IBM Japan Health Insurance Association

IBM Japan Health Insurance Association

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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.
Category Cost-Sharing Maximum Amounts Frequent qualification of expenditures
Low-income persons 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
Low-income persons 340,000 yen
Reference link

Inpatient meal standard expenses during hospitalization (per meal, up to three meals/day)

Category   Cost-Sharing Maximum Amounts
Low-income persons Through the 90th day hospitalized over the past 12 months prior to the month of application 210 yen
Beginning with the 91st day hospitalized over the past 12 months prior to the month of application 160 yen

Standard copayment when hospitalized at a convalescent facility

Category Cost-Sharing Maximum Amounts
Low-income persons Meal expenses: 210 yen/meal
Accommodation expenses: 320 yen/day
Reference link

Ages 70-74

  • ** Low income II: Persons more than 70 years of age whose entire household is exempt from municipal tax, etc.
  • ** Low income I: Persons more than 70 years of age whose entire household is exempt from municipal tax and whose income satisfies certain standards (e.g., pension income not exceeding 800,000 yen), etc.

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 8,000 yen 24,600 yen
Low income I 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 210 yen
Beginning with the 91st day hospitalized over the past 12 months prior to the month of application 160 yen
Low income I 100 yen

Standard copayment when hospitalized at a convalescent facility

Category Cost-Sharing Maximum Amounts
Low income II Meal expenses: 210 yen/meal
Accommodation expenses: 320 yen/day
Low income I Meal expenses: 130 yen/meal
Accommodation expenses: 320 yen/day
Reference link

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