- October 16, 2026
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The medical expense deduction in Japan can lower your income tax in a year when medical bills pile up — you simply claim it on a tax return. But if you are a foreign employee here, it is not always obvious what actually counts, or whether your family’s bills can go in too.
Here is the short version: if what you paid over the year — for yourself or for a family member you support — adds up to more than a certain amount, you can likely claim the medical expense deduction on a tax return, even as a company employee.
In this guide, certified financial planner Masamichi Takayanagi walks through the threshold, which costs qualify, how the deduction differs from the Self-Medication Tax System, what you need to file, and the overseas medical bills that so often catch foreign residents out.
So for your 2026 bills, it pays to start sorting your receipts and medical expense notices now.
About the Supervisor & Writer
Masamichi Takayanagi
Financial Planner & columnist;
An independent financial planner with extensive experience as a financial columnist, specializing in a wide range of topics including asset management, life insurance, inheritance, loan products, and credit cards. Over 1,000 articles and projects have been contributed to the field.
1st grade Certified Skilled Professional of Financial Planning, Certified Financial Planner®.
Table of Contents
Chapter 1: What Is the Medical Expense Deduction?
The medical expense deduction is an income deduction you can use when the medical bills you paid in a year — from January 1 to December 31, for yourself or for a spouse or relative who shares your household — go over a certain amount.
The deduction is calculated, in basic terms, like this:
Medical expenses actually paid − amounts reimbursed by insurance and the like − 100,000 yen
There is one exception. If your total income is under 2 million yen, you subtract 5% of your total income instead of 100,000 yen.
Say your total income is 1.8 million yen. Your threshold is then 90,000 yen. If your medical expenses after reimbursements come to 150,000 yen, 60,000 yen qualifies for the deduction.
The deduction is capped at 2 million yen.
One more point: payouts such as life insurance benefits and high-cost medical care benefits (kogaku ryoyohi) are, as a rule, subtracted from the specific medical expense they were paid for. Even if a payout is larger than that expense, you do not have to subtract the leftover from your other medical expenses.
Chapter2 : What Qualifies and What Doesn’t
Costs That Usually Qualify
Common costs that qualify for the medical expense deduction include:
- Examinations and treatment by a doctor or dentist
- Hospital stays
- Prescription medicine
- Over-the-counter medicine needed for treatment or recovery
- Train, bus, and other transport costs for getting to appointments
Taxi fares can qualify when your condition makes it hard to take a train or bus. Gasoline and parking costs for driving yourself to appointments, on the other hand, do not qualify.
Costs That Usually Don’t
Spending aimed at prevention or cosmetic purposes, rather than treatment, is generally not covered. For example:
- Vaccinations
- Routine health checkups and full medical screenings (ningen dock)
- Cosmetic surgery
- Cosmetic dental work and whitening
- Everyday glasses
- Supplements taken to maintain general health
The Exceptions
There are exceptions, though.
If a health checkup turns up a serious illness and you go straight into treatment, the cost of that checkup can qualify. Orthodontic work can also qualify when it is recognized as medically necessary — for a child’s development or to correct a bite, for instance.
Glasses are the same: everyday pairs don’t count, but certain ones needed specifically for medical treatment under a doctor’s care can.
For costs that are hard to judge, check the National Tax Agency’s guidance, or ask your tax office or a tax accountant.
If you buy a lot of over-the-counter medicine, you may be able to use the Self-Medication Tax System instead of the regular medical expense deduction.
It works like this: if you take part in certain health checkups or vaccinations, buy eligible medicines, and your purchases over the year exceed 12,000 yen, you can subtract the excess from your income. The deduction is capped at 88,000 yen.
You cannot use the regular medical expense deduction and the Self-Medication Tax System together. If you qualify for both, you choose one and file with that.
Some eligible products carry a common identification mark, and your receipt will note that an item qualifies. But if you want to be sure, check the list of eligible products published by the Ministry of Health, Labour and Welfare.
One more thing: from January 2027, a revision under the fiscal 2026 tax reform takes effect. Since the range of eligible medicines and other details will change, when you file for 2026, check which products qualify during 2026 itself.
Chapter4 : What to Gather, and How to File
Even as a company employee, you cannot claim the medical expense deduction through your year-end adjustment. You have to file a tax return yourself.
Start by gathering these documents:
- Receipts from hospitals and pharmacies
- The medical expense notice sent by your health insurance society or similar
- A record of your transport costs for appointments
- Documents showing any insurance payouts or high-cost medical care benefits you received
When you file, you generally attach a “medical expense deduction statement” (iryohi kojo no meisaisho) to your tax return. You don’t need to submit the receipts themselves, but keep them for five years in case the tax office asks to see them.
