This is a translation of the Japanese original. The Japanese version is authoritative; figures follow Japanese tax law.
Japan is debating whether to lower the line at which users of long-term care insurance (介護保険) services pay 20% of the cost, from today's "pension income etc. of ¥2.8 million" to somewhere between ¥2.6 million and ¥2.3 million. The Long-term Care Insurance Subcommittee of the Social Security Council (社会保障審議会介護保険部会, 136th meeting) took the question up again on 18 September 2026, with an eye on the 10th plan period starting in fiscal 2027. Under the widest option, ¥2.3 million, about 350,000 people would newly move to 20%, according to the government's estimate[MHLW, subcommittee 136th meeting, Document 2 (in Japanese)].
Nothing has been decided yet. The government's policy is to "reach a conclusion within fiscal 2026". For someone at care level 3 using ¥270,000 of home-care services a month, moving to 20% adds ¥17,400 a month, and if the proposed cap is adopted the increase stops at ¥7,000 a month (this site's estimate). Start by checking your parent's long-term care insurance co-payment certificate (介護保険負担割合証) and pension amount.
The short answer: a single person with a ¥2.4 million pension stays at 10% or moves to 20%, depending on the option
We applied the four thresholds put to the subcommittee to single people aged 65 or over who live on pension income only. The current line is ¥2.8 million.
| Pension income (single) | Current (¥2.8m) | ¥2.6m option | ¥2.5m option | ¥2.4m option | ¥2.3m option |
|---|---|---|---|---|---|
| ¥2.2 million | 10% | 10% | 10% | 10% | 10% |
| ¥2.4 million | 10% | 10% | 10% | 20% | 20% |
| ¥2.5 million | 10% | 10% | 20% | 20% | 20% |
| ¥2.6 million | 10% | 20% | 20% | 20% | 20% |
| ¥2.8 million | 20% | 20% | 20% | 20% | 20% |
| ¥3.2 million | 20% | 20% | 20% | 20% | 20% |
| ¥3.5 million | 30% | 30% | 30% | 30% | 30% |
| People newly at 20% (estimate) | - | about 130,000 | about 210,000 | about 280,000 | about 350,000 |
* This site's application of the options. We assume the total income (合計所得金額) threshold also falls, in line with the income distribution in the document, to roughly pension income minus ¥1.2 million. Head counts are the Ministry of Health, Labour and Welfare's (MHLW) rough estimate with a ¥7,000 monthly cap[same Document 2, p.22 (in Japanese)].
For households with two or more people aged 65 or over, such as couples, the current line is ¥3.46 million. The options lower it to between ¥3.26 million and ¥2.96 million. Until the government reaches a conclusion, all of these remain proposals.
Today's 10%, 20% and 30% are set in two steps: your own income, then the household's pension income etc.
Whether you pay 20% depends on meeting both of two conditions. First your own total income is checked, then the household's pension income etc.[MHLW, Overview of the Long-term Care Insurance System (July 2025) (in Japanese)].
| Co-payment | Your total income | Pension income + other total income (single) | Same (two or more) |
|---|---|---|---|
| 30% | ¥2.2 million or more | ¥3.4 million or more | ¥4.63 million or more |
| 20% | ¥1.6 million or more | ¥2.8 million or more | ¥3.46 million or more |
| 10% | Everyone else (91.8% of users aged 65 or over) | ||
- Total income is income before deductions. For pension only, it is pension income minus the public pension deduction, which is ¥1.1 million for people aged 65 or over with pensions of ¥3.3 million or less[National Tax Agency, No.1600 (in Japanese)].
- "Two or more" means the combined figure of everyone aged 65 or over in the same household on the resident register[MHLW, 2015 subcommittee document (in Japanese)].
- Only the person who crosses the line pays 20%. Even if the husband is at 20%, a wife with a small pension stays at 10%.
- Survivors' and disability pensions are tax-free, so they are not counted as "pension income"[Sapporo City (in Japanese)].
As of March 2025, of about 5.41 million users, 4.3% (234,062 people) paid 20% and 3.9% paid 30%[same Document 2, p.7 (in Japanese)]. When 20% was introduced in 2015, the line was drawn at the "top 20%" of insured people aged 65 or over. Among people who actually use care, those at 20% are under 5%.
