Guides · 医療費控除 · iryōhi kōjo
Getting Money Back on Medical Bills — Japan's Medical Expense Deduction
After a long course of treatment or a hospital stay, a common question is whether any of it comes back at tax time. Sometimes it does. Japan's medical expense deduction — 医療費控除 (iryōhi kōjo) — lets a household take its medical costs above a threshold off taxable income. It is not a refund of your bills, and nobody applies it for you. You have to claim it yourself.
This page explains the rule as the National Tax Agency (国税庁, NTA) states it for the 2026 tax year. It also covers the 2026 reform to its smaller cousin, the self-medication tax system. I am a doctor, not a tax accountant, so this is a map of the system, not advice on your own return.
The short version: who actually gets money back
- Your household's medical costs for the calendar year must exceed ¥100,000 after you subtract insurance payouts and benefits. If your total income is under ¥2 million, the bar is 5% of that income instead.
- You must file a tax return (確定申告, kakutei shinkoku). Your employer's year-end adjustment (年末調整, nenmatsu chōsei) cannot do it for you.
- What comes back is tax, not the bill. The deduction lowers the income your tax is calculated on. The money you actually get back is the tax on that slice of income, and how much that is depends on your tax bracket.
- Residence matters, not nationality. Foreign residents claim on the same terms as Japanese citizens. Non-residents cannot claim it.
- There is an alternative if most of your spending was on drugstore medicine: the self-medication tax system, with a ¥12,000 threshold. Each year you use one or the other, not both.
The formula: ¥100,000, or 5% of income
The NTA's formula (Tax Answer No.1120, Japanese) has three parts:
(medical costs you actually paid in the year − insurance payouts and benefits that covered them) − ¥100,000 = your deduction
If your total income for the year (総所得金額等, sō-shotoku kingaku tō) is under ¥2 million, the ¥100,000 is replaced by 5% of that total income. This is a figure from the tax calculation, not your gross salary. For an employee, it starts from salary minus the employment income deduction (給与所得控除, kyūyo shotoku kōjo), so it is lower than your gross pay. The deduction is capped at ¥2 million.
For example (every number here is invented to show the mechanics): a couple share one household budget, and one partner pays all of the household's medical bills. In October one of them has surgery. They used neither a My Number card registered as their health insurance card nor the ceiling certificate (限度額適用認定証), so they pay ¥300,000 at the hospital counter for insured care. Later, the high-cost medical expense benefit refunds ¥207,060. Their private medical insurance also pays a ¥50,000 hospitalization benefit for the same admission. Over the year, the household spends another ¥80,000 on clinic visits and prescriptions, ¥35,000 at the dentist, and ¥5,000 on bus fares to the hospital.
| For example | Amount |
|---|---|
| Surgery, paid at the counter | ¥300,000 |
| − high-cost benefit refunded | −¥207,060 |
| − private hospitalization benefit | −¥50,000 |
| The surgery counts as | ¥42,940 |
| Clinic visits and prescriptions | ¥80,000 |
| Dentist | ¥35,000 |
| Bus fares to the hospital | ¥5,000 |
| Net medical costs for the year | ¥162,940 |
| − threshold (total income ¥2 million or more) | −¥100,000 |
| Medical expense deduction | ¥62,940 |
The ¥207,060 refund is the one from the worked example in our high-cost benefit guide (middle income bracket, ¥1,000,000 of care billed in one month; August 2026 figures). If the couple had used either one, the counter bill would have been ¥92,940 and there would be no refund to subtract. The surgery would still count as ¥42,940. You reach the same result either way.
Now suppose the partner who paid had a total income of ¥1.6 million. Then the threshold is 5% of that, ¥80,000, and the deduction becomes ¥82,940.
Remember that ¥62,940 is taken off taxable income. It is not the cash that comes back. You get back the tax on it, which is a fraction of that figure.
