Big medical bill in Japan: what's my 高額療養費 monthly cap, how much comes back, does the new yearly cap apply, and what changes in Aug 2027?
japan_high_cost_medical_checkApplies Japan's high-cost medical expense benefit (高額療養費) as of 2026-11-04 (MHLW review tables 001726232.pdf, 協会けんぽ, Setagaya / Machida / Fukuoka NHI pages). Monthly cap = base + max(0, 10割 total − threshold) × 1% (flat for lower bands), three schedules by treatment month: up to 2026-07; 2026-08…2027-07 (≈7% higher, e.g. income ¥3.7M–7.7M 85,800 + (x − 286,000) × 1%, ≤ ¥3.7M ¥61,500, tax exempt ¥36,900); from 2027-08 twelve bands (e.g. ¥5.1M–6.5M 98,100 + (x − 327,000), ¥6.5M–7.7M 110,400 + (x − 368,000), ¥16.5M+ 342,000 + (x − 1,140,000)). 多数回該当 from the 4th benefit month in 12 (140,100 / 93,000 / 44,400 / 24,600; 34,500 for ≤ ¥2M from 2027-08). New yearly cap per Aug–Jul on what was paid after monthly refunds (¥1.68M / ¥1.11M / ¥530k / ¥410k / ¥290k / 70+ 低所得I ¥180k). 70+ outpatient caps (一般 ¥18,000 → ¥22,000 → ¥28,000/¥22,000, yearly ¥216,000). Income one way: band (y1650, y1410, y1160, y1040, y950, y770, y650, y510, y370, y260, y200, y0, nontaxable, nontaxable_low; ア/イ/ウ/エ/オ accepted), standardMonthlyRemuneration (標準報酬月額), nhiIncome (旧ただし書き所得), taxableIncome (70+ 課税所得), rough annualIncome, or nonTaxable. Optional months tracker (array [{month, totalCost|copay, setting}] or '2026-08:300000,2026-09:300000') auto-applies 多数回 and the yearly cap. Returns verdict (under_cap | cap_applies | many_times_cap | annual_cap_reached), summary, band, schedule, month {monthlyCap, formula, youPay, monthlyRefund, manyTimes}, caps, annualCap {period, amount}, from2027 {youPay, changeJPY}, beforeAug2026, claim {deadline: 2 years from the 1st of the next month}, tracker, steps, notCounted, sources, disclaimer. Use for '高額療養費 いくら戻る', '自己負担限度額 計算', '高額療養費 2027年8月 変更', '年間上限', 'hospital bill Japan how much will I pay', 'Japan medical cost cap'. Insured care only (meals, private rooms, 先進医療 excluded). Educational estimate, not medical, financial or legal advice; the insurer decides.
Tool call template
This tool declares no required parameters. Add optional parameters from the input schema as needed.
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}Input Schema
| Name | Required | Description | Default |
|---|---|---|---|
| band | No | Income band (y370 = income about ¥3.7M–5.1M). | |
| copay | No | Insured copay paid at the counter (窓口負担) in yen; give this or totalCost. | |
| month | No | Treatment month YYYY-MM (default this month JST); picks the schedule. | |
| months | No | Yearly tracker: [{month, totalCost|copay, setting}] or '2026-08:300000,2026-09:300000'. | |
| setting | No | inpatient / household total (default) or outpatient (70+ outpatient-only cap). | |
| ageGroup | No | under70 (default) or 70plus (70–74 and 75+ 後期高齢者). | |
| manyTimes | No | Already had a benefit in 3+ of the last 12 months (多数回). | |
| nhiIncome | No | NHI 旧ただし書き所得 (household) in yen. | |
| totalCost | No | 10割 total medical cost (総医療費) in yen. | |
| burdenRate | No | Copay rate 0.1 / 0.2 / 0.3 (default by age and band). | |
| nonTaxable | No | Resident-tax exempt household (住民税非課税). | |
| annualIncome | No | Rough annual income (年収) in yen. | |
| taxableIncome | No | 70+: 課税所得 in yen. | |
| priorHitMonths | No | Benefit months in the 12 months before. | |
| standardMonthlyRemuneration | No | Employee insurance 標準報酬月額 in yen (e.g. 300000). |