For amounts covered by a medical expense notice that meets certain conditions, you can fill in the statement in a simplified way. And for the medical costs listed on that notice, you may not need to keep the receipts at all.
If you use My Number Portal (Mynaportal) linkage, the corresponding medical expense information can be entered automatically into the National Tax Agency’s online return-preparation tool. For a family member who shares your household, you may be able to pull in their information too, by setting up proxy access and the like.
Here is the filing flow:
- Total up the medical expenses you paid over the year.
- Check the amounts reimbursed by insurance and the like.
- Prepare the medical expense deduction statement.
- Enter the medical expense deduction on your tax return.
- Submit it by e-Tax, by post, or another method.
For how tax returns work overall, see our guide to filing a tax return; for how to submit online, our e-Tax article may help too.
Source: National Tax Agency, “Medical Expense Deduction Q&A”
Chapter5 : Points Foreign Residents Often Find Tricky
Treatment costs you paid to a doctor overseas also qualify, as long as they meet the general requirements for the medical expense deduction.
If you paid in a foreign currency, convert it to yen at the mid-rate between the telegraphic selling and buying rates (TTM) on the day you paid. If you received overseas medical care benefits from Japanese health insurance, factor in that reimbursement too.
On the other hand, medical costs you paid during a period when you were a non-resident of Japan generally cannot be claimed under Japan’s medical expense deduction. If you returned partway through an overseas posting, for example, take care to separate the period when you were a resident from the period when you weren’t.
Family members living in your home country can also qualify, in certain cases. The key is that you share household finances with the relative — and that you, the person filing, are the one paying for that relative’s medical costs.
Say you regularly send living expenses to a parent back home and cover their medical costs yourself. That can qualify. But medical costs your parent paid from their own funds are not something family in Japan can freely add to their own deduction.
The same thinking applies to dual-income couples. As a rule, the medical expense deduction is claimed by the person who actually paid the costs. It is true that the higher someone’s income tax rate, the greater the tax relief an income deduction can bring — but you cannot freely reassign the costs to whoever benefits most once the year is over.
When it is unclear who covered a family member’s medical costs, or when relatives living abroad are involved, it is reassuring to check with your tax office or a tax accountant.
Chapter6 : Frequently Asked Questions
Here are the questions foreign residents ask most often about the medical expense deduction.
Q1: How much do I need to spend in medical costs to qualify?
As a rule, you take the medical expenses you paid over the year, subtract any reimbursements such as insurance payouts, and the portion above 100,000 yen qualifies for the medical expense deduction. If your total income is under 2 million yen, the threshold is 5% of your total income rather than 100,000 yen. So even if your medical costs are under 100,000 yen, you may still qualify — check your income as well. If you have no obligation to file but are filing for a refund, you can generally claim a missed medical expense deduction for five years from January 1 of the following year.
Q2: Do transport costs for appointments count?
Fares for public transport such as trains and buses, when needed to receive examination or treatment, do qualify. Taxis are limited to cases where your condition keeps you from using public transport, and gasoline and parking costs for your own car don’t count. Transport fares often come without receipts, so keep a record of the date, the hospital’s name, the stretch you traveled, and the amount.
Q3: Can I combine my family’s medical costs?
You can combine the medical costs you paid for a spouse, child, or relative who shares your household finances. It isn’t decided by whether you live together — a relative living apart, whose living costs you cover on an ongoing basis, can qualify too. That said, you can’t just bundle in any family member’s costs you like. As a rule, the person who actually paid the costs is the one who claims the deduction. If it’s hard to tell who paid within the family, check with a professional.
Chapter7 : In Closing
Japan’s medical expense deduction is a system you can use when the medical costs you paid over the year — for yourself or a family member who shares your household finances — exceed 100,000 yen, or 5% of your income if your total income is under 2 million yen.
Examination fees, medicines needed for treatment, and the cost of getting to appointments by public transport all qualify. Vaccinations, cosmetic spending, and gasoline for your own car generally do not.
Even as a company employee, you can’t claim the deduction through your year-end adjustment, so you’ll need to file a tax return. Organize your receipts and medical expense notices, and prepare your medical expense deduction statement.
For foreign residents, overseas treatment costs or a family member’s bills back home can come into play. When relatives abroad or a dual-income household are involved, confirm not just whose medical costs they are, but who actually paid them, before you file.
*This article is for general information only and is not individual tax advice. Information is accurate as of October 2026, but tax rules and the scope of eligible expenses change regularly. What qualifies and how much you can claim also depend on your income, your family situation, and your own circumstances, so always check the latest details with the National Tax Agency, your tax office, or a tax professional before filing.
