Act on Assurance of Medical Care for Elderly People

• Meals in hospital are paid for as dietary treatment expenses for inpatients (入院時食事療養費) — the standard cost less a standard amount the patient bears, which the Minister of Health, Labour and Welfare sets — or, for a patient in a long-term care bed (療養病床), as living support expenses for inpatients (入院時生活療養費). When co-payments are extremely high, the association pays high-cost medical expenses (高額療養費) on conditions and in amounts a Cabinet Order sets, and sizable medical and nursing expenses (高額介護合算療養費) when they and long-term care service charges together are extremely high. On a death it pays funeral expenses (葬祭費) or provides a funeral (葬祭の給付) as its local ordinance (条例) provides, though where there is a special reason it may withhold all or part of it, and its local ordinance may provide other benefits such as injury and sickness allowance (傷病手当金).(Art. 56(1), Art. 64(2)(i), Art. 64(2)(ii), Art. 74(1), Art. 74(2), Art. 75(1), Art. 75(2), Art. 84(1), Art. 84(2), Art. 85(1), Art. 86(1), Art. 86(2)) (the provisions it rests on)
• To meet the costs of old-old medical care (後期高齢者医療), municipalities must collect premiums (保険料), which the association imposes on each insured person at a premium rate set by its local ordinance (条例) and uniform across its whole area under standards a Cabinet Order gives, though a separate rate may apply in remote islands and other areas where medical care is very hard to secure. A municipality collects them by having the payer of an old-age or other pension a Cabinet Order names deduct them from the pension of an insured person who receives it (特別徴収), other than people a Cabinet Order excludes, and otherwise by sending a payment notice (普通徴収). Under a payment notice the insured person must pay, and the head of their household (世帯主) and their spouse, a de facto spouse included, are jointly liable.(Art. 104(1), Art. 104(2), Art. 107(1), Art. 107(2), Art. 108(1), Art. 108(2), Art. 108(3)) (the provisions it rests on)
• Every medical insurer (保険者) — for national health insurance, the municipality — must make a six-year plan and under it give its members aged 40 and over a special health examination (特定健康診査) for diabetes and other lifestyle diseases a Cabinet Order names, tell them the results, and give specified health guidance (特定保健指導) to those a Ministry of Health, Labour and Welfare Order names as needing it. The examination is not owed where the member had an equivalent checkup and a copy of its record was provided as the Order sets, and a checkup the member had, or could have had, under the Industrial Safety and Health Act (労働安全衛生法) or another law counts for all or part of it. For its own insured persons, the association must endeavour to provide health education, counselling, checkups and guidance suited to older people (高齢者保健事業).(Art. 7(2), Art. 18(1), Art. 19(1), Art. 20(1), Art. 21(1), Art. 23(1), Art. 24(1), Art. 125(1)) (the provisions it rests on)
• The State bears three-twelfths, and the prefecture and the municipalities one-twelfth each, of an association's costs of benefits and of certain contributions, leaving out those for people who pay the 30% co-payment, and the State also gives adjustment grants (調整交付金). A further share is met by the Old-Old Subsidy (後期高齢者交付金) that the Medical Information Infrastructure and Medical Fee Review and Payment Organization (医療情報基盤・診療報酬審査支払機構) pays each association out of the Medical Care Assistance for the Elderly Aged 75 and over (後期高齢者支援金) it collects every year from every insurer. To even out the burden that comes from insurers' differing shares of members aged 65 to 74 (前期高齢者, the young-old — from the month after they reach 65, or that month if they reach 65 on its first day, through the month they reach 75, and others a Ministry of Health, Labour and Welfare Order names), the Organization also collects Young-Old Payments (前期高齢者納付金) from every insurer and pays Young-Old Subsidies (前期高齢者交付金) to them, as the Act's formulas and Cabinet Orders provide.(Art. 93(1), Art. 95(1), Art. 96(1), Art. 98(1), Art. 100(1), Art. 100(3), Art. 118(1), Art. 118(2), Art. 32(1), Art. 32(2), Art. 36(1), Art. 36(2)) (the provisions it rests on)
• The Minister of Health, Labour and Welfare sets a basic policy and, every six years, a national plan for the optimization of medical expenses (全国医療費適正化計画), and each prefecture sets a prefectural plan in line with the policy, each with targets for keeping people healthy and for providing medical care efficiently and an estimate of medical spending over the period. The Minister publishes the national plan's progress, prefectures endeavour to publish theirs, and each plan's results are evaluated in the year after its period ends. Where the evaluation shows it necessary to meet the targets, the Minister may set medical fees (診療報酬) in one prefecture different from those elsewhere, within a reasonable range and after consulting the governors concerned.(Art. 8(1), Art. 8(4)(i), Art. 8(4)(ii), Art. 8(4)(vi), Art. 9(1), Art. 9(2)(i), Art. 9(2)(ii), Art. 9(2)(iv), Art. 11(1), Art. 11(5), Art. 12(1), Art. 12(3), Art. 14(1), Art. 14(2)) (the provisions it rests on)

• 1 October 2026

  The text on this site

  Act Partially Amending the Medical Care Act, etc.

