Medical Expense Deduction in Japan (医療費控除): A Guide for Foreigners

Quick Answer: Japan's medical expense deduction (医療費控除, iryōhi kōjo) lets you reduce your taxable income by the amount your household's yearly medical costs exceed ¥100,000 (or 5% of income if your total income is under ¥2 million), minus any reimbursements, up to a ¥2 million deduction. You claim it by filing a final tax return (確定申告) — even salaried employees must file it themselves. It is a deduction, not a refund, so the cash benefit is the deduction multiplied by your tax rate.

Most foreigners in Japan never claim the medical expense deduction — often because no one told them it exists, or they assume year-end adjustment at work already covers it. It doesn't. If your household spent more than about ¥100,000 on medical care in a calendar year, you may be leaving money on the table.

This guide covers the background, the rules behind it, what qualifies, and the step-by-step process to claim it.

This is educational information, not tax advice. Tax rules change and depend on your situation — confirm specifics with the National Tax Agency (NTA) or a qualified tax professional (税理士).

What is the medical expense deduction (医療費控除)?

The medical expense deduction is a long-standing part of Japan's income tax system that lets residents subtract a portion of their medical spending from their taxable income. It exists to soften the burden of years with unusually high medical costs — a major illness, a hospital stay, a pregnancy, expensive dental work.

It applies to medical expenses paid between January 1 and December 31 of a year, for you and the family members who share your household finances (生計を一に — spouse, children, and other dependent relatives you support). You don't all have to live under one roof, but you must share a livelihood.

Crucially, it is not handled by your employer's year-end adjustment (年末調整). To claim it, you file a final tax return (確定申告) yourself.

How much can you actually deduct?

This is the rule that trips people up, so here is the formula straight from the NTA (No. 1120):

Deduction = Total medical expenses paid − Reimbursements − ¥100,000

Two details matter:

The maximum deduction is ¥2 million per year.

Worked example: You paid ¥350,000 in medical costs and received ¥50,000 from insurance, on a ¥5 million salary. ¥350,000 − ¥50,000 = ¥300,000. Then ¥300,000 − ¥100,000 = ¥200,000 deduction.

One reality check: this is a deduction from taxable income, not money handed back. Your actual saving is roughly the deduction × your marginal tax rate (income tax + ~10% resident tax). A ¥200,000 deduction might mean somewhere around ¥30,000–¥60,000 in combined tax saved, depending on your bracket — meaningful, but not the full ¥200,000.

What medical costs qualify — and what doesn't?

Generally eligible:

Generally not eligible:

Keep every receipt — they're the evidence behind the claim.

Can couples and families combine their costs?

Yes — and this is where couples can gain. You can total the medical expenses of everyone in the household (生計を一に) and claim them on one person's return.

The Self-Medication alternative (セルフメディケーション税制)

If your household's medical costs didn't reach ¥100,000, there's a second route. The Self-Medication tax system lets you deduct spending on certain over-the-counter "switch OTC" medicines above ¥12,000, up to a ¥88,000 deduction — provided you did some qualifying health activity that year (a health check-up or vaccination, for example).

Two rules: it's available through December 31, 2026 under current law, and you must choose either the regular medical expense deduction or Self-Medication — not both. Run the numbers for whichever gives the bigger deduction.

How to claim it, step by step

  1. Gather a year's receipts for the whole household — treatment, prescriptions, hospital, qualifying transport.
  2. Add them up, then subtract reimbursements (insurance payouts, high-cost medical benefit, childbirth lump-sum).
  3. Apply the floor — subtract ¥100,000 (or 5% of total income if under ¥2 million).
  4. Prepare the itemized statement (医療費控除の明細書). The health-insurance "medical expense notice" (医療費のお知らせ) can simplify this; since this form replaced receipt submission, you no longer attach receipts.
  5. File a final tax return (確定申告) — online via e-Tax or on paper — for the relevant year. The annual window is usually mid-February to mid-March (for 2025 income it was Feb 16–Mar 16, 2026). Salaried employees must do this themselves; year-end adjustment doesn't include it.
  6. Keep your receipts for 5 years. With e-Tax you don't submit them, but the tax office can ask to see them.
  7. Receive the benefit: income tax is refunded, and your resident tax is reduced the following year.

Two steps people miss: you can claim retroactively for up to 5 years if you forgot a past year, and because employees aren't enrolled automatically, no one will do this for you — you have to file.

For how income tax and resident tax fit together first, our Japan Salary Tax Calculator estimates your net pay, and the Furusato Nozei guide covers another tax-saving route worth pairing with this — size your own cap with the free Furusato Nozei Simulator.

How this fits your bigger plan

A tax deduction isn't just a one-time refund — it's money that can go to work. Every yen you keep raises your savings rate, which is the single biggest driver of how fast you reach financial independence. The same logic runs through tax-free investing in your NISA and iDeCo accounts.

See what a higher savings rate does to your timeline with the free PlanTogetherFI calculator.

PlanTogetherFI is for educational planning only. It is not financial, tax, legal, or investment advice. Tax rules are set by Japanese law and depend on your circumstances — confirm details with the NTA or a qualified tax professional.

Frequently Asked Questions

Do I need to spend exactly ¥100,000 to qualify?

You need household medical spending (after reimbursements) above ¥100,000 — only the portion above it is deductible. If your total income is under ¥2 million, the threshold drops to 5% of your income, so you may qualify with less.

Can foreigners claim the medical expense deduction in Japan?

Yes. The deduction applies to tax residents of Japan regardless of nationality. You claim it by filing a final tax return (確定申告), keeping your receipts as evidence.

Is the deduction the amount I get back?

No. It reduces your taxable income, so your actual saving is the deduction multiplied by your tax rate (income tax plus roughly 10% resident tax). The income tax portion comes as a refund; the resident tax portion lowers next year's bill.

Can my spouse and I combine our family's medical bills?

Yes. You can total the medical expenses of everyone who shares your household finances and claim them on one return — usually the higher earner's, though if a spouse earns under ¥2 million their lower threshold can sometimes be better.

What if I forgot to claim it last year?

You can generally file retroactively for up to five years. Gather that year's receipts, prepare the itemized statement, and submit a return for the relevant year.

Sources and further reading

Figures reflect rules current as of 2026 and may change. Always confirm against the NTA or a qualified tax professional before filing.