August is the month when medical expense "income brackets" all switch over at once. For National Health Insurance and the medical system for those aged 75 and over, the income brackets for High-Cost Medical Expense Benefits and the Ceiling Amount Application Certificate are renewed every year on August 1 based on the previous year's income. And August 2026 is special: (1) the full transition under which expired paper health insurance cards can no longer be used, (2) the entry into force of the revised High-Cost Medical Expense ceilings, and (3) the annual bracket switchover — all three arrived at the same time. This article walks through the convenient rule that "with a Myna Insurance Card, the certificate is in principle unnecessary," the cases where you still need the certificate, and an August checklist that covers your family and your parents too.
The "three switchovers" that happened in August 2026
| What changed | Details |
|---|---|
| (1) Full transition away from paper insurance cards (August 1) | The transitional measure allowing you to see a doctor with an expired paper health insurance card ended on July 31. From then on, you must present a Myna Insurance Card or an Eligibility Confirmation Certificate (showing only an expired insurance card is treated the same as "forgetting your insurance card") |
| (2) Revision of High-Cost Medical Expense ceilings (from treatment received in August) | Higher out-of-pocket ceilings and a newly created "annual cap" took effect. For details, see our guide to the High-Cost Medical Expense Benefit system |
| (3) Annual income-bracket switchover (August 1) | For National Health Insurance and the medical system for those aged 75 and over, the High-Cost Medical Expense brackets (ceilings) and the copayment ratio for those aged 75 and over (10-30%) are redetermined based on the previous year's income. Ceiling Amount Application Certificates are also renewed to the new bracket |
In other words, this month is the perfect time to check whether the insurance card and certificate in your possession are still valid and whether your bracket has changed — or rather, it is a month when failing to check will cause trouble at the hospital counter.
With a Myna Insurance Card, the "Ceiling Amount Application Certificate" is in principle unnecessary
The High-Cost Medical Expense Benefit works in two ways: getting a refund afterward, or having your payment at the counter capped at the ceiling from the start. The Ceiling Amount Application Certificate was used for the latter. If you see a doctor using your Myna Insurance Card and consent to information sharing on the medical institution's card reader, your ceiling information is linked through online eligibility verification, and your payment at the counter is automatically capped at the ceiling even without the certificate.
- No advance application or annual renewal needed: unlike the paper certificate, there is no need to file a renewal application every August. Bracket switchovers are also reflected automatically
- All you do is give consent at reception: on the screen of the face-recognition card reader, consent to "providing ceiling amount information"
Main cases where you still need the certificate (paper document)
- When you visit a medical institution or pharmacy that does not support online eligibility verification
- For the reduction of hospital meal charges for residence-tax-exempt households, in cases of long-term hospitalization exceeding 91 days over the past 12 months (a separate application for long-term hospitalization status is required)
- When linkage of ceiling information is restricted, for example due to unpaid insurance premiums
If any of these may apply to you, apply to your insurer (municipality, health insurance society, or Japan Health Insurance Association) for issuance or renewal of the certificate.
If you use the paper certificate: the August renewal procedure
| Insurer | Certificate renewal |
|---|---|
| National Health Insurance / medical system for those aged 75 and over | As a rule, the certificate is valid through July 31, with the new bracket applying from August 1. Some municipalities send a new certificate automatically while others require a renewal application, so if yours has not arrived, contact your municipal office |
| Japan Health Insurance Association / health insurance societies | The certificate's validity period is set individually, such as up to one year from issuance (not uniformly the end of July). Check the expiration date on your certificate and reapply if it has expired |
If you present an expired certificate at the counter, the ceiling will not be applied; you will first pay the full 30% (or 20%/10%) copayment and receive a refund later (several months after applying). If you have a hospitalization or surgery planned, deciding before admission whether to use your Myna Insurance Card or renew the certificate is the arrangement that avoids rework.
If you have a parent aged 75 or over: the copayment ratio (10-30%) also changes in August
In the medical system for those aged 75 and over, the copayment ratio itself (10%, 20%, or 30%) is reviewed every year on August 1 based on the previous year's income. This is the time of year when it can rise to 20% or 30% in the year after a parent had income other than pensions, or conversely fall in the year after retirement.
- The new copayment ratio can be checked on the Eligibility Confirmation Certificate (or via Mynaportal)
- If you have a chance to see your parents, such as a trip home, check the "expiration date of their insurance card (Eligibility Confirmation Certificate) and their copayment ratio" as a set. From August 1, expired paper insurance cards can no longer be used
- For households paying out of pocket for both medical care and long-term care, the annual combined-cap mechanism also helps. See also High-Cost Long-Term Care Service Fees and the combined benefit
If you think your bracket may have changed
- The year after your income increased: your bracket goes up and your monthly ceiling rises. Because the revision of the ceilings themselves also takes effect from August 2026, if you feel that "the same hospitalization as last month now costs more," first suspect both the bracket switchover and the ceiling revision
- The year after retirement or an income drop: your bracket goes down and the ceiling falls (works in your favor). If every household member becomes exempt from residence tax, the ceiling drops significantly and you also qualify for reduced hospital meal charges. For how the determination works, see the conditions for residence-tax-exempt households
- Those leaving employer health insurance upon retirement: the three options — voluntary continuation, National Health Insurance, or becoming a family member's dependent — also change how the High-Cost Medical Expense Benefit applies. Compare them in the three health insurance options after retirement
- Those whose costs keep falling just short of the ceiling: you may still get money back through household aggregation, which combines family members' expenses, or the multiple-occurrence rule, which lowers the ceiling from the fourth time within the past 12 months. See household aggregation and the multiple-occurrence rule of the High-Cost Medical Expense Benefit for how they work. And if you belong to a large company's health insurance society, fuka kyufu (additional benefits) may cap your costs at an even lower level
FAQ
Q. What should family members without a Myna Insurance Card do?
A. They can see a doctor as before using the Eligibility Confirmation Certificate issued by their insurer. If they want the ceiling applied at the counter, they should apply for issuance or renewal of the paper Ceiling Amount Application Certificate.
Summary
- On August 1, 2026, three changes landed at once: the grace period for expired paper health insurance cards ended, the high-cost medical expense benefit caps were revised, and the annual income-bracket switchover took place.
- If you use the My Number Card health insurance card and agree to share your cap information via the card reader, you generally no longer need a Certificate of Eligibility for Ceiling-Amount Application.
- For people still using a paper certificate, National Health Insurance and the late-stage elderly healthcare system certificates expired on July 31. Check the expiration date on certificates from the Japan Health Insurance Association (Kyokai Kenpo) or a company health insurance union.
- The copayment rate for people 75 and over (1-3 of the cost) is also reassessed on August 1 based on the previous year's income. Check it via the parent's certificate of eligibility.
- With an expired certificate, the cap does not apply, so you must pay the full amount up front and get reimbursed later.
References (sources)
Note: How the certificate is renewed and whether it is mailed automatically differs by insurer (municipality, health insurance society, etc.). Always confirm your individual bracket and ceiling with your insurer. This article is general information based on what was known as of August 2026.
