What is the Self-Support Medical Care System? | Comprehensive Guide on Eligibility, 10% Copayment Mechanism, and Application Process

Supportive Medical Care is a system that reduces the out-of-pocket medical expenses for individuals with mental or physical disabilities through public funding.

By using the Supportive Medical Care system, the out-of-pocket expenses for eligible medical costs are generally reduced to 10%.

There are three categories: outpatient psychiatric care for those with mental disabilities (psychiatric outpatient care), surgeries, etc., for those with physical disabilities (rehabilitative care), and medical care for disabled children (developmental care). The monthly cap on out-of-pocket expenses is set according to income, significantly reducing the financial burden for those requiring ongoing medical care.

However, the eligible hospitals and pharmacies are limited to pre-designated medical institutions, and renewal applications are required for each validity period (generally one year). There have been cases where individuals faced a 30% burden for visiting non-designated medical institutions or forgot to renew, resulting in increased out-of-pocket expenses. Therefore, it is important to understand how to use the system correctly.

This time, we will clearly explain the eligibility, application process, and points to note when using the Supportive Medical Care system.
Additionally, the author's personal experience with this system is included for your reference.

1. What is Supportive Medical Care?

As mentioned at the beginning, Supportive Medical Care is a public funding medical system designed to reduce the out-of-pocket medical expenses for outpatient visits and treatments for individuals with disabilities.

The traditional public medical funding system was divided into three categories: rehabilitative care, developmental care, and psychiatric outpatient care, each with different burden amounts and income-based caps.

This led to issues of inconsistency due to the type of disability and disparities between systems.

Therefore, on April 1, 2006, based on the Disability Independence Support Act, the public medical funding system was unified across disability types, setting the out-of-pocket expense at a standard 10% with a monthly cap based on household income, implementing the Supportive Medical Care system.

The Supportive Medical Care system seeks to provide fairness in medical expenses for individuals with disabilities and stability for long-term outpatient visits by unifying the public funding ratio to 10%.

2. Types of Supportive Medical Care and Eligible Conditions

While Supportive Medical Care generally unifies medical expenses to a 10% burden, the eligible disabilities and conditions are categorized into the following three types.

Let's take a look at the types of Supportive Medical Care and the representative conditions that are eligible.

2-1. Psychiatric Outpatient Care

Psychiatric outpatient care is for individuals with mental disorders such as schizophrenia, as stipulated in Article 5 of the Mental Health and Welfare Act, who require continuous psychiatric medical care through outpatient visits.

In addition to outpatient visits, it can also be used for day care and home nursing.

However, psychiatric outpatient care does not cover hospitalization costs or medical expenses other than psychiatric outpatient care, so be cautious.

Representative conditions and disabilities eligible for psychiatric outpatient care include:

• Schizophrenia
• Depression
• Bipolar disorder
• Drug or substance addiction
• Intellectual disabilities
• Developmental disabilities
• Alzheimer's-type dementia
• PTSD and other stress disorders
• Epilepsy

The above conditions are representative names, and if long-term treatment is deemed necessary for conditions like schizophrenia or depression, individuals may qualify as "severe and continuous" cases, allowing those from households subject to municipal tax to have a separately defined monthly burden cap to ease their financial load.

Reference: About Supportive Medical Care (Psychiatric Outpatient Care)｜Ministry of Health, Labour and Welfare

2-2. Rehabilitative Care

Rehabilitative care applies to individuals aged 18 and over who have been issued a physical disability certificate under the Act on Welfare of Physically Disabled Persons, and who are expected to have their disabilities removed or reduced through surgery or treatment.

Examples of conditions and disabilities eligible for rehabilitative care include:

• Visual impairments
• Physical disabilities
• Hearing and balance function impairments
• Cardiac function impairments
• Small intestine function impairments
• Speech, language, and chewing function impairments
• Immune function impairments (such as HIV or leukemia)

For example, cataract lens extraction surgery for visual impairments or tympanoplasty for hearing impairments are eligible treatments.

Treatments for internal organ impairments, such as those affecting the heart or small intestine, are also covered by rehabilitative care.

