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HOME > Subject search by life stage > When you turn 70 > Elderly persons aged 70-74 pay 20% or 30% of medical costs, depending on their income
Elderly persons aged 70-74 pay 20% or 30% of medical costs, depending on their income Benefits in kind
 

Depending on income, individuals aged 70-74 will pay 20%* or 30% of the cost of medical treatment directly to the administering hospital. Persons in this age group also pay standard expenses (460 yen/meal for up to three meals/day) on their own in the event they are hospitalized.

In addition, patients must pay meal and accommodation expenses incurred in the event of a hospitalization in medical treatment facilities. Insurance will cover the standard amount of living expenses required (460 yen/meal for meal expenses, 370 yen/day for accommodation expenses; subject to measures for reducing patients' cost burdens).

Once you reach the age of 75, you will be covered under Medical Care System for the Advanced Elderly. This means that you will lose your status as an insured person or dependent under Health Insurance Society coverage.

(*: Cost-sharing rates for elderly persons aged 70-74)
Benefits ratios - Illustration


Persons receiving income at the same level as before retirement

Elderly persons receiving income at the same level as before retirement are not classified separately and instead fall under the category of persons receiving income at the same level as before retirement (applicable to persons receiving income at or above a certain level). Individuals in this category are charged personal cost burdens of 30%.

For health insurance purposes, it is defined as insured persons aged 70-74 whose standard monthly remuneration amount is 280,000 yen or more, and their dependents aged 70-74.

However, in the following cases, insured persons may, on application to their health insurance society, be classified as "elderly general income earners".

* If the combined annual income of multiple households is less than 5.2 million yen (or less than 3.83 million yen in the case of insured persons living alone)
* If the insured person is eligible under the standard for insured persons living alone (annual income of 3.83 million yen or above) whose dependent has become an insured person under Medical Care System for the Advanced Elderly; the household includes no other dependents aged 70 - 74; and the combined annual income earned by all elderly persons in the household, including persons who are now insured under Medical Care System for the Advanced Elderly and no longer considered to be dependents, is less than 5.2 million yen


Cost-sharing maximum amounts for the elderly


There are ceilings to elderly persons' monthly cost-sharing. Elderly persons pay amounts up to these maximum amounts by presenting a medical care certificate for the elderly.(*)

Insurers reimburse persons aged 70-74 for the applicable balances in the event they are living in the same household and covered under the same medical care insurance even when outpatient and inpatient medical care expenses borne within a period of one month surpass the cost-sharing maximum amounts per household.

Those falling in the category of the same income level as active workers II or active workers I must submit a Certificate of Application of Maximum Copayment Amount to avoid paying more than the cost-sharing maximum amount at a hospital.
If you expect to incur high medical care costs, apply to the Society to obtain a certificate in advance.


Individual payment limits for the elderly - Illustration
*1 Persons who are insured persons and dependents, and exempt from paying municipal tax.
*2 Persons above in households whose insured persons and dependents are all exempt from paying municipal tax and whose incomes meet certain standards. (e.g., annual pension income of no more than 800,000 yen)
*3 Amount in brackets applies to all subsequent treatments that correspond to high-cost medical care expenses after the household has already borne such expenses three months within the nearest twelve-month period.
*
Half of the corresponding amount in the table above will be exceptionally applied, for a new insured person under Medical Care System for the Advanced Elderly, as the cost-sharing maximum amounts (per person) for the month in which he or she will turn 75 and become an insured person under the system (not including cases in which the insured person's 75th birthday will be the first day of that month).
(The cost-sharing maximum amounts under Medical Care System for the Advanced Elderly will also be half of the corresponding amount.)
The same measure will also be applied for the case when their dependents shift to be covered under the National Health Insurance or other plans.
*
If you fall into the category of the same income level as active workers, you will be treated as such, even if you are exempt from paying municipal tax.
*
Even persons earning income at levels comparable to active workers will be grouped in the Normal category if their annual income is less than a certain base amount (3.83 million yen for an elderly person living alone, 5.2 million yen for multiple elderly persons living in the same household) and their patient cost-sharing rate shown on their medical care certificates for the elderly is 20% due to a request for application of the base income amount.


Annual High-Cost Medical Care Benefits for outpatient care (annual total of outpatient costs) for those aged 70 or older

Insured persons and dependents aged 70 or older whose total copayments for outpatient care during the one year period (from August 1 of the previous year to July 31) exceeded 144,000 yen are eligible to be reimbursed for the excess amount as High-Cost Medical Care Benefits.
See here for more information: "When your medical care costs grow large"



Payment of high aggregate cost for long-term care service

To reduce high co-payments, a system will be established whereby the co-payments for health insurance and long-term care insurance are aggregated annually and benefits paid to cover high aggregate cost for long-term care service if this annual aggregate is remarkably high.

See here for more information: In cases in which the co-payment for medical care or long-term care is remarkably high.



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When you turn 70
@ Elderly persons aged 70-74 pay 20% or 30% of medical costs, depending on their income
@ A medical care certificate for the elderly is issued
@ Persons aged 75 or over to be enrolled in medical service system for persons in the latter stage of old age
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