Long-Term Care Insurance Act

• Certification is applied for at the municipality, and takes effect from the day of the application. It lasts only for a period a Ministry of Health, Labour and Welfare Order sets for each category; a person still expected to need care or support after that may apply for renewal, and one kept by a disaster or other unavoidable reason from applying before it ran out may still apply within one month after the reason ends. A person whose need has changed may apply to have the category changed.(Art. 27(1), Art. 27(8), Art. 32(1), Art. 32(7), Art. 28(1), Art. 28(2), Art. 28(3), Art. 33(1), Art. 33(2), Art. 33(3), Art. 29(1), Art. 33-2(1)) (the provisions it rests on)
• The insurance pays three kinds of benefit: long-term care benefits for those certified as needing care, prevention benefits for those certified as needing support, and any further benefit a municipality provides by local ordinance (条例), the municipal special benefit (市町村特別給付). Long-term care benefits pay toward in-home, community-based and facility services, the purchase of specified welfare equipment, home modifications such as fitting handrails, the drawing up of care plans and very high out-of-pocket costs. For those a Ministry of Health, Labour and Welfare Order specifies in view of their income and assets, they also pay toward meals and accommodation in care facilities and some other services.(Art. 18(1), Art. 62(1), Art. 40(1), Art. 52(1), Art. 41(1), Art. 42-2(1), Art. 48(1), Art. 44(1), Art. 45(1), Art. 46(1), Art. 51(1), Art. 51-3(1)) (the provisions it rests on)
• For most services the benefit is 90 percent of the cost worked out under a standard the Minister of Health, Labour and Welfare sets (or of the actual cost, if lower), and the rest is the user's share; for facility care and several other services, meals, accommodation and other daily living costs are left out of that cost. For a Primary Insured Person (第一号被保険者) whose income, counted as a Cabinet Order provides, is at or above an amount a Cabinet Order sets, the benefit is 80 percent, and at or above a higher amount a Cabinet Order sets, 70 percent. Benefits for in-home and community-based services (other than care in a small community-based special nursing home) are capped for each month by limit amounts the Minister sets in view of the category of need, which a municipality may raise by local ordinance (条例).(Art. 41(1), Art. 41(4), Art. 48(1), Art. 48(2), Art. 53(2), Art. 49-2(1), Art. 49-2(2), Art. 59-2(1), Art. 59-2(2), Art. 51(1), Art. 43(1), Art. 43(2), Art. 43(3)) (the provisions it rests on)
• Primary Insured Persons pay a premium to their municipality, at a rate the municipality sets by local ordinance (条例) under standards a Cabinet Order gives, so that its finances balance over about three years. Where a pension insurer (年金保険者) reports that a person aged 65 or over draws an old-age, disability or survivors' pension a Cabinet Order lists (老齢等年金給付), the municipality as a rule has the pension insurer take the year's premium out of the pension (special collection, 特別徴収) — pensions below an amount a Cabinet Order sets, or suspended, are not reported, and the exceptions below apply. Otherwise the municipality sends a payment notice to the person, the householder or the spouse (ordinary collection, 普通徴収), and the householder and the spouse are jointly liable to pay.(Art. 129(1), Art. 129(2), Art. 129(3), Art. 131(1), Art. 134(1), Art. 135(1), Art. 135(5), Art. 132(1), Art. 132(2), Art. 132(3)) (the provisions it rests on)
• Secondary Insured Persons (第二号被保険者) pay no premium to the municipality. Instead each medical insurer pays a yearly levy (納付金) toward long-term care and must collect premiums for it within its own scheme. Under the Health Insurance Act (健康保険法), an insured person who is a Secondary Insured Person pays a long-term care premium on top of the general premium, worked out from standard monthly pay and bonuses, of which the employer and the insured person each bear half (a voluntarily continuing insured person (任意継続被保険者) bears all of it, and a health insurance society may by its rules raise the employer's share); under the National Health Insurance Act (国民健康保険法), the municipality collects the premium from the head of the household (unless it levies National Health Insurance tax instead), and the part that funds the long-term care levy is charged in respect of members who are Secondary Insured Persons.(Art. 129(4), Art. 150(1), Art. 150(2), Art. 150(3), Health Insurance Act Art. 156(1)(i), Health Insurance Act Art. 161(1), Health Insurance Act Art. 162(1), National Health Insurance Act Art. 76(1), National Health Insurance Act Art. 76(3)) (the provisions it rests on)
• The municipality may pay a designated in-home service provider directly, in the person's place and up to the benefit due, only where the person has notified it in advance that they receive designated care planning (指定居宅介護支援) covering that service, or in other cases a Ministry of Health, Labour and Welfare Order sets; that payment counts as the benefit paid to the person. For care in a long-term care insurance facility, the municipality may pay the facility directly in the same way, with no advance notification required.(Art. 41(6), Art. 41(7), Art. 46(4), Art. 48(4), Art. 48(5)) (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

