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High-cost medical expense benefit: monthly out-of-pocket ceiling per household, under 70, by income band (care until July 2026)

{"a_over_11.6m":{"formula":"252,600円＋(医療費－842,000)×1%","multi_month":140100,"band":"年収約1,160万円～ 標報83万円以上/旧ただし書き所得901万円超"},"b_7.7m_to_11.6m":{"formula":"167,400円＋(医療費－558,000)×1%","multi_month":93000,"band":"標報53万～79万円/旧ただし書き所得600万～901万円"},"c_3.7m_to_7.7m":{"formula":"80,100円＋(医療費－267,000)×1%","multi_month":44400,"band":"標報28万～50万円/旧ただし書き所得210万～600万円"},"d_under_3.7m":{"amount":57600,"multi_month":44400,"band":"標報26万円以下/旧ただし書き所得210万円以下"},"e_resident_tax_exempt":{"amount":35400,"multi_month":24600}} JPY/month per household (formula or amount; multi_month = 4th and later month in 12; annual_cap = per year)

from 2018-08-01 · verified 2026-10-24 against the official source

ア 252,600円＋(医療費－842,000)×１% … エ 57,600円 オ 住民税非課税者 35,400円
key
jp/benefits/high-cost-medical-under-70
value
{"a_over_11.6m":{"formula":"252,600円＋(医療費－842,000)×1%","multi_month":140100,"band":"年収約1,160万円～ 標報83万円以上/旧ただし書き所得901万円超"},"b_7.7m_to_11.6m":{"formula":"167,400円＋(医療費－558,000)×1%","multi_month":93000,"band":"標報53万～79万円/旧ただし書き所得600万～901万円"},"c_3.7m_to_7.7m":{"formula":"80,100円＋(医療費－267,000)×1%","multi_month":44400,"band":"標報28万～50万円/旧ただし書き所得210万～600万円"},"d_under_3.7m":{"amount":57600,"multi_month":44400,"band":"標報26万円以下/旧ただし書き所得210万円以下"},"e_resident_tax_exempt":{"amount":35400,"multi_month":24600}} JPY/month per household (formula or amount; multi_month = 4th and later month in 12; annual_cap = per year)
period
—
effective
2018-08-01 to 2026-07-31
source
https://www.mhlw.go.jp/content/000333280.pdf
verified
2026-10-24 — fresh (13 days ago; next check by 2026-11-28)
next expected change
none named (irregular: changed by statute or order on no fixed date)
source checked
2026-11-02 (the newest day the automated check fetched the source page)
scope
児童手当 amounts from 令和6年10月分 (no income limit; paid in even months for the previous two months). 出産育児一時金 from April 2023. 高額療養費 for patients under 70: the table for care up to July 2026, the August 2026 – July 2027 table with the new 年間上限, and the 13-band table from August 2027 (健保 bands by 標準報酬月額; 国保 by 旧ただし書き所得 — see the PDF). 70歳以上 tables are not included.
hash
sha256:a3accdc6f9791128862a757f9291ee0d4d29bba6861d04893c8029725b89b085
signature
EdDSA, key db-2026-10 — keys

As JSON

curl -s https://databutler.dev/f/jp/benefits/high-cost-medical-under-70?max_age=30d — schema; verify with npx verified-facts verify https://databutler.dev/f/jp/benefits/high-cost-medical-under-70

{
  "protocol": "verified-facts/0.3",
  "key": "jp/benefits/high-cost-medical-under-70",
  "label": "High-cost medical expense benefit: monthly out-of-pocket ceiling per household, under 70, by income band (care until July 2026)",
  "value": {
    "a_over_11.6m": {
      "formula": "252,600円＋(医療費－842,000)×1%",
      "multi_month": 140100,
      "band": "年収約1,160万円～ 標報83万円以上/旧ただし書き所得901万円超"
    },
    "b_7.7m_to_11.6m": {
      "formula": "167,400円＋(医療費－558,000)×1%",
      "multi_month": 93000,
      "band": "標報53万～79万円/旧ただし書き所得600万～901万円"
    },
    "c_3.7m_to_7.7m": {
      "formula": "80,100円＋(医療費－267,000)×1%",
      "multi_month": 44400,
      "band": "標報28万～50万円/旧ただし書き所得210万～600万円"
    },
    "d_under_3.7m": {
      "amount": 57600,
      "multi_month": 44400,
      "band": "標報26万円以下/旧ただし書き所得210万円以下"
    },
    "e_resident_tax_exempt": {
      "amount": 35400,
      "multi_month": 24600
    }
  },
  "unit": "JPY/month per household (formula or amount; multi_month = 4th and later month in 12; annual_cap = per year)",
  "period": null,
  "effectiveFrom": "2018-08-01",
  "effectiveTo": "2026-07-31",
  "source": "https://www.mhlw.go.jp/content/000333280.pdf",
  "quote": "ア 252,600円＋(医療費－842,000)×１% … エ 57,600円 オ 住民税非課税者 35,400円",
  "verifiedDate": "2026-10-24",
  "nextScheduledRefresh": "2026-11-28",
  "changeCadence": "irregular",
  "nextExpectedChange": null,
  "sourceCheckedAt": "2026-11-02",
  "status": "fresh",
  "ageDays": 13,
  "maxAgeDays": null,
  "scope": "児童手当 amounts from 令和6年10月分 (no income limit; paid in even months for the previous two months). 出産育児一時金 from April 2023. 高額療養費 for patients under 70: the table for care up to July 2026, the August 2026 – July 2027 table with the new 年間上限, and the 13-band table from August 2027 (健保 bands by 標準報酬月額; 国保 by 旧ただし書き所得 — see the PDF). 70歳以上 tables are not included.",
  "hash": "sha256:a3accdc6f9791128862a757f9291ee0d4d29bba6861d04893c8029725b89b085",
  "signature": {
    "alg": "EdDSA",
    "kid": "db-2026-10",
    "jws": "eyJhbGciOiJFZERTQSIsImtpZCI6ImRiLTIwMjYtMTAifQ..IT5aOHOAB61-8WAhmAv5HiK0gJMbOgRhb9cxHkTEuzaZWvktXYbrc1lubRpr9RKSb0skNiNXjO5XMEzCJWkaDA",
    "keys": "https://databutler.dev/.well-known/jwks.json"
  },
  "publisher": {
    "name": "Data Butler",
    "url": "https://databutler.dev/"
  },
  "cite": {
    "url": "https://databutler.dev/facts/jp/benefits/high-cost-medical-under-70",
    "text": "databutler.dev, verified 2026-10-24 against https://www.mhlw.go.jp/content/000333280.pdf"
  }
}