IBM Japan Health Insurance Association

IBM Japan Health Insurance Association

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Benefits for the elderly

he copayment rate and cost-sharing maximum amounts for elderly persons aged 70–74 are lower than for persons less than 70 years of age.

Individual cost-sharing for medical care costs

The copayment rate for medical care costs for elderly persons aged 70–74 is 20% (10% for persons those born through April 1, 1944) for normal-income and low-income individuals but remains 30% for persons earning income at levels comparable to active workers.
Elderly persons aged 70–74 must present their elderly benefits card when undergoing examinations.

Standard hospitalization costs

Inpatient meal expenses

During any hospital stay, you are responsible for paying for 260 yen/meal (100–210 yen for low-income households) for each of up to three meals/day as the standard amount for meal costs; any amount beyond the standard amount will be defrayed as inpatient meal expenses.

Inpatient living expenses

6If an elderly person aged 65 or older is hospitalized in a convalescent facility, he or she is responsible for paying the standard amount for living expenses himself or herself; any amount beyond the standard amount will be defrayed as inpatient living expenses. The standard amount for meal expenses is 460 yen/meal for up to three meals/day. The standard amount for accommodation expenses is 320 yen/day.
Depending on income status, measures to reduce costs are available. Note that costs are also lower for patients with greater need for inpatient care. The amount paid by these is equal to the amount of the inpatient meal standard expenses.

Meal expenses: intended to cover the cost of ingredients and preparation 460 yen/meal (up to three meals/day)
(approx. 42,000 yen/month)
Living expenses: intended to cover the cost of utilities 320 yen/day
(approx. 10,000 yen/month)
  • *Note: The cost is 420 yen/meal at certain medical care institutions due to differences in meal service systems and other factors.

Standard expenses are reduced based on income status.

Households exempted from residence tax: approx. 30,000 yen/month
Recipients of pension benefits in amounts of 800,000 yen or less and similar cases: approx. 22,000 yen/month
Old-age welfare pension recipients: approx. 10,000 yen/month

  • *Note: Standard meal (three meals) and living expenses are calculated based on a one-month period.

Cost-sharing maximum amounts

Limits on maximum amounts of patient cost-sharing apply to elderly persons aged 70–74. Costs beyond the maximum amount are defrayed as high-cost medical care benefits. The cost-sharing maximum amount for elderly persons aged 70–74 is lower than for persons less than 70 years of age. Additionally, a per-person cost-sharing maximum amount for outpatient care and a combined cost-sharing maximum amount for total outpatient and inpatient cost-sharing amounts per household in cases where there is more than one member covered under the same medical insurance plan in one household apply to such elderly persons. While the amount you pay at the hospital will not exceed the cost-sharing maximum amount for inpatient care, for outpatient care and cases in which the total amount paid per household exceeds the cost-sharing maximum amount, you will be refunded the excess amount at a later date.
Elderly persons aged 70–74 must present their elderly benefits card before examinations.

Cost-sharing maximum amount
Category Copayment Outpatient Per household
Persons earning income at levels comparable to active workers 30% 57,600 yen 80,100 yen +
(medical care costs − 267,000 yen)
x 1% [44,400 yen]
Normal 20%
(10% for persons those born through April 1, 1944)
14,000 yen
(Annual maximum: 144,000 yen)
57,600 yen
[44,400 yen]
  Low-income 8,000 yen 24,600 yen
  Income below a certain level
and similar cases
15,000 yen
  • *1 Figures in brackets indicate the reduced cost-sharing maximum amount for frequent qualification of expenditures, applied starting the fourth month when an eligible person qualifies for high-cost medical care benefits for at least three months in a 12-month period.

Persons earning income at levels comparable to active workers

For health-insurance purposes, this category refers to persons whose standard monthly remuneration is 280,000 yen or more. However, persons whose households consist of two or more elderly persons with a combined annual income of less than 5.2 million yen or elderly persons living alone whose annual income is less than 3.83 million yen may apply to the Health Insurance Society to reduce their copayment to 20% (10% for persons those born through April 1, 1944).

Overview of copayment rates

Category based on insured person’s age and income Copayment rates
Insured person Dependents
Aged 70–74 69 or younger
Aged 70–74 Income at levels comparable to active workers 30% 30% 30%
(20% for preschool children)
Normal/low income 20%* 20%*
69 or younger 30% 20%* 30%
(20% for preschool children)
  • * 10% for persons those born through April 1, 1944

Combination of high-cost medical care and long-term care

Together with the establishment of the new Medical Care Service System for the Aged, a system was established in April 2008 to combine the amounts of high-cost medical care and high-cost long-term care and to pay the high aggregate cost for long-term care service benefits when the combined copayments exceed the maximum.

Under this system, when the combined total of copayments* paid by persons in the same household covered by the same health insurance under health insurance and long-term care insurance over the one-year period starting each August exceeds the standard amount, the excess amount is paid as benefits.

  • • * The amount after deducting benefits such as high-cost medical care benefits (statutory) and additional benefits (provided by the IBM Japan Health Insurance Society). This excludes inpatient meal expenses, the extra cost of premium hospital beds, and other such expenses.

Examples of cost savings

Two-person household (both aged 74 and low income earners)

For example, if over one year:
The husband has paid 300,000 yen under health insurance and the wife has paid 300,000 yen under long-term care insurance (household total cost in one year: 600,000 yen)

Then:
By applying for this benefit after paying 600,000 yen in one year, they can receive a refund for the amount beyond (290,000 yen) of the standard amount (310,000 yen).

The standard amount varies with the age of household members, their income categories, and other factors.
Check with your municipality’s long-term care insurance office for more information.

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