The disabilities introduced here are merely examples, and eligibility for rehabilitative care can vary based on the disability condition and treatment plan.

Even if a condition or treatment example is applicable, it does not necessarily mean it will be eligible for rehabilitative care, so be cautious.

2-3. Developmental Care

Developmental care targets children under 18 with physical disabilities, based on Article 4, Paragraph 2 of the Child Welfare Act, who are expected to benefit significantly from surgeries or treatments to remove or reduce their disabilities.

The eligible conditions and disabilities are the same as those for rehabilitative care, but developmental care does not require a physical disability certificate.

Developmental care primarily aims to prevent future disabilities by addressing congenital disabilities or conditions that could lead to lasting impairments if left untreated.

For more detailed information on other allowances and financial support available to children with disabilities besides developmental care, please refer to

3. Supportive Medical Care has Income and "Severe and Continuous" Based Caps on Out-of-Pocket Expenses

The out-of-pocket expense for Supportive Medical Care is generally 10%, but for households with low income or individuals eligible as "severe and continuous" cases, a monthly cap is set to prevent an increase in out-of-pocket medical expenses.

The categories for the monthly cap are as follows:

Reference: Basic Framework of Patient Burden for Supportive Medical Care｜Ministry of Health, Labour and Welfare
Reference: Supportive Medical Care｜Tokyo Metropolitan Welfare Bureau

As a supplement, for those in the middle-income category using developmental care, even if they are not high-cost treatment continuous users ("severe and continuous"), transitional measures are in place until March 31, 2027, with the following monthly cap:

Income Tax Exempt: 5,000 yen
Income Tax Below 300,000 yen: 10,000 yen

Additionally, for those with income tax of 300,000 yen or more, who are generally not eligible for Supportive Medical Care, if they qualify as "severe and continuous," a transitional measure allows for a monthly cap of 20,000 yen until March 31, 2027.

4. How to Apply for Supportive Medical Care

4-1. Required Documents for Application

The documents required for applying for Supportive Medical Care (in the case of psychiatric outpatient care) are as follows:

• Application for Certification of Supportive Medical Care Expense Payment
• Supportive Medical Care Diagnosis (a diagnosis from the primary doctor within three months of the application date)
• Consent and Household Situation Declaration Form
• Proof of Health Insurance (for national insurance, for the entire household)
• My Number Card
  ※In addition to the above documents, a seal is also required.

The Application for Certification of Supportive Medical Care Expense Payment can be downloaded from each municipality's website.

For those without a printer or internet access, the application form can also be obtained at the municipal office.

The doctor's diagnosis must be prepared by the primary doctor using the format specified by each municipality.

Be aware that only diagnoses issued within three months of the application can be used for Supportive Medical Care applications.

Additionally, the issuance of the diagnosis is not covered by health insurance, so it will be a full cost.

If applying as a "high-cost treatment continuous user (severe and continuous)," a separate opinion letter must be attached.

The Consent and Household Situation Declaration Form is a consent form for investigating the income of the individual and household.

This can also be downloaded from the municipal website or obtained at the office.

Proof of Health Insurance refers to any of the following:
(This may vary by municipality, so please check your local municipality's website.)

・Traditional health insurance card
・Qualification confirmation or notification of qualification information
・Printed screen showing health insurance card information from My Portal

Additionally, while it varies by municipality, bringing a My Number Card is recommended as it is the most effective form of identification. For those without a My Number Card, bring a notification card with your individual number, a disability certificate, a driver's license, or another form of identification.

Reference: Tokyo Metropolitan Welfare Bureau | Changes to Applications for "Supportive Medical Care (Psychiatric Outpatient Care)" Due to Abolition of Health Insurance Cards
Reference: About Supportive Medical Care (Psychiatric Outpatient Care)｜Tokyo Metropolitan Welfare Bureau

4-2. Application Process

The application process for Supportive Medical Care is as follows:

1. Confirm that the hospital is a "Designated Supportive Medical Care Institution"
2. Request the primary doctor to prepare a diagnosis
3. Fill out the necessary documents at the municipal office (such as the social welfare department) and apply
4. Once the application is approved, a "Supportive Medical Care Recipient Certificate" and a "Self-Burden Limit Management Form" are issued

First, confirm whether the hospital is applicable under the Supportive Medical Care system, then request the primary doctor to prepare a diagnosis.