On the table: four options from ¥2.6 million to ¥2.3 million, and two ways to soften the blow
There are four thresholds and two relief measures to pair with them. The 18 September document re-presented, as reference material, the options and estimates shown to the subcommittee in December 2025, and asked members how to think about them[same Document 2, pp.15 and 22 (in Japanese)].
| Option (single / couple) | Top share of insured | Newly at 20% (with ¥7,000 cap) | Benefit spending saved | Premiums saved |
|---|---|---|---|---|
| ¥2.6m / ¥3.26m | about 24% | about 130,000 | about ¥8 billion | about ¥4 billion |
| ¥2.5m / ¥3.16m | about 26% | about 210,000 | about ¥12 billion | about ¥6 billion |
| ¥2.4m / ¥3.06m | about 28% | about 280,000 | about ¥17 billion | about ¥8 billion |
| ¥2.3m / ¥2.96m | about 30% | about 350,000 | about ¥21 billion | about ¥10 billion |
Source: MHLW subcommittee Document 2 (fiscal estimates on p.22, income distribution on p.19). The top share is the proportion of Category 1 insured persons (aged 65 or over) above the line, as of 1 April 2025.
The first relief measure would cap the increase at ¥7,000 a month for the time being. Even at 20%, anything more than ¥7,000 above what you paid at 10% would not be charged. The second would return people with savings below a set amount to 10% on application. Three lines were shown: ¥7 million, ¥5 million and ¥3 million for singles (¥17 million, ¥15 million and ¥13 million for couples).
Under the savings option, with the ¥2.3 million line and the ¥7 million test, about 160,000 people would newly pay 20% while about 190,000 would return to 10% on application, the estimate says[same Document 2, p.22 (in Japanese)]. It would work by self-declaration with copies of bank books, and municipalities could query banks.
How much more a month at 20%? The ¥44,400 cap puts a ceiling on it
The increase depends on how many services you use, and heavy users hit the ceiling. For a typical taxed household, the high-cost long-term care benefit (高額介護サービス費) caps the co-payment at ¥44,400 a month[MHLW, Long-term care service information system (in Japanese)].
- At 10%: ¥270,000 × 10% = ¥27,000
- At 20%: ¥270,000 × 20% = ¥54,000 → the ¥9,600 above the ¥44,400 cap is refunded → ¥44,400 (up ¥17,400 a month, ¥208,800 a year)
- With the ¥7,000 monthly cap: ¥27,000 + ¥7,000 = ¥34,000 (up ¥84,000 a year)
The monthly benefit limit for home care at care level 3 is ¥270,480 (at ¥10 per unit). In some areas a unit is worth more than ¥10.
| Use (per month) | 10% | 20% (cap ¥44,400) | Increase | ¥7,000 cap option |
|---|---|---|---|---|
| Care level 1, home care ¥100,000 | ¥10,000 | ¥20,000 | +¥10,000 | ¥17,000 (+¥7,000) |
| Home care ¥222,000 | ¥22,200 | ¥44,400 | +¥22,200 (maximum) | ¥29,200 (+¥7,000) |
| Care level 3, home care ¥270,000 | ¥27,000 | ¥44,400 | +¥17,400 | ¥34,000 (+¥7,000) |
| Care level 5, home care ¥360,000 | ¥36,000 | ¥44,400 | +¥8,400 | ¥43,000 (+¥7,000) |
| Nursing home, care level 5, shared room | ¥26,130 | ¥44,400 | +¥18,270 | ¥33,130 (+¥7,000) |
* This site's estimate. The nursing home service fee is MHLW's guide figure (871 units × 30 days). Meals and accommodation are charged separately, regardless of the co-payment rate.
Note that the amount above the cap is refunded later. You first pay the full 20% at the counter, and the excess is repaid after you apply to your municipality. Only the first time needs an application; see our guide to the high-cost long-term care benefit.
Couples face a ¥3.46 million line, and when a spouse dies the ¥2.8 million single line applies
The couple line is ¥660,000 higher than the single line, and when the number of people in the household changes, the assessment changes from the following month[MHLW, 2015 subcommittee document (in Japanese)]. This switch is easy to miss.
- Husband's total income: ¥2.9 million − ¥1.1 million = ¥1.8 million (¥1.6 million or more)
- Household pension income etc.: ¥2.9 million + ¥400,000 = ¥3.3 million → below ¥3.46 million, so 10% today
- Under every option (¥2.96m, ¥3.06m, ¥3.16m, ¥3.26m), ¥3.3 million is over the line: 20%
- If the wife dies: single with ¥2.9 million → already over ¥2.8 million, so 20% from the next month
A survivors' pension the wife receives is tax-free and does not count toward the line. How far the couple line falls will decide whether many households now at 10% change. Compare premiums from age 65 in our municipal comparison of long-term care premiums, and see the full picture of tax and premiums on a pension in tax and premiums for people living on a pension.
How not to read this, and cautions: figures not yet decided, and assessments that shift with resident tax filings
The option figures in this article will not simply become next year's charges. With that in mind, here are the assessment gaps that already happen under the current system.