• 3 September 2026

  Act on the Development of Related Acts for the Promotion of Reform to Enhance Regional Autonomy and Independence

  地域の自主性及び自立性を高めるための改革の推進を図るための関係法律の整備に関する法律

  Act No. 27 of 2026The text after this amendment, on e-Gov

• 25 June 2026

  Act Partially Amending the Social Welfare Act, etc.

  社会福祉法等の一部を改正する法律

  Act No. 51 of 2026The text after this amendment, on e-Gov

• 3 June 2026

  Act on the Development of Related Acts for the Promotion of Reform to Enhance Regional Autonomy and Independence

  地域の自主性及び自立性を高めるための改革の推進を図るための関係法律の整備に関する法律

  Act No. 27 of 2026The text after this amendment, on e-Gov

• 1 April 2026

  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 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

• 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

• 1 April 2024

  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

All 49 amendments already in force

• A person who moves their address into a facility in another municipality on entering it stays insured by the municipality where they lived before, not the one where the facility is, if the facility is one subject to the domicile exception (住所地特例対象施設): a long-term care insurance facility (介護保険施設 — a designated special nursing home for the elderly, a long-term care health facility or an integrated medical and long-term care facility), a specified facility (特定施設 — a fee-charging home for the elderly (有料老人ホーム) or another facility a Ministry of Health, Labour and Welfare Order names, other than a small community-based one), or a nursing home for the elderly (養護老人ホーム) for a person placed there by a municipal measure. The same holds through a chain of such facilities, as Article 13(2) sets out.This is the rule until 31 March 2027.(Art. 13(1), Art. 13(2), Art. 8(11), Art. 8(25)) (the provisions it rests on)
• A person who moves their address into a facility in another municipality on entering it stays insured by the municipality where they lived before, not the one where the facility is, if the facility is one subject to the domicile exception (住所地特例対象施設): a long-term care insurance facility (介護保険施設 — a designated special nursing home for the elderly, a long-term care health facility or an integrated medical and long-term care facility), a specified-area long-term care insurance facility (特定地域介護保険施設 — such a home or facility in a specified area (特定地域) whose care is paid through the special-case facility benefit), a specified facility (特定施設 — a fee-charging home for the elderly (有料老人ホーム) or another facility a Ministry of Health, Labour and Welfare Order names, other than a small community-based one), or a nursing home for the elderly (養護老人ホーム) for a person placed there by a municipal measure. The same holds through a chain of such facilities, as Article 13(2) sets out. These rules apply until a day a Cabinet Order sets, no later than 24 June 2028, when the wider list below replaces them.This is the rule from 1 April 2027.(Art. 13(1), Art. 13(2), Art. 8(11), Art. 8(24), Art. 49(1), Suppl. Prov. Art. 1(1)(iii)) (the provisions it rests on)
• From a day a Cabinet Order sets, no later than 24 June 2028, a person who moves their address into a facility in another municipality on entering it stays insured by the municipality where they lived before, not the one where the facility is, if the facility is one subject to the domicile exception (住所地特例対象施設): a long-term care insurance facility (介護保険施設), a specified-area long-term care insurance facility (特定地域介護保険施設), a specified facility (特定施設 — a registered fee-charging home for the elderly (登録有料老人ホーム) or another facility a Ministry of Health, Labour and Welfare Order names, other than a small community-based one), a nursing home for the elderly (養護老人ホーム) for a person placed there by a municipal measure, or any other fee-charging home for the elderly (有料老人ホーム), except a home of 29 residents or fewer whose residents are limited to people needing care, their spouses and others that Order names. The same holds through a chain of such facilities, as Article 13(2) sets out.This is the rule from a day still to be set, 24 June 2028 at the latest.(Art. 13(1), Art. 13(2), Art. 8(11), Suppl. Prov. Art. 1(1)(iii)) (the provisions it rests on)