The format of the diagnosis varies by municipality, so check with the municipal office or website in advance.

During the application, specify the hospital for outpatient visits and the pharmacy for prescriptions from the "Designated Supportive Medical Care Institutions" defined by each municipality and fill out the necessary details.

Once the application is approved, a "Supportive Medical Care Recipient Certificate" and a "Self-Burden Limit Management Form" to manage the monthly cap on out-of-pocket expenses are issued.

Once the amount recorded on the Self-Burden Limit Management Form reaches the monthly cap, any further medical expenses will be covered by public funding, and no payment will be required.

5. Points to Note When Using Supportive Medical Care

5-1. Can Only Be Used at Pre-Designated Medical Institutions and Pharmacies

Supportive Medical Care can only be used at pre-designated medical institutions and pharmacies.

For example, even if you visit a hospital not designated at the time of application for Supportive Medical Care, the out-of-pocket expense will not be reduced to 10% at the counter but will remain at the usual 30%.

Also, if you visit for conditions or disabilities unrelated to Supportive Medical Care, it will not apply, so be cautious.

5-2. Must Submit Documents Before Each Payment

To use Supportive Medical Care, you must submit the "Supportive Medical Care Recipient Certificate" and the "Self-Burden Limit Management Form" before each payment.

If you forget to submit the documents, the burden will not be reduced to 10%, so make sure to bring them.

If you forget, consult with the hospital's counter to either confirm the recipient certificate later for payment or apply for a refund from the municipality.

When applying for a refund from the municipality, a receipt is required, so be sure to obtain one from the medical institution.

5-3. Has an Expiration Date (Requires Renewal)

Supportive Medical Care has a maximum validity period of one year.

Additionally, the certification period for rehabilitative care is generally three months, but it can be extended up to one year based on the treatment progress and condition assessment.

As the expiration date approaches, a renewal notice will be sent by mail to the address provided at the time of application from your local municipality.

5-4. Renewal Takes About Two Months After Application

The validity period for Supportive Medical Care is a maximum of one year, but renewal allows for continued reduction of out-of-pocket expenses.

Renewal involves gathering the necessary documents, similar to the initial application, and completing the procedure at the municipal office.

For the doctor's diagnosis, submission is required every two years for continuous cases.

Renewal takes about two months after application, which is quite a long period.

Renewal applications can be submitted three months before the expiration date, so it is advisable to apply as early as possible.

5-5. What to Do If the New Recipient Certificate Hasn't Arrived Before Your Appointment

Until the new recipient certificate arrives, present the copy of the Supportive Medical Care application at the counter.

It takes about two months for Supportive Medical Care to be approved.

During that time, the application copy issued at the municipal counter can be used, and many medical institutions and pharmacies will defer billing for medical expenses until after the recipient certificate is issued.

In other words, the payment of medical expenses is deferred until the new recipient certificate arrives.

6. What the Author Using Supportive Medical Care (Psychiatric Outpatient Care) Wants to Convey

The author of this article is an individual who is actually using the Supportive Medical Care system (psychiatric outpatient care).

I learned about this system about three years after I started visiting a psychiatrist.

Although I was aware of the system, I thought, "The application seems troublesome," and "Even if the 30% burden is reduced to 10%, it might not make much difference," so I didn't apply.

However, once I decided to apply, thanks to the detailed explanation from the staff at the city hall counter, I was able to apply surprisingly smoothly.

Currently, I feel that my financial burden has significantly eased.

For those who frequently visit medical institutions, the benefits of Supportive Medical Care are even greater.

I recommend consulting with your doctor to see if your disability or condition qualifies for Supportive Medical Care.

7. In Conclusion

This time, we explained the eligibility and detailed system content of Supportive Medical Care.

The advantage of Supportive Medical Care is that it significantly reduces ongoing medical expenses.

This system can be said to make it easier to focus on treatment and recuperation by alleviating the financial burden.

If this article has made you consider using the "Supportive Medical Care System," why not consider applying?