certificate for health insurance, even when using a Myna health insurance card.
| Category | Cost-Sharing Maximum Amounts | Frequent qualification of expenditures |
|---|---|---|
| Persons with low income | 35,400 yen | 24,600 yen |
- *When an eligible person qualifies for high-cost medical care benefits for at least three months of a 12-month period, starting with the fourth month, the cost-sharing maximum amount is reduced to the amount for cases of frequent qualification of expenditures
Cost-Sharing Maximum Amounts for High Aggregate Cost for Long-term Care Service
| Category | Cost-Sharing Maximum Amounts |
|---|---|
| Persons with low income | 340,000 yen |
- Reference link
Inpatient meal standard expenses during hospitalization (per meal, up to three meals/day)
| Category | Cost-Sharing Maximum Amounts | |
|---|---|---|
| Persons with low income | Through the 90th day hospitalized over the past 12 months prior to the month of application | 230 yen |
| Beginning with the 91st day hospitalized over the past 12 months prior to the month of application | 180 yen |
- * When submitting to the medical care institution a maximum copayment/reduced standard copayment certificate certifying eligibility for long-term inpatient treatment
Standard copayment when hospitalized at a convalescent facility
| Category | Cost-Sharing Maximum Amounts |
|---|---|
| Persons with low income | Meal expenses: 230 yen/meal Accommodation expenses: 370 yen/day |
- Reference link
Ages 70-74
- ** Low income II: Persons aged 70 or above who are insured persons and dependents etc., and exempt from paying municipal tax
- ** Low income I: Persons aged 70 or above in households whose insured persons and dependents are all exempt from paying municipal tax and whose incomes meet certain standards (e.g., pension income not exceeding 800,000 yen), etc.
- ** Those in the category of persons with the same income level as active workers do not fall in the category of persons with low income, even if they are exempt from paying municipal tax.
- ** To be placed in the low income I or II category, you must apply in advance for a maximum copayment/reduced standard copayment certificate for health insurance, even when using a Myna health insurance card.
Cost-Sharing Maximum Amounts for High-Cost Medical Care Benefits
| Category | Cost-Sharing Maximum Amounts (outpatient) |
Cost-Sharing Maximum Amounts (per household) |
|---|---|---|
| Low income II (Elderly benefits card copayment rate: 20%) |
8,000 yen | 24,600 yen |
| Low income I (Elderly benefits card copayment rate: 20%) |
8,000 yen | 15,000 yen |
- *No frequent qualification of expenditures applies.
Cost-Sharing Maximum Amounts for High Aggregate Cost for Long-term Care Service
| Category | Cost-Sharing Maximum Amounts |
|---|---|
| Low income II | 310,000 yen |
| Low income I | 190,000 yen |
- * 310,000 yen when multiple persons in the household use long-term care services.
Inpatient meal standard expenses during hospitalization (per meal, up to three meals/day)
| Category | Cost-Sharing Maximum Amounts | |
|---|---|---|
| Low income II | Through the 90th day hospitalized over the past 12 months prior to the month of application | 230 yen |
| Beginning with the 91st day hospitalized over the past 12 months prior to the month of application | 180 yen | |
| Low income I | 110 yen | |
- * When submitting to the medical care institution a maximum copayment/reduced standard copayment certificate certifying eligibility for long-term inpatient treatment
Standard copayment when hospitalized at a convalescent facility*1
| Applicable category | Meal costs/meal | Living expenses/day | Meal costs/meal | Living expenses/day |
|---|---|---|---|---|
| Those with low degrees of medical necessity (Medical Care Category I) | Those with high degrees of medical necessity (Medical Care Categories II or III) | |||
| Low income II | 230 yen | 370 yen | 210yen*2 Over 90 days 160円 |
370 yen |
| Low income I | 140 yen | 370 yen | 110 yen | 370 yen |
| Borderline persons*3 | 110 yen | 0 yen | 110 yen | 0 yen |
- *1 Long-term medical treatment beds are beds for hospitalization for extended periods for chronic conditions. These beds are often used by patients with cognitive impairment or the like.
- *2 When submitting to the medical care institution a maximum copayment/reduced standard copayment certificate certifying eligibility for long-term inpatient treatment
- *3 Those who will not require public assistance if meal costs and living expenses are reduced to 110 yen/meal and 0 yen/day (Borderline persons must attach a certificate issued by the director of the welfare office and receive a maximum copayment/reduced standard copayment certificate.)
- * Living expenses are 0 yen/day for patients with specified intractable diseases.
- Reference link