• A person the domicile exception keeps insured by their former municipality can still receive specified community-based services (特定地域密着型サービス) and their preventive counterparts from providers the mayor of the facility's municipality designates, and preventive care support (介護予防支援) from providers that mayor designates, and is covered by that municipality's community support projects (地域支援事業) rather than the former municipality's.(Art. 42-2(1), Art. 54-2(1), Art. 58(1), Art. 115-45(1)) (the provisions it rests on)
• Where a municipality finds that a disaster or other special circumstance a Ministry of Health, Labour and Welfare Order names makes it hard for a person to pay for services or home modifications, it may raise the benefit above 90 percent — or above 80 or 70 percent for higher-income Primary Insured Persons — up to 100 percent, at a rate it sets.(Art. 50(1), Art. 50(2), Art. 50(3), Art. 60(1)) (the provisions it rests on)
• A municipality may, as its local ordinance (条例) provides, reduce or waive the premium of a person with special reasons, or defer its collection.(Art. 142(1)) (the provisions it rests on)
• Special collection from the pension is not used for a person the municipality finds it would be very hard to collect from that way because of a disaster or other special circumstance, or for others a Cabinet Order names; a municipality with few people reported, or in another special circumstance that makes special collection unsuitable, need not use it at all. Where a Ministry of Health, Labour and Welfare Order provides, only part of the year's premium is collected this way.(Art. 135(1)) (the provisions it rests on)
• No long-term care or prevention benefits are paid for the time a person is held in a penal institution, a workhouse (労役場) or a similar facility. A municipality may withhold benefits, in whole or in part, for a condition a person caused or worsened by their own intentional crime or gross negligence, or by refusing without good reason to follow instructions on using services; it may also do so where a person receiving benefits refuses, without good reason, the municipality's requests concerning benefits for documents or other things, or refuses to answer its questions.(Art. 63(1), Art. 64(1), Art. 65(1), Art. 23(1)) (the provisions it rests on)
• Benefits are not paid to the extent that an equivalent benefit is available under the Industrial Accident Compensation Insurance Act (労働者災害補償保険法) or other laws a Cabinet Order lists, or is provided at national or local government expense. Where the need arose from a third party's act, the municipality that pays benefits takes over the person's claim for damages against that party up to the value paid, and pays nothing to the extent the person has already received damages for the same cause.(Art. 20(1), Art. 21(1), Art. 21(2)) (the provisions it rests on)
• A person certified by one municipality who becomes insured by another may be certified by the new municipality without the Certification Committee's review, on the terms of the old certification, if they apply within 14 days of becoming insured there and attach the document the old municipality issued.(Art. 36(1)) (the provisions it rests on)