Subtract what came back
The NTA lists the payouts you must subtract:
- hospitalization benefits and medical insurance payouts from private insurance (入院費給付金・医療保険金)
- injury expense insurance payouts (傷害費用保険金)
- the high-cost medical expense benefit (高額療養費) and the family medical benefit (家族療養費)
- the childbirth lump-sum allowance (出産育児一時金), covered in our pregnancy and birth guide
- compensation for damages (損害賠償金) paid by whoever caused an injury
Two rules decide how the subtraction works.
First, you subtract each payout only from the costs it was paid for. If a payout is larger than that cost, the surplus does not reduce your other bills. In the example above, suppose the private policy had paid ¥150,000 instead of ¥50,000. The surgery would then count as zero. The extra ¥57,060 would not come off the family's other ¥120,000. Their deduction would be ¥20,000.
Second, if the money has not arrived yet, subtract what you expect to get. A high-cost refund or an insurance claim may still be in process when you file. In that case you subtract the amount you expect. If the final amount turns out different, you correct the return afterwards with an amended return (修正申告, shūsei shinkoku) or a request for correction (更正の請求, kōsei no seikyū).
One benefit is not subtracted: the maternity allowance (出産手当金, shussan teatekin), which is the pay replacement during maternity leave.
Travel insurance and insurance from your home country are not named on the NTA's list. They may fall under "medical insurance payouts," but I would not assume so. If one of those policies paid toward a Japanese medical bill, ask your tax office how to treat it.
What counts, what doesn't
The NTA's answers keep coming back to treatment. The cost of treating an illness counts. The cost of preventing one, or of improving your appearance, generally does not.
| Expense | Counts? | The detail that decides it |
|---|---|---|
| Doctor and hospital fees (診療費・治療費) | Yes | Fees for diagnosis and treatment |
| Medicine, including drugstore medicine | For treatment, yes | Cold medicine counts. Vitamins and other products taken for prevention do not |
| Train and bus fares to hospital or clinic (通院費) | Yes | Fares for your trips to get treatment |
| Taxi | Usually no | It counts only when you cannot use a train or bus. A taxi to the hospital when you are admitted to give birth counts |
| Dental treatment | Yes | Gold and porcelain restorations count. Orthodontics count when they are needed given the patient's age and the purpose; the NTA's example is correcting a growing child's bite. Straightening for appearance does not. Implants are not named either way, so ask your tax office |
| Glasses | Usually no | Everyday glasses for short or long sight do not count. Glasses a doctor instructs you to wear as part of treatment do count, for example for a short time after surgery for strabismus, cataract or glaucoma, or to develop a young child's vision. Contact lenses are not named, so ask your tax office |
| LASIK, orthokeratology | Yes | Both are named as counting |
| Health checkups (健康診断, kenkō shindan) | Usually no | The exception: if the checkup found a serious illness and you went on to have it treated, the checkup counts |
| Vaccinations for prevention (予防接種) | No | Prevention costs do not count. A checkup, or a routine or flu vaccination, does qualify you for the self-medication system below |
| Pregnancy and birth | Yes, mostly | Prenatal checkups, tests, and travel to them count once a pregnancy has been diagnosed. Travel home to give birth near family (里帰り出産) does not |
| Acupuncture, moxibustion, anma massage, judo therapy (はり・きゅう・あん摩・柔道整復) | For treatment, yes | They must be given as treatment |
| Long-term care (介護保険) | Partly | Part of the care-insurance co-payment counts. Welfare-type home services count only when you use them alongside medical-type services |
For the dental side of that table, our dental care guide explains which treatments fall outside insurance. For drugstore purchases, the pharmacy guide and our guide to Japanese over-the-counter medicines explain how to tell a treatment from a supplement.
Family: one household budget, one claimant
You can add together the medical costs of your spouse and other relatives who share your household budget (生計を一にする, seikei o itsu ni suru). The test is a shared budget, not a shared address. The relative has no income limit either: in a couple where both work, one partner can count both partners' bills.
The deduction goes to the person who actually paid. If one partner paid the bills, that partner makes the claim.
How to claim
- Gather the year's costs. Your health insurer's medical expense notice (医療費通知, iryōhi tsūchi) lists the care it paid for. If you file with e-Tax, the same notice data can be pulled in through the My Number portal (マイナポータル). Check the notice against your own receipts and add whatever it leaves out.
