Frequently Asked Questions (National Health Insurance)

QuestionI will turn 70 this month, will my out-of-pocket expenses at medical institutions decrease?

Response

From the month following the month of your 70th birthday (if your birthday is on the 1st, it will be the birthday month), the percentage of the co-payment you will need to pay at medical institutions will be either 20% or 30%, depending on your income from the previous year and your date of birth.
For those who turn 70 years old, we will issue a "Older Adults Benefit Certificate" that specifies the burden ratio of the partial payment. Therefore, starting from the month following the month of your 70th birthday (if your birthday is on the 1st, it will be the month before your birthday), please present both your Health Insurance Card and the Older Adults Benefit Certificate at the medical institution's reception.
In addition, households exempt from resident tax can apply for the "Certificate of Eligibility for Maximum Limit and Standard Burden Reduction" and present it at the medical institution's reception. This will limit the payment to each medical institution to the "maximum out-of-pocket limit" per month. Please note that if there are any unpaid health insurance premiums, the "Certificate of Eligibility for Maximum Limit and Standard Burden Reduction" may not be issued.

Burden Ratio for Those Aged 70 and Over

Resident Taxable Income for Those Aged 70 and Over (National Health Insurance Members) Less than 1.45 million yen	Resident Taxable Income for Those Aged 70 and Over (National Health Insurance Members) 1.45 million yen or more
20%	30%

Note: Even for those who fall under the 30% burden, if the total income of National Health Insurance members aged 70 and over is less than 5.2 million yen for two or more people, or less than 3.83 million yen for one person, it will become a 20% burden upon application.