Medical Care System for the Elderly （75+）

Contact the persons responsible for medical care for the elderly at your local city hall, ward office, or town office

What is the Medical Care System for the Elderly?

This is a medical insurance system that allows senior citizens age 75 and up to receive medical care with a minimum of worries about the costs.

A person enrolled in this system pays 10% of the medical treatment fee at the hospital. The remaining 90% is divided into 3 parts: 50% of which is paid by the government, 40% paid by the Health Insurance system, and 10% comes from a pool of funds paid by all members of this system as a kind of health insurance.

1. Eligibility for the Medical Care System for the Elderly

When a person reaches 75 years of age, he or she may enroll in this system, but must first withdraw from the National Health Insurance System or any private health insurance systems.
However, people receiving welfare benefits, or non-Japanese with a Resident Status （visa） of less than one year, may not enroll.
If a person enrolled in the system moves to a new location, begins receiving welfare benefits, or dies, this information must be taken as soon as possible to the local municipal office. If the person moves within Shizuoka Prefecture, that person is still eligible for this Medical Care System and coverage will continue. If the person moves to a different prefecture, he or she must enroll in that prefecture's system

2. Proof of Coverage at Hospitals

Each person 75 years old and up will be given a Medical Care System for the Elderly Insurance Card, which includes an insurance number. This card will be issued from the municipal office near the person's residence.
This card must be shown at the reception desk in the hospital
This card is issued once a year, which will occur late July. The card is valid from August 1st to July 31st of the next year.
The percentage of medical treatment costs to be paid will be written on the insurance card （10% for general users of this system, 30% for those receiving income other than pension*）. The card user must pay that amount at the hospital.

*This means that if either the card-holder or another household member also enrolled in this system has an individual annual taxable income of ￥1,450,000, he or she must pay 30% of treatment costs）

3. Meal Costs During Hospital Stays （standard cost burden）

During a hospital stay, the patient enrolled in this system must pay ￥260 per meal. The remainder of the meal cost is paid for by the Medical Care System for the Elderly.
During a long term hospital stay where the patient is bedridden, the patient must pay ￥460 per meal.
The patient must also pay ￥320 per day for other residency expenses.

※For a patient from a household that is not required to pay municipal taxes, the cost of meals is reduced. Please apply for this benefit at your local municipal office before being admitted to hospital.

4. In Cases of High Medical Costs

When medical treatment for illness or injury incurs a high cost, there is a maximum amount that a single household must pay per month, in order to keep the monthly burden from being too high.
If the monthly fee paid for medical treatments exceeds the levels written in the chart below, the extra costs will be paid by the Medical Care for the Elderly System.

In Cases of High Medical Costs
Income Designation		Hospital Stays
Income Designation	Hospital Visits	Visit + Stays
Receiving Income beyond Pension	￥44,400	￥80,100 + （cost - 267,000）× 1%
General	￥12,000	￥44,400
Low Income II	￥8,000	￥24,600
Low Income I	￥8,000	￥15,000

5. In Cases of Pre-payment

In the cases outlined below, people enrolled in this system must pay in full at the hospital or clinic where treatment was given, and then afterwards apply for reimbursement at their local municipal office. Recognized treatments will be partly repaid, with amounts repaid depending on the circumstances and treatment involved.

In the case of an emergency or during a trip, and the person does not have the insurance card in hand
During an overseas trip, and the person must receive medical treatment for illness or injury at an overseas hospital or clinic
Judo-orthopedic or orthopedic treatment
Treatment accessories as required by the physician （such as a corset）
Blood transfusions as required by the physician
Acupuncture, moxibustion, acupressure, massage, etc., as required by the physician
ransfer costs for seriously injured or ill patients to other hospitals, as required by the physician

6. High Cost Medical Treatment/High Cost Care Calculation System

（In the case of households that have incurred high medical treatment or care costs）

If the medical treatment costs and the care costs paid in one year by a person enrolled in the Medical Care System for the Elderly exceed the amounts listed in the chart below, the person can apply for the excess amounts to be covered by this system.

Income Designation	Maximum Cost Limit
Receiving Income beyond Pension	￥670,000
General	￥560,000
Low Income II	￥310,000
Low Income I	￥190,000

7. Insurance Cost

All people enrolled in the Medical Care System for the Elderly must pay an insurance fee.
The insurance cost will be taken from pensions that reach or exceed ￥180,000 per year.
People whose pensions are less than the above amount must take their tax notifications （納入通知書）, which includes insurance cost information, to the local municipal office and pay in person

The insurance cost is determined by two factors

Per capita portion: this number is equal among all people enrolled in the program
●Annual fee per person　￥36,400
Income portion: this number is determined by the individual's income

These two portions are added together to determine the person's insurance payments.

※The maximum insurance fee for one year is ￥500,000

※People enrolled in the program who had been receiving social insurance, or who had very low incomes, will be eligible to have their insurance payments reduced.