- Fill in the Statement of Medical Expenses (医療費控除の明細書, iryōhi kōjo no meisaisho) and attach it to your return. If you attach the insurer's notice, you do not have to write out the costs it already lists.
- Keep the receipts; don't send them. Receipts are not submitted with the return. But the tax office can ask to see them for five years after the filing deadline, so keep them for five years.
- File a tax return. One way to file is the NTA's online Tax Return Preparation Corner (確定申告書等作成コーナー), and the NTA publishes an English walkthrough of it (2025 edition at the time of writing). You do not need a personal seal (印鑑, inkan). Seals have not been required on returns since 1 April 2021, although some English checklists still list one.
Missed a year? It may not be too late. Suppose you file only to get tax back — a refund return (還付申告, kanpu shinkoku), as many employees do. You can file it from 1 January of the following year, and you have five years from that date. So costs paid in 2026 can be claimed from 1 January 2027. If you had a heavy medical year recently and never claimed, check whether you are still inside that five years.
The self-medication alternative
The regular deduction's ¥100,000 threshold can be out of reach if most of your spending was at the drugstore rather than the clinic. The self-medication tax system (セルフメディケーション税制, serufu medikēshon zeisei) exists for this case.
- It covers eligible over-the-counter medicines. Eligible products are marked on the receipt, and some packages also carry an identification mark.
- You deduct the amount above ¥12,000, up to a maximum of ¥88,000.
- It is open to people who are taking steps for their own health. Officially, that means one of these: a checkup through your health insurer, a municipal checkup, a routine workplace checkup, the specific health checkup (特定健診, tokutei kenshin, the "metabo" checkup described in our chronic conditions guide), a vaccination (a routine vaccination, 定期接種, or a flu shot), or municipal cancer screening.
- It replaces the regular deduction. It cannot be combined with it. Each year you choose one; which gives the larger deduction depends on your own figures. For example (invented figures), suppose you spent ¥40,000 on eligible medicine and little else. Self-medication would give you a ¥28,000 deduction. The regular rule would give you nothing if your total income is ¥2 million or more.
The 2026 change. The system was set to cover purchases from 1 January 2022 to 31 December 2026. Many English pages still describe it as ending in 2026. The 2026 tax reform, which passed on 31 March 2026 according to the Ministry of Finance, changes this in two ways:
- For switch OTC medicines (medicines that began as prescription-only and later went on sale over the counter), the end date is abolished.
- For all other eligible medicines, the end date is extended by five years.
The range of eligible products also changes from the 2027 income tax year (fiscal 2028 for residence tax). In practice, 2026 purchases work as they always have, and the system continues after 2026. The Ministry of Health, Labour and Welfare keeps an overview page (Japanese).
For foreign residents
The deduction has nothing to do with nationality. What matters is whether you are a resident (居住者, kyojūsha) for tax purposes. That means someone who has a domicile (住所, jūsho) in Japan, or who has had a place of residence (居所, kyosho) here continuously for one year or more (Tax Answer No.2875, Japanese).
Non-residents cannot claim it. A non-resident can take only three income deductions: casualty losses, donations, and the basic deduction.
Medical costs you paid abroad generally count too, as long as you are a resident — treatment during a trip home, for instance. The details are exactly the kind of question to take to your tax office: which parts count, and which exchange rate to use. The same goes for the year you leave Japan, if you leave partway through it.
Residence tax (住民税, jūminzei). Filing the national tax return also takes care of the residence-tax side. Yokohama City, for example, confirms that you then do not need to file a separate residence-tax declaration.
For official material in English, start at the NTA's Individual Income Tax page. It also links to the NTA's annual English income tax guide.
General information, not tax advice. Rules follow the National Tax Agency's Tax Answer pages as of 1 April 2026 (the 2026 tax year) and the 2026 tax reform as passed. Your own figures and unusual cases belong with your local tax office (税務署, zeimusho) or the NTA.