  医療法等の一部を改正する法律

  Act No. 87 of 2025The text after this amendment, on e-Gov

• 1 August 2026

  Act Partially Amending the Health Insurance Act, etc.

  健康保険法等の一部を改正する法律

  Act No. 31 of 2026The text after this amendment, on e-Gov

• 5 June 2026

  Act Partially Amending the Health Insurance Act, etc.

  健康保険法等の一部を改正する法律

  Act No. 31 of 2026The text after this amendment, on e-Gov

• 1 April 2026

  Act Partially Amending the Health Insurance Act, etc. to Establish a Sustainable Social Security System for All Generations

  全世代対応型の持続可能な社会保障制度を構築するための健康保険法等の一部を改正する法律

  Act No. 31 of 2023The text after this amendment, on e-Gov

• 1 April 2026

  Act Partially Amending the Act on Support for Children and Child-rearing, etc.

  子ども・子育て支援法等の一部を改正する法律

  Act No. 47 of 2024The text after this amendment, on e-Gov

• 12 December 2025

  Act Partially Amending the Medical Care Act, etc.

  医療法等の一部を改正する法律

  Act No. 87 of 2025The text after this amendment, on e-Gov

• 1 June 2025

  Act on the Arrangement of Related Acts upon the Enforcement of the Act Partially Amending the Penal Code, etc.

  刑法等の一部を改正する法律の施行に伴う関係法律の整理等に関する法律

  Act No. 68 of 2022The text after this amendment, on e-Gov

• 1 April 2025

  Act Partially Amending the Health Insurance Act, etc. to Establish a Sustainable Social Security System for All Generations

  全世代対応型の持続可能な社会保障制度を構築するための健康保険法等の一部を改正する法律

  Act No. 31 of 2023The text after this amendment, on e-Gov

• 2 December 2024

  Act Partially Amending the Act on the Use of Numbers to Identify a Specific Individual in Administrative Procedures, etc.

  行政手続における特定の個人を識別するための番号の利用等に関する法律等の一部を改正する法律

  Act No. 48 of 2023The text after this amendment, on e-Gov

• 1 October 2024

  Act Partially Amending the Act on Support for Children and Child-rearing, etc.

  子ども・子育て支援法等の一部を改正する法律

  Act No. 47 of 2024The text after this amendment, on e-Gov

All 42 amendments already in force

• An insured person who moved their address by entering a hospital, a clinic or one of the care or welfare facilities Article 55 lists, and who had an address in another association's area when they entered, is insured by that other association rather than the one where the place is, with its own rule for someone who has moved through more than one such place; the place must cooperate with both associations. Someone whom Article 116-2 of the National Health Insurance Act (国民健康保険法) treats as having an address in an earlier municipality, and who reaches 75 or is certified as disabled, likewise joins the association that municipality belongs to.(Art. 55(1), Art. 55(2), Art. 55(3), Art. 55-2(1)) (the provisions it rests on)
• An association may reduce the co-payment, waive it, or collect it itself and defer it, for an insured person who is found to have difficulty paying it because of a disaster or other special circumstance a Ministry of Health, Labour and Welfare Order names.(Art. 69(1), Art. 69(2)) (the provisions it rests on)
• An association may, under its local ordinance (条例), reduce or exempt the premium, or defer its collection, for a person with a special reason.(Art. 111(1)) (the provisions it rests on)
• No benefits for treatment are given for an illness or injury where the person can get medical benefits for it under the Industrial Accident Compensation Insurance Act (労働者災害補償保険法), the accident compensation Acts for national or local public officers or another law a Cabinet Order names, or equivalent benefits under the Long-Term Care Insurance Act (介護保険法), or where treatment was given at public expense under another law. But where that other benefit is given in kind and leaves the person paying more than this Act's co-payment, or, under a law other than the Long-Term Care Insurance Act, is a payment of money smaller than this Act would pay, the association pays them the difference. Where someone else caused the illness or injury, the association that gives benefits takes over the insured person's claim for damages against them up to the value of the benefits, and need not give benefits up to what that person has already paid in compensation for it.(Art. 57(1), Art. 57(2), Art. 58(1), Art. 58(2)) (the provisions it rests on)
• No benefits for treatment are given for an illness or injury caused by the person's own intentional crime or brought on intentionally, or for the period someone is held in a penal institution, workhouse or similar facility. They may be withheld in whole or in part for one caused by fighting, drunkenness or gross misconduct, and in part from someone who without good reason does not follow instructions about their treatment.(Art. 87(1), Art. 88(1), Art. 89(1), Art. 90(1)) (the provisions it rests on)
• Where an insured person is treated at an insurance-covered institution without being confirmed as insured, and the association finds that was for an emergency or other unavoidable reason, it pays medical expenses (療養費) in place of the benefit; it may also pay them where it finds the benefit hard to give, or where treatment from a provider outside the scheme was unavoidable.(Art. 77(1), Art. 77(2)) (the provisions it rests on)
• An insured person who cannot use electronic eligibility confirmation may ask the association for a document, or an electronic record, of their eligibility, which it must provide promptly, and can show it to be confirmed as insured instead.(Art. 54(3), Art. 54(4)) (the provisions it rests on)

