If your parent's long-term care costs exceed 40,000 yen a month, you may be entitled to a refund. The High-Cost Long-Term Care Service Fee benefit (kogaku kaigo service-hi) sets income-based monthly caps on out-of-pocket payments for long-term care insurance services, and the municipality refunds any amount above the cap — a long-term care counterpart to the high-cost medical expense benefit. You apply only once, the first time; after that, refunds are deposited automatically. The statute of limitations is 2 years, so amounts you kept paying without knowing about the system can be claimed retroactively. There is also the "High-Cost Medical and Long-Term Care Combined Expense benefit," which aggregates medical and long-term care costs over a year; its calculation period runs from August 1 to July 31 of the following year each year. With a new benefit year having just begun, this article organizes both systems together.
What the High-Cost Long-Term Care Service Fee benefit is: a monthly "cap" on out-of-pocket costs
When your out-of-pocket share for long-term care insurance services (10-30%) exceeds the following caps within the same month, the excess is refunded. Eligibility is determined per household (if more than one person in the household uses long-term care services, their payments are combined).
| Income bracket | Monthly cap (household) |
|---|---|
| Taxable income of 6.9 million yen or more (annual income roughly 11.6 million yen and up) | 140,100 yen |
| Taxable income of 3.8 million to under 6.9 million yen (annual income roughly 7.7-11.6 million yen) | 93,000 yen |
| Subject to resident tax, with taxable income under 3.8 million yen | 44,400 yen (most typical households fall here) |
| All household members exempt from resident tax | 24,600 yen |
| Among the above, those with pension income etc. below a certain amount, public assistance recipients, etc. | 15,000 yen (per person) |
From August 2026, the threshold for the low-income brackets rises to 826,500 yen: the pension-income benchmark used to determine the "lower caps (24,600 yen / 15,000 yen)" within the resident-tax-exempt household bracket was raised from 809,000 yen to 826,500 yen for service use from August 2026 onward (linked to the revision of pension amounts). If you are near the borderline, your bracket may change, so check the notice from your municipality.
Watch out for costs that are not covered: meal and residence (stay) charges at facilities, private-room surcharges equivalent to extra-bed fees, purchases of welfare equipment and home renovation costs, and services paid entirely out of pocket beyond the benefit ceiling are not covered. The cap applies not to "everything you pay for care" but to "the out-of-pocket portion under long-term care insurance."
Procedure: apply only once, the first time; statute of limitations is 2 years
- When you qualify, the municipality sends you an application form: typically, a "notice of benefit application" is mailed 2-3 months after the first month you exceeded the cap
- Return the application form only for the first time: once you register a bank account, subsequent refunds are deposited automatically
- The statute of limitations is 2 years: even if you left the application form untouched or overlooked the notice, you can apply retroactively within 2 years from the first day of the month following the month of service use
"No notice arrived" does not necessarily mean "not eligible." There are cases where the application slipped through due to an address change or overlooked paperwork. If there is any month in which the user's out-of-pocket long-term care payments exceeded 44,400 yen a month (the cap for typical households), it is worth asking the municipality's long-term care insurance division about the benefit payment status. For a parent living apart from you, the quickest route is to ask the care manager for the monthly out-of-pocket amount.
More comes back annually: the "High-Cost Medical and Long-Term Care Combined Expense benefit"
Even after the monthly caps are applied (medical = high-cost medical expense benefit; long-term care = High-Cost Long-Term Care Service Fee benefit), households whose combined annual out-of-pocket total for medical plus long-term care costs is still large have one more layer: an annual cap.
- Calculation period: August 1 to July 31 of the following year, every year (a new benefit year has just begun)
- Who qualifies: households within the same medical insurance plan (latter-stage elderly medical care, National Health Insurance, or employer health insurance) that have out-of-pocket costs for both medical care and long-term care
- Rough cap amounts: for example, 560,000 yen a year for the standard income bracket of those aged 70 and over; caps are set by income and age bracket. Because the medical-side high-cost medical expense benefit was revised from August 2026, the combined-benefit caps may also change, so check the latest amounts with your insurer (municipality, health insurance society, etc.)
