Long-Term Care Insurance procedures

1.Who joins Long-Term Care Insurance

Long-Term Care Insurance (kaigo hoken) is insurance run by the municipality (city, ward, town or village) where you live. People aged 40 and over join, and they are divided by age into Category 1 insured persons and Category 2 insured persons.

• Cancer (terminal stage)
• Rheumatoid arthritis
• Amyotrophic lateral sclerosis
• Ossification of the posterior longitudinal ligament
• Osteoporosis with fractures
• Dementia in the presenile period
• Progressive supranuclear palsy, corticobasal degeneration and Parkinson's disease
• Spinocerebellar degeneration
• Spinal canal stenosis
• Progeria
• Multiple system atrophy
• Diabetic neuropathy, diabetic nephropathy and diabetic retinopathy
• Cerebrovascular disease
• Arteriosclerosis obliterans
• Chronic obstructive pulmonary disease
• Osteoarthritis with marked deformity of both knee joints or both hip joints

On your 65th birthday you become a Category 1 insured person. As a rule, you do not need to file a notification yourself at that time.

To use services, you must be certified by your municipality as needing care (yokaigo nintei; this includes certification as needing support).

2.Premiums

Premium amounts for people aged 65 and over are set by each municipality by ordinance every 3 years. They are divided into brackets based on income and other factors, and the amounts and brackets differ by municipality. Check with the counter of the municipality where you live.

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3.From applying for certification of need for care to the decision

To use Long-Term Care Insurance services, first apply for certification of need for care (yokaigo nintei; or certification of need for support, yoshien nintei) at the counter of the municipality where you live.

1. 1

   Apply at the municipal counter

   You need your Long-Term Care Insurance insured person's card (hihokenshasho). For people aged 40 to 64, enrollment in health insurance is checked.

2. 2

   Have the certification survey

   A municipal surveyor visits your home or facility and asks about your physical and mental condition and other matters.

3. 3

   The attending physician's opinion is prepared

   The municipality asks your regular doctor for a written opinion (shujii ikensho). If you do not have a regular doctor, you are examined by a doctor designated by the municipality. The applicant does not pay a fee for preparing the opinion.

4. 4

   Review and decision

   Based on the survey results and the attending physician's opinion, a computer makes a primary assessment using a nationally uniform method, and then the Long-Term Care Certification Committee (kaigo nintei shinsakai), made up of health, medical and welfare experts, makes a secondary assessment.

5. 5

   You receive the result

   You are notified whether you are certified as Support Level 1 or 2 or Care Level 1 to 5, or not eligible (higaito).

As a rule, you are notified of the result within 30 days of the date you applied. The certification takes effect retroactively from the date you applied.

4.Validity period of the certification, renewal and change of level

A certification has a validity period. After the validity period ends you can no longer use services, so if you want to keep using them, apply for renewal before the period ends.

If the certification takes effect in the middle of a month, the period until the last day of that month is added to the period above.

Even during the validity period, you can apply for a change of level if your physical or mental condition changes. The procedure is the same as for a first application.

5.Needing support vs. needing care, and the care plan

Before you start using services, a care plan (kaigo service keikaku) is made that sets out which services you will use and how much. Who makes it depends on the result of your certification.

There is no charge to the user for having a care plan made.

A Community General Support Center is a counter set up by the municipality that handles general consultations about the daily life and care of older people. Consult it even if you are not sure where to go.

6.Types of long-term care services

There are also community-based services that help you keep living in the area you are used to. Examples include small-scale multifunctional home care, which combines home visits, day visits and overnight stays, and group homes for people with dementia.

You can search for service providers on the Ministry of Health, Labour and Welfare's "Long-Term Care Service Information Publication System".

7.What users pay, and ways to reduce the cost

When you use services, you pay 10% of the cost. People with income above a certain level pay 20% or 30%.

Within the limit, you pay 10% (or 20% or 30%). For use beyond the limit, you pay the full amount yourself. When you enter a facility, you also pay for accommodation, meals and daily living expenses in addition to this.

8.Home modification and purchase of welfare equipment

When a person certified as needing support or care modifies their home, for example by installing handrails, or buys welfare equipment used for bathing, toileting and similar, part of the cost is paid by Long-Term Care Insurance.

For the 200,000 yen for home modification, you can use up to 200,000 yen again if your care level becomes 3 or more levels more severe, or if you move.

When you buy welfare equipment, as a rule you first pay the full amount and later 90% (80% or 70%) is refunded. For some equipment, such as walkers and fixed ramps, you can choose either rental or purchase.

9.When you move or lose eligibility

Because you join Long-Term Care Insurance through each municipality, when you move to another municipality you join the Long-Term Care Insurance of your new municipality.

If your address changes within the same municipality, also notify within 14 days. In some cases, filing the certificate-of-residence (juminhyo) notification is treated as also filing the Long-Term Care Insurance notification.

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If you lose eligibility, for example because you move, return your Long-Term Care Insurance insured person's card to the municipality. For procedures when the person dies, also see the following page.

arrow_forwardProcedures after someone close to you dies