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
- * 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.
About [Maximum copayment/reduced standard copayment certificate]
Individuals younger than 70 should prepare a Maximum Copayment Certificate for greater convenience if they expect to incur high medical care costs. If the insured person is exempt from municipal residents’ tax, he or she will be issued a maximum copayment/reduced standard copayment certificate that reduces the maximum copayment still further.
Those issued a certificate are required to pay only the copayment for low-income individuals at the medical care institution. This cannot exceed \35,400 (\24,600 for multiple eligible copayments).
Submit the following documents to obtain a maximum copayment/reduced standard copayment certificate:
[Documents to submit]
･ Request for Issuance of Maximum Copayment Certificate
･ Tax exemption certificate for municipal residents’ tax*
- * About the tax exemption certificate
Please continue to submit the attached documents to facilitate issuance administration of maximum copayment/reduced standard copayment certificates.
Cost-Sharing Maximum Amounts for High-Cost Medical Care Benefits
| 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 | 240 yen |
| Beginning with the 91st day hospitalized over the past 12 months prior to the month of application | 190 yen |
Standard copayment when hospitalized at a convalescent facility
| Category | Cost-Sharing Maximum Amounts | |
|---|---|---|
| Persons with low income | Those with low degrees of medical necessity (Medical Care Category I) | Meal expenses: 240 yen/meal Accommodation expenses: 370 yen/day |
| Those with high degrees of medical necessity (Medical Care Categories II or III) | Meal expenses: 240 yen/meal Accommodation expenses: 370 yen/day (0 yen for patients with designated intractable diseases) |
|
- 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 (Copayment rate: 20%) |
8,000 yen | 24,600 yen |
| Low income I (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 |
- Reference link
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 | 240 yen |
| Beginning with the 91st day hospitalized over the past 12 months prior to the month of application | 190 yen | |
| Low income I | 110 yen | |
Standard copayment when hospitalized at a convalescent facility
| Category | Cost-Sharing Maximum Amounts | |
|---|---|---|
| Low income II | Those with low degrees of medical necessity (Medical Care Category I) | Meal expenses: 240 yen/meal Accommodation expenses: 370 yen/day |
| Those with high degrees of medical necessity (Medical Care Categories II or III) | Meal expenses: 240 yen/meal Accommodation expenses: 370 yen/day (0 yen for patients with designated intractable diseases) |
|
| Low income I | Those with low degrees of medical necessity (Medical Care Category I) | Meal expenses: 140 yen/meal Accommodation expenses: 370 yen/day |
| Those with high degrees of medical necessity (Medical Care Categories II or III) | Meal expenses: 110 yen/meal Accommodation expenses: 370 yen/day (0 yen for patients with designated intractable diseases) |
|
- Reference link