The most a person at the top care level (Care Level 5) can use under Japan’s public long-term care insurance in one month is 36,217 units. Treat one unit as roughly 10 yen and that comes to about ¥362,000. With the standard 10% copay, the bill is around ¥36,000 (Ministry of Health, Labour and Welfare, Overview of the Long-Term Care Insurance System, July 2025; the benefit ceiling was last revised in October 2019 and has not moved since).
Anything used beyond that ceiling is paid entirely out of pocket. But the 10% copay inside the ceiling has its own cap, too.
The “high-cost long-term care benefit”
If your combined copays in one month exceed a household limit, the excess is refunded afterward. The limit depends on income. The Ministry’s Long-Term Care Information Disclosure System lists these tiers:
| Tier | Monthly limit |
|---|---|
| Recipients of public assistance | ¥15,000 (individual) |
| Everyone in the household exempt from resident tax, pension and other income of ¥826,500 or less | ¥24,600 (household), ¥15,000 (individual) |
| Everyone in the household exempt from resident tax, income above ¥826,500 | ¥24,600 (household) |
| Taxable income under ¥3.8 million | ¥44,400 (household) |
| Taxable income ¥3.8 million to under ¥6.9 million | ¥93,000 (household) |
| Taxable income ¥6.9 million or more | ¥140,100 (household) |
For taxable households, the tier is set by the highest taxable income among the person and anyone aged 65 or over in the same household. It is based on the previous year’s income and applies from August through the following July (Shinjuku Ward public notice). So a high-earning relative aged 65 or older living under the same roof can push the limit up, even if the person receiving care has little income.
For a taxable household under the ¥3.8 million line, monthly care copays stop at ¥44,400.
What the cap does not cover
This is where people get caught. According to Itabashi Ward’s guidance, the cap excludes purchases of assistive equipment, home renovation costs, room charges at facilities, meals, and the copay for services outside insurance coverage.
Move into a nursing facility and meals and room charges stack up every day. In the Ministry’s published standard amounts for a special nursing home for the elderly, meals are ¥1,545 per day and a private unit-type room is ¥2,066 per day. Multiply by 30 days and you get ¥46,350 for meals and ¥61,980 for the room, ¥108,330 in total, on top of the 10% copay.
People with low income and limited savings can get those charges reduced through a certification process. At the second tier (household exempt from resident tax, pension and other income of ¥826,500 or less), the daily charge drops to ¥390 for meals and ¥880 for a private unit-type room. The savings guideline is ¥6.5 million or less for a single person and ¥16.5 million or less for a couple. You have to apply to your municipality.
A yearly cap that combines medical and care costs
Households that pay copays under both health insurance and long-term care insurance fall under a combined annual cap, and the excess is refunded. For people 75 and over, the limits are:
| Income tier | Annual limit |
|---|---|
| Annual income of about ¥3.7 million or less | ¥560,000 |
| Household exempt from resident tax, etc. | ¥310,000 |
| Exempt household with pension income of ¥826,500 or less (individual) | ¥190,000 |
You can claim when the excess is ¥500 or more, by applying to your health insurer. Higher-income tiers run from ¥670,000 up to ¥2.12 million.
Refunds don’t show up on their own
You have to file an application. In Itabashi Ward, eligible households get a notice and an application form roughly three months after the service month. If the form never goes back, the money never comes back.
Procedures differ somewhat by municipality.
This is my opinion, but the system works best for people who know it exists. Asking your care manager, “Am I covered by the high-cost benefit?” is enough to start the check. Limits and copay rates are still under review, so confirm current amounts with your municipal long-term care office or your care manager.
On Monday we get back to health habits.
If you want the walking side of this story, my book Walking to 110 draws on the world’s longest-lived communities. Kindle edition here.
References
- Ministry of Health, Labour and Welfare. Overview of the Long-Term Care Insurance System (July 2025).
- Ministry of Health, Labour and Welfare. Long-Term Care Information Disclosure System, “Costs of Long-Term Care Insurance” (https://www.kaigokensaku.mhlw.go.jp/commentary/fee.html, accessed October 8, 2026).
- Shinjuku Ward, Tokyo. Public notice on the high-cost long-term care (prevention) service benefit (accessed October 8, 2026).
- Itabashi Ward, Tokyo. Public notice on the high-cost long-term care (prevention) service benefit (accessed October 8, 2026).