• After an application, a municipal official interviews the applicant about their condition and surroundings, and the municipality asks the applicant's doctor for an opinion — or, where there is none, may order an examination by a doctor it names; the municipality's Certification Committee of Needed Long-Term Care (介護認定審査会), whose members the mayor appoints from experts in health, medical care and welfare, then judges the case against standards the Minister of Health, Labour and Welfare sets. The municipality must decide within 30 days of the application, unless there is a special reason, such as the survey taking time, and within those 30 days it tells the applicant how much longer it needs and why; if no decision comes in time, the applicant may treat the application as rejected. An applicant who without good reason refuses the interview or the ordered examination may have the application dismissed.(Art. 27(2), Art. 27(3), Art. 27(4), Art. 27(5), Art. 14(1), Art. 15(2), Art. 27(11), Art. 27(12), Art. 27(10), Art. 32(2), Art. 32(9)) (the provisions it rests on)
• The municipality may on its own move a certified person to a lower category of need when it finds their need has fallen, and may cancel a certification when it finds the person no longer needs care or support, or when the person refuses without good reason the survey or an examination it orders. When it certifies, it may also, on the opinion of the Certification Committee of Needed Long-Term Care, designate the kinds of service the person can receive benefits for; benefits are not paid for other kinds, and the person may apply to have the designation changed.(Art. 30(1), Art. 31(1), Art. 33-3(1), Art. 34(1), Art. 37(1), Art. 37(2), Art. 41(1), Art. 48(1)) (the provisions it rests on)
• A person dissatisfied with a decision on benefits — certification included — or on premiums and other money collected under the Act may request review (審査請求) by the Certification Committee for Long-Term Care Insurance (介護保険審査会) of the prefecture that includes the municipality that decided. Despite its name, this is the prefecture's appeals body, separate from the municipality's Certification Committee of Needed Long-Term Care (介護認定審査会) that judged the need for care; the request is made in writing or orally within three months from the day after the person learned of the decision, unless they show a good reason for being late. A court action to cancel such a decision may be brought only after the appeals body has ruled on the request.(Art. 183(1), Art. 184(1), Art. 191(1), Art. 192(1), Art. 196(1), Art. 14(1)) (the provisions it rests on)
• If a certified Primary Insured Person — other than one entitled to medical benefits such as those for atomic bomb survivors that a Ministry of Health, Labour and Welfare Order names — leaves premiums unpaid past a period a Ministry of Health, Labour and Welfare Order sets after the due date, the municipality changes the way benefits are paid (支払方法変更), and it may do so before that period ends, unless it finds a disaster or other special circumstance a Cabinet Order names: the provisions that let it pay providers and facilities in the person's place stop applying, so the benefit is paid to the person rather than to the provider, until the arrears are paid in full or the municipality finds them much reduced or another such circumstance. Any certified Primary Insured Person whose premiums stay unpaid past such a period also has benefit payments suspended in whole or in part, and may have them suspended earlier, unless such a circumstance exists. If a person whose way of payment has been changed and whose benefits are suspended still does not pay, the municipality may, after notice, deduct the premiums from the suspended benefits.(Art. 66(1), Art. 66(2), Art. 66(3), Art. 66(4), Art. 41(1), Art. 41(6), Art. 48(1), Art. 48(4), Art. 67(1), Art. 67(2), Art. 67(3)) (the provisions it rests on)
• Where a Primary Insured Person's premiums went uncollected until the right to collect them lapsed, the municipality, on certifying the person, reduces benefits for a period set according to that gap, unless it finds a disaster or other special circumstance a Cabinet Order names: 90 percent becomes 70 percent (80 becomes 70, and 70 becomes 60), and the high-cost and meals-and-accommodation benefits are not paid. A Secondary Insured Person who has left medical insurance premiums unpaid may likewise have the municipality stop paying providers in their place and suspend benefit payments, unless it finds such a special circumstance.(Art. 69(1), Art. 69(3), Art. 69(4), Art. 69(5), Art. 69(6), Art. 68(1), Art. 68(3), Art. 68(4)) (the provisions it rests on)