• If an insured person — other than one who can receive general medical expenses as an atomic bomb survivor (原子爆弾被爆者) or other medical benefits a Ministry of Health, Labour and Welfare Order names — still does not pay a premium by the end of a period a Ministry of Health, Labour and Welfare Order sets after the due date, despite the municipality's reminders and offers of consultation, then, unless a disaster or other special circumstance a Cabinet Order names explains it, they no longer receive ordinary benefits for treatment and are instead paid special medical expenses (特別療養費), the cost less the co-payment share, after being told in advance; this may also be done before that period ends. Ordinary benefits return once the arrears are paid in full, a marked fall in them or another special circumstance a Cabinet Order names is found, or the person becomes able to receive those atomic bomb survivors' or other benefits.This is the rule until 28 February 2027.(Art. 82(1), Art. 82(2), Art. 82(3), Art. 82(4), Art. 82(6)) (the provisions it rests on)
• If an insured person — other than one who can receive general medical expenses as an atomic bomb survivor (原子爆弾被爆者) or other medical benefits a Ministry of Health, Labour and Welfare Order names — still does not pay a premium by the end of a period a Ministry of Health, Labour and Welfare Order sets after the due date, despite the municipality's reminders and offers of consultation, then, unless a disaster or other special circumstance a Cabinet Order names explains it, they no longer receive ordinary benefits for treatment and are instead paid special medical expenses (特別療養費), the cost worked out under the fee standards less the co-payment share at their rate, after being told in advance; this may also be done before that period ends. Ordinary benefits return once the arrears are paid in full, a marked fall in them or another special circumstance a Cabinet Order names is found, or the person becomes able to receive those atomic bomb survivors' or other benefits. Treatment given before this rule took effect, and medicine dispensed on a prescription issued before it, is still covered under the earlier rules.This is the rule from 1 March 2027.(Art. 82(1), Art. 82(2), Art. 82(3), Art. 82(4), Art. 82(4)(i), Art. 82(4)(i)(a), Art. 82(5), Suppl. Prov. Art. 25(1)) (the provisions it rests on)
• Under the same conditions — but with no exclusion for atomic bomb survivors — the association must temporarily suspend, in whole or in part, payment of benefits to an insured person in arrears with a premium, and may do so before that period ends; where special medical expenses already apply and the arrears are still unpaid, it may, after notice, deduct the unpaid premiums from the benefits it is holding back.(Art. 92(1), Art. 92(2), Art. 92(3)) (the provisions it rests on)
• Under the heading disposition for delinquency (滞納処分), premiums and other money collected under the chapter on old-old medical care are revenue of the kind Article 231-3(3) of the Local Autonomy Act (地方自治法) names, and that separate Act governs how they are collected. The right to collect premiums or to have them refunded, like the right to receive benefits, lapses two years after it could first be exercised, though a notice of collection or a demand for payment (督促) starts the period again; and a premium cannot be assessed once two years have passed from the day after that year's first due date.(Art. 113(1), Art. 160(1), Art. 160(2), Art. 160-2(1)) (the provisions it rests on)
• An association may recover all or part of a benefit obtained by deception or other wrongful means, may order a doctor whose false medical certificate led to it to pay jointly, and may make a medical institution, pharmacy or home-nursing provider paid that way return the amount plus 40% of it. Its local ordinance (条例) may set a non-criminal fine (過料) of up to 100,000 yen for an insured person who fails to notify, unless the head of household did, or notifies falsely, and for an insured person, their spouse or a household member, past or present, who without good reason does not produce documents when ordered or does not answer or answers falsely; and of up to five times the amount evaded for evading money it collects by deception. A municipality may set the same fines for its own inquiries about premiums and for evading premiums.(Art. 59(1), Art. 59(2), Art. 59(3), Art. 171(1), Art. 171(2), Art. 171(3), Art. 171(4), Art. 171(5)) (the provisions it rests on)
