Medical Expense Deduction in Japan: How to Claim

Last updated: 19 October 2026 · the National Tax Agency’s guidance as of 1 April 2026 · figures for the 2026 tax year

If you paid more than ¥100,000 in a year for medical care for yourself and family who share your living costs, the part above it, after anything insurance pays back, can be deducted from your income. That is the medical expense deduction (医療費控除). Your employer’s year-end adjustment cannot include it, so you claim it on a final tax return (確定申告). What comes back is your income tax rate on the deduction, plus a cut in the next resident tax bill: on a salary of ¥4,000,000, ¥250,000 of medical costs gives back ¥7,700 of income tax and takes ¥15,000 off resident tax.

This is a general explanation for somebody paid a salary in Japan. The National Tax Agency and your tax office are the authority on your own return.

How much you can deduct

The deduction is what you paid in the calendar year, minus what insurance pays back for it, minus ¥100,000 — up to ¥2,000,000. If your income for the year (総所得金額等) is under ¥2,000,000, the ¥100,000 is replaced by 5% of that income, so a smaller amount qualifies. What insurance pays back includes hospital benefits from a life insurance policy and the high-cost medical care benefit (高額療養費) from health insurance; each is taken off only the cost it was paid for. Costs count in the year you paid them, not the year of the treatment. If an insurance payment or the high-cost benefit is not settled by the time you file, take off what you expect it to be; if the final amount turns out different, correct the return afterwards (修正申告 if you claimed too much, 更正の請求 if too little).

What counts and what does not

• Counts: doctors’ and dentists’ fees; medicine to treat an illness, including cold medicine bought at a pharmacy; a hospital stay, with its room and meals; childbirth; treatment by a licensed massage therapist, acupuncturist or judo therapist (柔道整復師) for a condition; and getting to treatment by train or bus, or by taxi when there is no public transport.
• Does not count: health checks, as a rule; vitamins and other medicine to stay healthy rather than to treat something; petrol and parking when you drive yourself; and gifts to doctors.

The National Tax Agency lists each case, and anything beyond what a condition normally needs is left out.

Family members

You can add what you paid for your spouse and other relatives who share your living (生計を一にする), whatever their own income. Living under one roof is not required: in the National Tax Agency’s own example, a mother living alone in her home town on money her son sends her shares his living, and her medical bills that he pays go on his return. The cost goes on the return of whoever paid it: if one of you pays everybody’s bills, all of it goes on that person’s return.

Treatment abroad

Fees paid to a doctor abroad count in the same way. Convert them to yen at the mid-rate (TTM, the average of the banks’ buying and selling rates) on the day you paid. Anything travel or other insurance pays back is taken off first, as with Japanese insurance.

The self-medication option

Instead of the ordinary deduction, you can claim the self-medication option (セルフメディケーション税制): what you spent on certain over-the-counter medicines, marked as eligible on the receipt, above ¥12,000, up to ¥88,000. You must have had a health check, a vaccination or similar that year. It is one or the other: you cannot claim both, or change your choice after filing. Under the law as it stands it covers purchases up to 31 December 2026, and the fiscal 2026 tax reform carries it on from 2027.

How to claim

• A tax return: fill in the medical expense statement (医療費控除の明細書) from your receipts and attach it to a tax return. A notice of medical costs from your health insurer (医療費通知), or the same data through the My Number portal, can stand in for most of the lines.
• When: an employee who files only for a refund does not have to wait for the February to March season. A refund return can be filed for 5 years, counted from 1 January of the year after.
• Receipts: you do not attach them, but keep them for five years after the filing deadline: the tax office can ask to see them.
• Furusato nozei: if you gave donations that year under the one-stop exception (ワンストップ特例), filing a return cancels those applications. Put every donation of the year on the same return, or you lose the relief for them. The guide to furusato nozei explains it.
• Resident tax: follows from the return; apart from the donations above, you do nothing else.

Two examples

For somebody single, aged 30, in Tokyo, paid the same salary each month, with no other deductions, whose employer settled the year’s tax in the year-end adjustment:

The income tax comes back as a refund after you file; the resident tax is taken off the bill that starts the following June. A higher salary gets more back from the same deduction, because more of its income is taxed at a higher rate. The take-home calculator shows the year’s tax on your own salary before any deduction like this one.

Questions people ask

Can I claim medical expenses in the year-end adjustment?

No. Your employer's year-end adjustment cannot include it. You claim it on a tax return, and an employee who files only to claim a refund can do so after the year ends rather than only in the February to March season.

Do medical bills from my home country count?

Fees paid to a doctor abroad count in the same way, converted to yen at the mid-rate on the day you paid. Anything travel or other insurance pays back is taken off first.

Is it worth claiming if I spent only a little over the threshold?

Only the part above the threshold is deducted, so a small excess gives back little. If most of the spending was on over-the-counter medicine, the self-medication option may give more.

Sources

• National Tax Agency — No.1120 医療費を支払ったとき（医療費控除） (what you paid less insurance, less ¥100,000 or 5% of income under ¥2,000,000, up to ¥2,000,000; your spouse and relatives who share your living; the statement, the insurer’s notice and five years for receipts). Japanese, as of 1 April 2026.
• National Tax Agency — No.1122 医療費控除の対象となる医療費 (what counts and what does not) and its questions (Q4: a doctor abroad, converted at TTM on the day of payment); No.1120’s questions (Q2: insurance not yet settled — use the expected amount and correct it later). Japanese, as of 1 April 2026.
• National Tax Agency — No.1129 セルフメディケーション税制 (above ¥12,000, up to ¥88,000; a health check or similar; one or the other, not changed after filing). Japanese, as of 1 April 2026.
• National Tax Agency — 生計を一にしていない親族の医療費を子供が負担した場合（質疑応答事例） (a parent living elsewhere on money sent regularly shares your living; 所得税基本通達2-47). Japanese, as of 1 August 2025.
• Act on Special Measures Concerning Taxation (租税特別措置法) 第41条の17 — e-Gov (purchases up to 31 December 2026), and Ministry of Finance — 令和8年度税制改正の大綱 (carried on from 2027). Japanese, opened 19 October 2026.
• Ministry of Internal Affairs and Communications — 制度改正について（2015年4月1日） (filing a tax return cancels the one-stop applications; the donations go on the return). Japanese.
• National Tax Agency — No.2030 還付申告 (a refund return for 5 years from 1 January of the following year). Japanese.