This is the deduction people leave unclaimed most often, for a simple reason: they compare their own medical spending against ¥100,000, decide they are nowhere near, and stop. The threshold is not personal. It covers everyone in the household you support, and it includes a lot more than doctors' fees.
The threshold
You may deduct qualifying medical expenses above ¥100,000 in a calendar year, up to a ceiling of ¥2 million.
If your total income is under ¥2 million, the threshold is 5 per cent of income instead. On an income of ¥1.5 million that is ¥75,000. Students, part-time workers and anyone who had a partial year of earnings should check against the lower figure, not the headline one.
Subtract any insurance payouts or benefits received for the same treatment before comparing.
What counts, and what surprises people
Qualifying:
- Doctor, dentist and hospital fees, including the part your insurance did not cover
- Prescription medicine, and over-the-counter medicine bought to treat an illness
- Transport to and from treatment — train and bus fares, and taxis where the condition made public transport unreasonable. Keep a note of the journeys; tickets are not required for trains
- Dental treatment including medically necessary orthodontics, typically for children
- Childbirth costs, less the lump-sum birth allowance
- Acupuncture, moxibustion and osteopathy for treatment by qualified practitioners
- Nursing care and certain home-care services
- Medical devices such as prescribed corrective lenses for specific conditions
Not qualifying:
- Health checkups and screening — unless they find something and treatment follows, in which case the checkup can count
- Cosmetic procedures
- Vitamins, supplements and general tonics
- Glasses or contact lenses for ordinary short-sightedness
- Your own car's fuel or parking for hospital trips
The OTC alternative
If your household spending falls short of ¥100,000, the self-medication tax system may fit instead. It applies to qualifying switch-OTC medicines, with a threshold of ¥12,000 and a cap of ¥88,000.
Two conditions: you must have undergone a qualifying health measure during the year — a workplace checkup, a specific health examination, a vaccination — and you must choose one scheme or the other. You cannot claim both in the same year, so total both ways and take the larger.
Eligible products are marked with an identifying logo on the packaging, and receipts distinguish them.
Your employer cannot do this for you
The medical expense deduction is not available through the year-end adjustment. Your employer has no way to include it. You must file a tax return (確定申告) yourself, typically between mid-February and mid-March for the previous calendar year.
That is the whole reason this deduction goes unclaimed. Employees whose tax is otherwise handled for them assume there is nothing to do.
What to keep
Since the rules changed you submit a statement of medical expenses (医療費控除の明細書) rather than the receipts themselves — but you must retain the receipts for five years in case they are requested.
The practical approach: one envelope per calendar year, everything in it as you go, and a note of transport journeys at the time. Reconstructing a year of clinic visits the following February is how people give up.
If you use the health insurance statement of medical expenses issued by your insurer, it can substitute for itemising the treatments it covers — but it will not include transport or over-the-counter purchases, so keep those separately.
What it is actually worth
This is a deduction from taxable income, not a credit, so the refund is the deductible amount multiplied by your marginal rate. It also reduces next year's residence tax, which is a second saving people forget to count.
The phrases
- 医療費控除の申告をしたいです。 — Iryōhi kōjo no shinkoku o shitai desu. — I would like to claim the medical expense deduction.
- 領収書は必要ですか。 — Ryōshūsho wa hitsuyō desu ka? — Are receipts required?
- セルフメディケーション税制はどちらが得ですか。 — Serufu medikēshon zeisei wa dochira ga toku desu ka? — Which scheme is better for me?
Where to confirm this
- National Tax Agency, English pages
- Our guide to the year-end adjustment and residence tax
- Our guide to health insurance costs
Guides are dated rather than undated: last reviewed 21 August 2026. This is an organisational aid, not legal or immigration advice — always confirm anything consequential with your ward office, the Immigration Services Agency, or a qualified professional.