- Where to apply: the office of the medical insurance you are enrolled in as of the base date (July 31). Because it spans both long-term care and medical care, payment takes several months. The statute of limitations here is also 2 years
Example: one year for a parent in latter-stage elderly medical care (standard bracket)
- Medical out-of-pocket costs (after the high-cost medical expense benefit): 300,000 yen a year
- Long-term care out-of-pocket costs (after the High-Cost Long-Term Care Service Fee benefit): 400,000 yen a year → total 700,000 yen
- If the annual cap for the bracket is 560,000 yen, the difference of roughly 140,000 yen comes back upon application (actual cap amounts vary by bracket and year)
For how the monthly cap on medical costs (the high-cost medical expense benefit) works, see our guide to the high-cost medical expense benefit. Note that from August 2026 the high-cost medical expense benefit has undergone a revision of its caps and the introduction of a new annual ceiling; that article follows the latest developments.
Don't stumble over how "household" is defined
- Household for the High-Cost Long-Term Care Service Fee benefit: the household on the resident register; if multiple members use long-term care services, their out-of-pocket payments can be combined
- Household for the combined expense benefit: not the resident register but the unit of "family members enrolled in the same medical insurance plan." For example, a parent under latter-stage elderly medical care and a child under an employer's health insurance society cannot combine their costs
- Whether you add a parent as a dependent also matters: tax dependency and medical insurance dependency are separate things, and making a parent a dependent on your medical insurance can mean their out-of-pocket cap bracket is based on the child's income. We weigh the pros and cons in the pros and cons of adding a parent as a dependent
- If all household members are exempt from resident tax, the caps drop substantially. For how that determination works, see the conditions for resident-tax-exempt households
What to do today
What to do today
- Check the most recent monthly out-of-pocket amount for long-term care services (from the user's statement of charges, or by asking the care manager). If any month exceeded 44,400 yen, ask the municipality about the benefit payment status
- Check your parent's mail to see whether any "notice of benefit application" from the past 2 years has been left unanswered (if the limitation period has not run out, the money can be recovered)
- Households with out-of-pocket costs for both medical and long-term care should start recording their payments for the combined benefit year that has just begun (August 2026 to July 2027)
FAQ
Q. Are the monthly fees of a private fee-based nursing home also covered?
A. Not in full. Only the out-of-pocket portion for long-term care insurance services (such as daily life care for residents of specified facilities) is covered; rent, meals, management fees, and premium add-on service charges are not. Check the breakdown on the invoice to see how much of it is "the out-of-pocket share under long-term care insurance."
Q. Can I get back past amounts I forgot to apply for?
A. You can apply retroactively within 2 years from the first day of the month following the month of service use. The surest way is to ask the municipality's long-term care insurance division whether there are any unclaimed High-Cost Long-Term Care Service Fee benefits from the past.
Q. Is this paid separately from the high-cost medical expense benefit?
A. Yes, separately. It is a three-tier structure: medical costs are refunded through the high-cost medical expense benefit (monthly), long-term care costs through the High-Cost Long-Term Care Service Fee benefit (monthly), and if the combined annual burden is still large, the High-Cost Medical and Long-Term Care Combined Expense benefit (annual) is added on top.
Q. What changed from August 2026?
A. On the long-term care side, the pension-income benchmark used to determine the lower caps (24,600 yen and 15,000 yen) within the resident-tax-exempt household bracket was raised from 809,000 yen to 826,500 yen. On the medical side, a revision of the high-cost medical expense benefit caps and the introduction of a new annual ceiling have begun. If you are near a borderline, check for a bracket-change notice.
Reference links (sources)
* Amounts and brackets reflect information as of August 2026. The caps for the combined expense benefit may change along with revisions to the medical-side system. For individual decisions, check with your municipality, your medical insurer, or a professional.