• The penalty chapter (Chapter 8) punishes with up to one year's imprisonment (拘禁刑) or a fine of up to 1,000,000 yen an association's staff, members of the Medical Fee Review Committees for Old-Old Healthcare (後期高齢者医療診療報酬審査委員会) and of the Examination Boards for Old-Old Medical Treatment (後期高齢者医療審査会), officers and staff of the National Health Insurance Federations (国民健康保険団体連合会), and officers and staff of the designated corporation (指定法人) that reviews medical fee claims and the people who carry out that review, past or present, who without good reason leak secrets learned in their work. It does the same to people entrusted with special health examinations or the association's health services who leak a person's secrets. An insured person, past or present, who without good reason disobeys an order of the Minister of Health, Labour and Welfare or a prefectural governor to report on the treatment received, or does not answer or answers falsely when questioned, faces a fine of up to 300,000 yen, as does a person concerned, a doctor or a dentist, other than the applicant and the parties notified, who without good reason disobeys an Examination Board's order to appear, state, report or examine, or states or reports falsely.(Chapter 8, Art. 167(1), Art. 167(2), Art. 167(2)(i), Art. 167(2)(ii), Art. 167(2)(iii), Art. 167(2)(iv), Art. 30(1), Art. 125-2(2), Art. 125-4(3), Art. 169(1)(i), Art. 169(1)(ii), Art. 61(2)) (the provisions it rests on)
• A person dissatisfied with a decision on benefits — including on a request for an eligibility document — or on premiums or other money a municipality or association collects may file an application for examination (審査請求) with the Examination Board for Old-Old Medical Treatment (後期高齢者医療審査会) set up in each prefecture. Articles 93 to 103 of the National Health Insurance Act (国民健康保険法) apply to the Board with the adjustments a Cabinet Order makes: the application is made in writing or orally within three months from the day after learning of the decision, unless good reason for missing that is shown, and a court action to revoke the decision can be brought only after the Board has decided. For suspending and renewing the limitation period (時効), the application counts as a claim made in court.(Art. 128(1), Art. 128(2), Art. 129(1), Art. 130(1), National Health Insurance Act Art. 99(1), National Health Insurance Act Art. 103(1)) (the provisions it rests on)
• An association may order an insured person, their spouse, or the head or another member of their household, past or present, to produce documents and have its staff question them about eligibility, benefits and premiums, and a municipality may do the same about premiums; the association may also order someone receiving benefits to produce documents or be questioned or medically examined, and may withhold benefits for treatment, in whole or in part, from someone who refuses without good reason. On the same matters an association, and a municipality for premiums, may ask public offices and pension payers for documents and information, and banks, trust companies, the insured person's employer and others to report, about the assets and income of the insured person and their household and the pensions paid to them. The Minister of Health, Labour and Welfare or a prefectural governor may also order doctors, dentists, pharmacists and others who gave treatment covered by these benefits, and their employers, to report on it or show medical and other records, and have staff question them; failing without good reason to comply, or not answering or answering falsely, is punishable by a non-criminal fine (過料) of up to 100,000 yen.(Art. 137(1), Art. 137(2), Art. 60(1), Art. 91(1), Art. 138(1), Art. 138(3), Art. 61(1), Art. 170) (the provisions it rests on)
• No one may, in the course of business, require a person applying for or entering into a sale, lease, employment or other contract with them to disclose their own or anyone else's insurer and insured numbers (被保険者番号等), or build a database of those numbers meant to be provided to others, except people who use the numbers to run the scheme, where they need to, and cases a Ministry of Health, Labour and Welfare Order allows. The Minister may recommend that someone likely to keep doing so stop, and, if they do not follow the recommendation, order them to do so by a deadline; disobeying the order is punishable by up to one year's imprisonment (拘禁刑) or a fine of up to 500,000 yen, and the corporation or employer is fined as well.(Art. 161-2(3), Art. 161-2(4), Art. 161-2(5), Art. 161-2(6), Art. 167-3(1), Art. 169-3(1)) (the provisions it rests on)