- Decided: the current thresholds (¥2.8m, ¥3.46m, ¥1.6m) and the ¥44,400 high-cost benefit cap
- Not decided: which option, whether relief measures apply, and from when. The government's policy is to "reach a conclusion within fiscal 2026" (Basic Policy on Economic and Fiscal Management 2026), and the subcommittee plans to conclude before the 10th period starts in fiscal 2027
- The Ministry of Finance's Fiscal System Council has called for the government to "expand those subject to 20% co-payment"[Ministry of Finance, 28 April 2026 (in Japanese)]. At the subcommittee, cautious members warned that people would cut back on care and their condition would worsen
Things that do not affect the assessment
- The medical expense deduction, disability deduction and social insurance deduction (total income is before deductions)
- Survivors' and disability pensions (tax-free)
- A spouse's small pension (at 10% as long as their own income is under ¥1.6 million)
Things that change the assessment
- Income other than pensions, such as part-time pay or rent
- Corrections to your resident tax return (the rate changes retroactively)
- Changes in household size (from the month after a move or death)
Municipalities assess automatically from the previous year's income data for resident tax. If non-pension income was not declared and income is later corrected, the co-payment rate changes retroactively back to the most recent August[MHLW, 2015 subcommittee document (in Japanese)]. The difference is billed in one go. A disability deduction for a parent needing care lowers resident tax but does not change the co-payment rate. How to claim it is covered in a parent needing care may qualify for the disability deduction.
Reading the co-payment certificate: it arrives in late July and is valid for a year from 1 August
The rate switches every August, and the figure on the certificate sets the charge for that year. Everyone certified as needing care or support receives one, including those at 10%.
- Know when it arrives. Many municipalities post it in late July. It is valid from 1 August to 31 July of the next year[Sapporo City (in Japanese)].
- Look at the co-payment rate field. It shows 10%, 20% or 30%. Give copies to the care manager and service providers.
- Check it against the pension withholding slip. The "amount paid" on the public pension withholding slip that arrives in January is the pension income used in the assessment.
- Once new thresholds are set, repeat the same steps. The document also floats moving the switch to October if a savings test is introduced[same Document 2, p.25 (in Japanese)].
Relief on meals and accommodation in facilities is a separate application from the co-payment rate. People exempt from resident tax should also check certification of the burden limit in long-term care insurance. The co-payment rate for medical care at 75 and over is also reassessed every August (how the medical care system for people aged 75 and over works).
Frequently asked questions
Does moving to 20% reduce the amount of care services I can use?
No. The monthly benefit limit for each care level is the same whatever the co-payment rate. What changes is your share, and for a typical taxed household the high-cost long-term care benefit refunds anything over ¥44,400 a month.
Summary
- A subcommittee is weighing 4 proposals to lower the threshold for 20% nursing-care co-payments from "pension income etc. of ¥2.8 million" to somewhere between ¥2.3 million and ¥2.6 million, with a conclusion expected during FY2026.
- Under the ¥2.3 million proposal, about 350,000 more people would move to the 20% rate; the threshold for couples would also drop from ¥3.46 million to between ¥2.96 million and ¥3.26 million.
- Even at 20%, the monthly cap on high-cost long-term care services stays at ¥44,400. For someone needing Care Level 3 with ¥270,000 in home care costs, the increase would be about ¥17,400 a month.
- Other proposals on the table include capping the increase at ¥7,000 a month, and letting people with savings below a certain amount apply to stay at 10%.
- Start by checking your parent's long-term care co-payment rate certificate and pension withholding statement to confirm their current rate and pension amount.
References (sources)
- MHLW, materials for the 136th meeting of the Long-term Care Insurance Subcommittee (18 September 2026) (in Japanese)
- MHLW subcommittee (136th) Document 2, "Ensuring sustainability (benefits and burdens)" (in Japanese) - four options, relief measures, fiscal estimates, income distribution, switch timing
- MHLW, Overview of the Long-term Care Insurance System (July 2025) (in Japanese) - current 20% and 30% thresholds
- MHLW, "Review of the co-payment rate for people with income above a set level" (2015) (in Japanese) - assessment method, certificates, retroactive changes
- MHLW, Long-term care service information system, "Charges for services" (in Japanese) - benefit limits, high-cost long-term care benefit
- Ministry of Finance, Fiscal System Council, "Building a sustainable social security system" (28 April 2026) (in Japanese)
- National Tax Agency, Tax Answer No.1600 "Taxation of public pensions" (in Japanese)
- Sapporo City, "Co-payment rates for long-term care insurance services" (in Japanese) - when certificates are sent, treatment of tax-free pensions
* The assessment table by option and the increases are this site's estimates applying the thresholds in MHLW documents. This article is general information. For your own assessment, check with your municipality's long-term care insurance counter or your care manager.
