Long-life Medical Insurance Plan

The Long-life Medical Insurance plan has been established for the elders, at the age of 75 and over. People at the age from 65 through 74 can claim their enrollment if they have a certain level of disability.

This plan is financed by the general account bodget up to a half of its necessary expenses, although it is called an " Insurance plan". A conriderable part of the other half is contributed by the Social Health insurance premiums and the National Health Insurance premiums. Therefore, it may not absolutely be pertinent to call this plan an insurance plan. This plan is far from somthing which is run based on the premiumes contributed by the insureds.

The insureds can visit a doctor by paying only 10%, except those who earn as much gains as the middle-aged perople. In comparison with the 30% payment of the public health insurance plans for the youngers, the benefits are far larger. Heretofore, it has been regarded as fair and impartial, considering that the elders generally earn less and need to visit doctors more often. But the younger generations lose their power to spare for elders with various changes of situations and more people insist the elders shoud pay more.

You can refer to the site made by Tokyo Association of this insurance system for the minute information.

〔In Japanese〕


この制度は”保険”と名づけられていますが、実際には、その必要経費の半分が一般会計予算によって賄われています。残りの半分についても、社会保険制度や国民健康保険制度の保険料を原資とする支援金が相当割合を占めており、 ”保険”と呼ぶのは的確ではないのかもしれません。加入者の保険料によって運営されているとは、到底言い難いものなのです。

被保険者は、現役並所得者を除き、1割負担のみで医療機関を受診することができます。社会保険や国民健康保険が3割負担であることと比べ、極めて有利な給付を得ていることになります。 従来は、高齢者は一般的に収入が少なく、また、頻繁に医療機関を訪れる必要があることから、これが公平で平等なものだと考えられていました。しかし、さまざまな環境変化を経て、 現役世代が高齢者世代を支える余裕を失ってきたことが多くの人に自覚されるのにつれて、高齢者世代により多くの負担を求めるべきだと主張する人がでてきています。


Insurance Premiums

The amount of the Long-life Medical Insurance premiums are calculated and notified by a local body, established in each prefecture to run the system. The premiums amount can vary with prefectures you live in.

The premiums for the Long-Life Medical Insurance plan is levied on the each insured.

Most of the people at the age around 70 are coverd by the National Health Insurance plan. The premiums for the plan are levied on each households, which often have 2 or more family members. If a member of such a household reaches 75 years old, he/she will be excluded from the National Health Insurance plan and enrolled into the Long-Life Medical Insurance plan. Premiums for the latter will be newly levied, but premiums for the former do not always decrease correspondingly. As a result, the total amount of the public insurance premiums can be much higher. This problem is caused by the difference between the calculation methods of these 2 plans. Please refer to the relevant page of this site.

The premiums are collected by the municipality office. You can pay the premiums with payment slips, which are sent to you together with a notification of the premiums amount. They are sent in late May or June every year. As is the case with the National Health Insurance premiums, you can pay them by automatic transfer from your bank account by submitting an appropriate application in advance.

Besides, if you receive public pensions of 180 thousands yen or more per year, the premiums shall be deducted from the public pensions under the Special Collection method.

〔In Japanese〕



70歳代の人の多くが国民健康保険の被保険者となっています。その保険料は世帯ごとに課されていますが、2人世帯あるいは3人以上の世帯というのが一般的です。 そこで、家族の1人が75歳に達すると、その人は国民健康保険から脱退し、後期高齢者医療保険に加入することとなります。そして、後期高齢者医療保険料が新たに課されることとなりますが、国民健康保険料がそれに対応して減るとは限りません。 結果として、公的医療保険の保険料が激増することがあります。これは、2つの保険制度の保険料の計算方式の違いから生じる問題ですが、詳しくはこのサイトの関連ページをご覧ください。

保険料を徴収するのは市町村役場です。賦課通知書とともに送付される納付書によって納付できます。これらは毎年5月末から6月に送付されます。 国民健康保険料と同様に、事前に申し込むことで銀行預金口座からの自動引落とすることもできます。


Actual cases of the premium calculation

Here, I introduce 2 actual cases of the premiums calculation. One is that in Gotsu city, Shimane prefecuture. The other is that in Kita ward, Tokyo.

Long-life Medical Insurance in Gotsu city for 2020
Element Basis for premiums calculation Premiums amount/rate
Income Total amount of income for the previous year 9.55%
Per capita - 50,640yen
Maximum Limitation amount 640,000yen

Long-life Medical Insurance in Kita ward, Tokyo for 2021
Element Basis for premiums calculation Premiums amount/rate
Income Total amount of income for the previous year 8.72%
Per capita - 44,100yen
Maximum Limitation amount 640,000yen

Several preferential treatments are prescribed for those who are assumed to have a difficulty to bear the regular premiums amount. Among them, one for people who were dependents of the insured of the Social Health Insurance plan right before they join this system is significant. But, the range of the eligible persons to these preferential treatments has been narrowed these days. The background is what I tell before.

〔In Japanese〕


島根県江津市の後期高齢者医療保険料 2020年
算定要素 後期高齢者医療保険料の算定基準 保険料率/額
所得割 前年の合計所得金額 9.55%
均等割 - 50,640円
最大限度額 640,000円

東京都北区の後期高齢者医療保険料 2021年
算定要素 後期高齢者医療保険料の算定基準 保険料率/額
所得割 前年の合計所得金額 8.72%
均等割 - 44,100円
最大限度額 640,000円

保険料の負担が困難であると認められる人については、いくつかの優遇措置が定められています。 特に、後期高齢者医療保険への加入前において、社会保険の被扶養者であった人についての優遇措置は重要です。しかし、これらの優遇措置の対象範囲は、近年において狭められています。その背景事情は前述のとおりです。