Frequently Asked Questions (Long-Term Care Insurance)

QuestionHow much is the cost burden when using Long-Term Care Insurance services?

Response

When using Long-Term Care Insurance services, the insured person (service user) pays a portion of the costs, while the remaining amount is covered by the insurer (municipality). At this time, the amount that the insured person should bear in relation to the actual costs incurred is indicated by the "burden ratio".

Self-Payment Ratio for Nursing Care Services

The burden ratio for those aged 65 and over will be in three stages: 10%, 20%, or 30%, depending on the income situation from the previous year.

Income Category	Self-Payment Ratio
Those who meet both 1 and 2 Total income amount of 2.2 million yen or more for individuals aged 65 and over Pension income for those aged 65 and over in a unified household including the individual + "Total other income amount" For one person, 3.4 million yen or more For two or more people, a total of 4.63 million yen or more	30%
Those who meet both 1 and 2, and do not have a 30% burden Total income amount of 1.6 million yen or more for individuals aged 65 and over Pension income for those aged 65 and over in a unified household including the individual + "Total other income amount" For one person, 2.8 million yen or more For two or more people, a total of 3.46 million yen or more	20%
Persons not subject to 20% or 30% co-payment	10%

• The total income amount refers to the amount obtained by deducting the necessary expenses from the income amount (the calculation method varies depending on the type of income), and it is the amount before applying income deductions such as dependent deductions and Medical Expenses deductions. If there are special deductions related to long-term (short-term) capital gains from the transfer of land, buildings, etc., the amount after deducting the special deduction from the total income amount will be used.
• Pension income does not include non-taxable pensions (disability pensions and survivor's pensions).
• The total income amount other than pension income refers to the amount obtained by excluding miscellaneous income related to pension income from the total income amount.
• Those who are subject to benefit restrictions due to delinquency in Long-Term Care Insurance premiums will be assessed based on a percentage according to their income; however, regardless of this percentage, the burden ratio stated on the Health Insurance Card will take precedence during the restriction period. Once the period of benefit restriction ends, the burden ratio will be based on income.

About the Issuance of Burden Ratio Certificates

A Long-Term Care Insurance burden ratio certificate will be issued to all individuals who have received certification for long-term care or support needs.
The Long-Term Care Insurance burden ratio certificate is a document that states the "burden ratio" when using Long-Term Care Insurance services.

The burden ratio is determined based on the income from the previous year, so it will be issued to those who have received certification for long-term care or support around late June to July each year.
Once the ratio certificate arrives, please keep it safely along with your long-term care insurance health insurance card.

• Note 1: Those who have newly received certification for long-term care or support will be issued at the time of sending the certification result notification.
• Note 2: It will not be issued to those without certification for long-term care or support.

Application Period and Issuance Timing of Burden Ratio Certificate

Application Period: From August 1st every year to July 31st of the following year

Issuance period: From late June to around July every year

Be sure to submit when using the service

The burden ratio certificate should be kept together with the Long-Term Care Insurance beneficiary certificate, and when using care services, be sure to submit both documents together to the service operators or facilities.
If you forget the burden ratio certificate, you may not be able to receive care services at the original burden ratio.

The burden ratio may change

In the case of income correction for resident tax

If the income of the individual or household member (aged 65 or older) changes due to a revised tax return, the burden ratio will be adjusted retroactively to the most recent August of the applicable period of the burden ratio certificate (for newly certified individuals, it will be adjusted up to the certification start date).

In cases of moving in and out of households

If the burden ratio changes due to the moving in or out, or death of a household member (65 years or older), it will be changed from the first day of the month following the relevant month (if the relevant day is the 1st, it will be changed from that month).

If you turn 65 years old

The burden is uniformly 10% until the age of 64.
If the burden ratio changes upon reaching the age of 65, it will change from the first day of the month following the birth month (if the birthday is on the 1st, it will change in that month). (The burden ratio and applicable period are noted on the ratio certificate.)