Patients' medical cost cap to rise 38% in Aug 2027

2026-07-24

High medical cost cap to rise in two stages

The government on the 24th formally decided to raise the upper limit on patients' out-of-pocket payments under the high-cost medical expense reimbursement system, which keeps medical costs borne by patients at a fixed amount, in two stages. Starting Aug. 1, it will raise the benchmark monthly cap by 4% to 7%, and from August 2027 it will lift it by as much as 38% from current levels.

Annual cap introduced to ease burden of long-term treatment

The cabinet on the 24th approved revisions to ordinances under the Health Insurance Law and related legislation. While the higher monthly cap will increase patients' burden, the government will introduce an annual cap to consider patients who need long-term treatment. Depending on the revisions, some patients are expected to pay less than under the current system.

A rough estimate presented by the Health, Labour and Welfare Ministry in December 2025 projects an effect of reducing insurance premiums by around 3,000 yen per person a year, including the corporate share, at health insurance associations covering company employees and at the Japan Health Insurance Association, known as Kyokai Kenpo.

Income brackets to be narrowed, outpatient exception revised

In the first stage from August, the benchmark monthly cap set for five income categories, including those exempt from resident tax, will be raised by 4% to 7%. For those with annual income of roughly 3.7 million yen to 7.7 million yen, it will rise from the current 80,100 yen to 85,800 yen. The annual cap will be set at 530,000 yen.

In the second stage from August 2027, the income brackets will be subdivided. The category for annual income of roughly 3.7 million yen to 7.7 million yen will be split into three brackets: 3.7 million yen to 5.1 million yen, 5.1 million yen to 6.5 million yen and 6.5 million yen to 7.7 million yen, and the benchmark monthly cap for annual incomes of 5.1 million yen and above will be raised further. The biggest increase will be for annual income of roughly 6.5 million yen to 7.7 million yen, where it will rise 38% from the current 80,100 yen to 110,400 yen.

The outpatient special measure available to some people aged 70 and over will also be revised. Patients with annual income of roughly 2 million yen to 3.7 million yen can currently make unlimited outpatient visits if they pay 18,000 yen a month, but from August this will rise to 22,000 yen. Taking into account longer healthy life expectancy, the government will reconsider raising the age threshold from fiscal 2026 onward.

When patients visit hospitals and other facilities, they pay 10% to 30% of medical costs out of pocket depending on age. The high-cost medical expense system allows them to pay only up to a certain ceiling even when out-of-pocket expenses swell, and insurers such as health insurance associations cover the amount above the ceiling.

Enjoyed this article? Share it with your network!