• A municipality may recover from anyone who obtained benefits by deception or other wrongdoing all or part of their value, and, for the meals-and-accommodation benefits, a further amount of up to twice what was paid; a doctor whose false entry in a medical certificate led to the payment can be ordered to pay jointly. A provider paid by deception must repay, and may be charged a further 40 percent of the amount to be repaid.(Art. 22(1), Art. 22(2), Art. 22(3)) (the provisions it rests on)
• For a designated in-home service provider, the prefectural governor or the mayor may, where needed in connection with benefit payments, order it to report or produce its books, question it, and have officials enter and inspect its premises. The governor may recommend that the provider put right a failure to meet the standards, publish that it did not follow the recommendation, and order it to comply if it fails without good reason; on grounds the Act lists — among them fraudulent claims for in-home service benefits and no longer meeting the staffing or operating standards — the governor may revoke the designation or suspend it in whole or in part for a period. Over the providers the mayor designates, such as community-based service providers, the mayor has these powers, and a designation of an in-home service provider lapses unless it is renewed every six years.(Art. 76(1), Art. 76-2(1), Art. 76-2(2), Art. 76-2(3), Art. 77(1), Art. 70-2(1), Art. 78-7(1), Art. 78-9(1), Art. 78-10(1), Art. 83-2(1), Art. 84(1)) (the provisions it rests on)
• The penalties are in Chapter 14. Members of the certification, benefit-review and examination bodies, care managers and staff of bodies entrusted with the Act's work who disclose, without good reason, secrets learned in that work face imprisonment (拘禁刑) of up to one year or a fine of up to 1,000,000 yen. A provider that fails to report, reports falsely or obstructs an inspection faces a fine of up to 300,000 yen, as does a person who received benefits and, when the Minister or the governor orders a report on the services received, fails to report or answers falsely; for many offences the business is fined as well as the person who acted.(Art. 205(1), Art. 205(2), Art. 69-37, Art. 209(1), Art. 208(1), Art. 24(2), Art. 211(1)) (the provisions it rests on)
• A Primary Insured Person must notify the municipality of becoming and ceasing to be insured and of other matters a Ministry of Health, Labour and Welfare Order sets — though, unless that Order says otherwise, not on becoming insured by turning 65 outside medical insurance — and the householder may notify for them; a moving-in, moving-out or similar notification under the Basic Resident Registration Act (住民基本台帳法) annotated for this purpose counts as one. A municipality may by local ordinance (条例) set a non-criminal fine (過料) of up to 100,000 yen for failing to notify (unless the householder did) or notifying falsely, for not handing over the insurance card when the municipality asks for it under the Act, and for an insured person or member of their household who refuses without good reason to produce documents or answer questions about eligibility, benefits or premiums. For evading premiums by deception, the fine may be up to five times the amount evaded.(Art. 12(1), Art. 12(2), Art. 12(5), Art. 214(1), Art. 214(2), Art. 214(3), Art. 214(4), Art. 202(1)) (the provisions it rests on)
• The prefectural governor may require a care manager (介護支援専門員) to report on their work and, where they breach their duties, give instructions or order them to take training; if they do not comply, the governor may prohibit them from working as a care manager for up to one year. The governor must delete a registration on some grounds the Act lists, among them registration obtained by fraud, and may delete it on others, among them a breach of the care manager's duties.(Art. 69-38(1), Art. 69-38(2), Art. 69-38(3), Art. 69-39(1), Art. 69-39(2)) (the provisions it rests on)
• The right to benefits cannot be transferred, pledged or seized, and no tax or other public charge is levied on what is paid as a benefit. That right lapses two years after it could first be exercised, as does the right to collect premiums and other money due under the Act or to have it refunded; a demand for payment of premiums renews the period. Premiums and other money a municipality collects under the Act are a revenue of the kind Article 231-3(3) of the Local Autonomy Act (地方自治法) names, whose enforced collection from a person in arrears (滞納処分) that separate Act governs.(Art. 25(1), Art. 26(1), Art. 200(1), Art. 200(2), Art. 144(1)) (the provisions it rests on)