What Japan's Medical Expense Deduction Covers: Transport, Orthodontics and Childbirth
Japan's medical expense deduction covers more than hospital consultation fees: over-the-counter medicine, train fares to the hospital and childbirth costs can count too. Vaccinations, glasses and cosmetic treatment don't. This article lists what is and isn't covered by category, explains how to judge, sets out conditional items such as taxi fares and orthodontics, and shows how to subtract insurance payouts and the childbirth lump-sum allowance.
How to judge whether something is covered
The deduction covers payment for medical care and treatment by doctors and dentists, and costs necessary for treatment, at amounts generally spent. If you're unsure, these 3 points make it easier to decide.
- Is it for treatment, or for prevention and staying healthy? Treatment is covered. Prevention and health maintenance, such as vaccinations and supplements, aren't
- Is it for appearance? Cosmetic surgery, whitening and orthodontics for looks aren't covered
- Did you actually pay it that year? Costs count in the year paid, not the year of treatment. Unpaid amounts count in the year you pay them
What is and isn't covered, by category
| Category | Covered | Not covered |
|---|---|---|
| Hospitals and medicine | Consultation and treatment fees, hospitalization (including meals), prescription medicine, over-the-counter medicine for treatment, smoking cessation treatment by a doctor | Vaccinations, vitamins and supplements, fees for medical certificates, gifts of thanks to doctors, pajamas and daily necessities during hospitalization |
| Teeth and eyes | Treatment for cavities and gum disease, implants and ceramics, LASIK and ICL, orthokeratology | Whitening, glasses and contact lenses for nearsightedness or astigmatism |
| Transport | Train and bus fares to the hospital, transport for an attendant accompanying a child or elderly person who needs one | Gasoline and parking for your own car, travel home to give birth near family |
| Childbirth and infertility | Prenatal checkups, childbirth costs, epidural delivery, infertility treatment and IVF | — |
| Therapy | Acupuncture, moxibustion and massage by licensed practitioners (for treatment), treatment at bonesetting clinics | Seitai and chiropractic, massages to relieve fatigue |
| Long-term care | Out-of-pocket costs for medical services such as home nursing, half of the out-of-pocket costs at special nursing homes | — |
| Other | Medical costs of family who share living expenses, medical costs paid by credit card (in the year charged) | Cosmetic surgery, hair removal, AGA (hair loss) treatment |
Over-the-counter medicine is covered even without a prescription if you bought it to treat something like a cold or headache. Anything taken for prevention or to improve your constitution isn't.
What's covered on conditions
| Item | Condition for coverage |
|---|---|
| Taxi fares to the hospital | When you can't use trains or buses, such as being unable to walk due to sudden illness or injury, or when labor has started |
| Orthodontics | When done to treat your bite. Adults are covered if it's for treatment, but not if it's for looks |
| Private room charges | When a doctor judges a private room necessary because of your condition. Not covered if you or your family chose it |
| Full health checkups | When a serious illness is found and you go straight on to treatment |
| Glasses for treatment | When made on a doctor's instructions, for amblyopia, strabismus or after cataract surgery, for example |
| Hearing aids | When you've been seen by a hearing aid consultant doctor and they certify it as directly necessary for treatment |
| Diapers | When you've been bedridden for 6 months or more and a doctor has issued a diaper use certificate |
| PCR tests | When taken on a doctor's judgment, or taken on your own judgment and you tested positive and received treatment |
Subtract insurance payouts and the childbirth lump-sum allowance
If you receive money that makes up for medical costs, subtract it from what you paid. This includes hospitalization and surgery benefits from life or medical insurance, high-cost medical care benefits and family medical care benefits from health insurance, the childbirth lump-sum allowance, and municipal subsidies for infertility treatment. Injury and sickness allowances and maternity allowances replace salary, so they aren't subtracted.
For example, someone earning 4 million yen pays 550,000 yen for childbirth and receives the 500,000-yen allowance, leaving 50,000 yen for childbirth. If they also paid 120,000 yen that year for prenatal checkups and family hospital visits, then 100,000 yen comes off the 170,000-yen total, for a 70,000-yen deduction. That returns 3,574 yen of income tax and 7,000 yen of resident tax, 10,574 yen in all.
Recording and keeping items without receipts
- 1
Record date, route and amount for transport
Train and bus fares are covered even without a receipt. Note the date of the visit, hospital name, route and fare in a memo or spreadsheet. Transit IC card histories also serve as support.
- 2
Keep receipts for over-the-counter medicine
Drugstore receipts list product names, so keep them in a way that shows which medicine you bought. Total only what you bought for treatment.
- 3
Ask early for items needing a doctor's certificate
For items needing a doctor's document, such as a diaper use certificate or a copy of a prescription for treatment glasses, it's awkward to ask after the new year, so request them during a visit.
- 4
Keep them for 5 years
If you submit the statement of expenses, you don't need to submit receipts, but keep them for 5 years so you can show them if the tax office asks.
Check coverage with the tool
In the Check eligibility tab of the Medical Expense Deduction Refund Calculator, you can search 45 commonly confusing items by keywords such as taxi, orthodontics or glasses to see whether each is covered, conditional or not covered. Once you have your covered total, enter it with any reimbursed amounts in the Calculate refund tab to see what comes back.
If you buy a lot of over-the-counter medicine, also check the self-medication tax system vs the medical expense deduction. The conditions for combining family costs are explained in which spouse should claim the medical expense deduction.
FAQ
- Are taxi fares to the hospital covered?
- Only when something prevents you from using trains or buses, such as being unable to walk due to sudden illness or injury, or when labor has started. Taxi fares used simply for convenience, and gasoline and parking for your own car, aren't covered.
- Is adult orthodontics covered?
- If it's to treat a problem such as an abnormal bite, it's covered even for adults. Orthodontics for looks isn't. Whether it's for treatment depends on the dentist's diagnosis, so it's reassuring to get a medical certificate if needed.
- Are childbirth costs covered?
- Prenatal checkups and childbirth costs are covered, minus the childbirth lump-sum allowance (500,000 yen in principle) and similar. Even if the allowance is larger, the excess doesn't need to be subtracted from other medical costs.
- Is a flu vaccination covered?
- No. Costs for prevention aren't included. Consultation fees and prescription medicine after you catch the flu are covered.
Tools in this article
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