“Lately, I feel like my out-of-pocket costs at the hospital have gone up…”
Many people may be feeling this kind of anxiety. In fact, the “20% copayment” system for the elderly, which began in 2022, reached a major milestone in October 2025.
The “consideration measures” that had previously helped keep payment amounts down have ended, meaning the actual burden for hospital visits could increase.
This time, we’ll explain everything from the system’s structure to the key changes, keeping technical jargon to a minimum.
1. Who is subject to the “20% copayment” in the first place?
Under Japan’s healthcare system, individuals aged 75 and older enroll in the “Later-Stage Elderly Medical Care System.”
Previously, except for those with income comparable to working-age individuals, the copayment at the point of service was “10%.”
However, to reduce the burden on the working-age population and ensure the system’s sustainability, starting October 2022, individuals with income above a certain threshold have been subject to a “20% copayment.”
| Burden ratio | Target Audience |
| 10% copay | General income earners, households exempt from resident tax, etc. |
| 20% copay担 | Individuals whose household taxable income is ¥280,000 or more, etc. |
| 30% copay | Individuals with income comparable to that of working individuals (e.g., taxable income of ¥1.45 million or more) |
2. What is the “Consideration Measure” ending in October 2025?
The “Consideration Measure” was introduced in response to concerns that “suddenly doubling medical expenses would be problematic” when the 20% copayment system was implemented.
Details of the Support Measures
A system to limit the maximum monthly increase in out-of-pocket expenses for outpatient care to 3,000 yen.
For example, if your monthly medical expenses (100% coverage) were ¥50,000, a 10% copay would be ¥5,000, but a 20% copay would be ¥10,000.
Thanks to the consideration measure, this ¥5,000 difference only increased to ¥3,000, meaning you actually only paid ¥8,000.
However, this lenient rule ended completely at the end of September 2025.
3. 【Starting October 2025】How will payments at service counters change?
With the elimination of the consideration measure, the amount paid at service counters after October 2025 will literally be “20% of the total cost.”
- Previously
Even for those subject to the 20% copay, the increase was capped at 3,000 yen per month. - Going forward
The cap will be removed, and the full 20% copay will be paid at the point of service.
※Of course, the original upper limit under the high-cost medical expense system (e.g., ¥18,000 per month for general income earners) will still apply. However, compared to the previous limited upper limit of “up to an additional ¥3,000,” the burden will increase.
4. Why Are Burdens Increasing? The Underlying Social Issue
This change stems from Japan’s severe “declining birthrate and aging population.”
Medical expenses for the elderly are largely supported not only by premiums paid by the individuals themselves, but also by “support payments” contributed by the working generation.
As the working generation continues to shrink, maintaining the system necessitates asking those with higher incomes to bear a “fair burden commensurate with their income.” This is the current reality.
5. Preparations We Can Make Now
To avoid straining your household budget due to rising medical costs, check the following two points in advance.
Recheck Your “Co-payment Rate”
Look at your “Late-Stage Elderly Medical Insurance Card (Insurance Card)” to confirm whether you fall under the 10%, 20%, or 30% co-payment category.
Estimate Your Medical Expense Budget Slightly Higher
Starting October 2025, depending on the number of visits and types of medications, your expenses could increase by several thousand yen.
Reviewing your household budget and contingency fund plans now will provide peace of mind.
Summary
The October 2025 “end of consideration measures” will directly impact the household finances of those subject to the 20% copayment.
By understanding the system correctly and preparing in advance, you can continue your medical visits without panic.
If you want to know your exact copayment amount, consulting the Late-Stage Elderly Medical Care System office in your municipality is the most reliable approach.
