Medical expense deduction (医療費控除) for foreign residents in Japan

The medical expense deduction (医療費控除, iryōhi kōjo) takes part of your medical bills off your taxable income, so you can get some income tax back. As of October 2026, the National Tax Agency (国税庁) counts the part of your costs above ¥100,000 (or above 5% of your total income, if that is under ¥2 million), up to a maximum deduction of ¥2,000,000. You claim it on a tax return, not through your employer.

How is the medical expense deduction calculated?

The National Tax Agency gives this formula:

Deduction = (medical costs you paid − insurance payouts) − threshold

The threshold is ¥100,000, or 5% of your total income if that is under ¥2 million. The result is capped at ¥2,000,000.

Two examples, to show the arithmetic only. They are not tax advice.

The deduction lowers your taxable income. How much tax you get back depends on your tax rate and on what was withheld, so the deduction is not the refund.

Costs count in the year you actually paid them. An unpaid bill counts in the year you pay it.

Does it cover my family, and is it only for permanent residents?

The National Tax Agency page covers costs you paid for yourself, or for a spouse or relative who shares your household budget (生計を一にする). The page does not mention visa type, nationality or permanent residency. We could not confirm from the official pages how it treats relatives who live abroad, so ask the tax office or a licensed tax accountant (税理士) before you include them.

What medical costs count?

The agency’s list is about treatment of an illness or injury. Examples it gives:

• Medicine to treat an illness, such as cold medicine.
• Public transport to and from treatment. Taxis count only when public transport is not available.
• Room and meal charges during a hospital stay.
• Dentist treatment and dentures. Gold and porcelain count as standard materials.
• Glasses, hearing aids, crutches and similar items needed for treatment.
• Treatment by a licensed massage therapist, acupuncturist or bonesetter.
• Fees for a licensed nurse or a hired caregiver.
• Midwife fees. Prenatal checkups and tests after pregnancy is diagnosed also count, with the cost of getting there.

What does not count?

• Gasoline and parking if you drive your own car to the clinic.
• Taxis when public transport is available.
• Vitamins taken for prevention or general health.
• Massage for relaxation.
• Payments to a relative for caring for a patient.
• Orthodontics to improve appearance. Correcting a growing child’s bite can count.
• Routine health checkups, generally. A checkup can count if it finds a serious condition and you then receive treatment. Our health checkup guide explains checkups in Japan.
• For a birth: travel to your parents’ home to give birth, nightwear, toiletries and meals from outside the hospital.

What do I subtract before I calculate?

Subtract money you got back for the same costs. The National Tax Agency lists insurance payouts, high-cost medical care benefits (高額療養費), family medical benefits and childbirth lump-sum payments (出産育児一時金). The maternity allowance (出産手当金) does not need to be subtracted.

A payout reduces only the costs it covers. If it is bigger than those costs, the excess cannot be subtracted from your other medical bills.

If you are on National Health Insurance, our National Health Insurance guide explains what you pay at the counter.

Can I claim treatment I paid for abroad?

Yes. The National Tax Agency says payments to a foreign doctor are eligible. If you paid in a foreign currency, convert the amount to yen at the telegraphic transfer middle rate (TTM) on the payment date.

We could not confirm from the official pages whether receipts in a foreign language need a Japanese translation. Ask your tax office before you file.

How do I claim it as an employee?

If your employer does your year-end adjustment (年末調整), you still claim medical expenses yourself. The National Tax Agency says to file a final tax return (確定申告) with your local tax office and attach a medical expense statement (医療費控除の明細書).

If you were not required to file but tax was withheld from your pay, you can file a refund return (還付申告). The National Tax Agency allows this from 1 January of the next year for 5 years. If nothing was withheld, there is no refund. The regular filing period is generally 16 February to 15 March.

For dates, e-Tax and what a My Number card does, see our tax return guide. To see what your employer already handles, read the year-end adjustment guide.

What should I bring or keep?

• Receipts for every payment you list, kept at home for 5 years from the filing deadline.
• The 明細書 you filled in.
• Your insurer’s medical expense notice (医療費通知), if you have one. With one, the National Tax Agency says you do not need to keep the receipts it covers.
• If you file by e-Tax, medical expense notice data can be pulled through My Number Portal (マイナポータル) and sent with the return, according to the National Tax Agency.

If you do not understand a Japanese receipt, our guide to an English-speaking hospital may help you find clinics that support patients in English.

What is the self-medication tax scheme?

The self-medication tax scheme (セルフメディケーション税制) is an alternative for people who buy specified over-the-counter drugs. It applies to purchases above ¥12,000, up to a maximum deduction of ¥88,000. You must have done certain health checkups or vaccinations. You choose either this scheme or the regular deduction, not both.

More guides: tax return in Japan, year-end adjustment, National Health Insurance, health checkups in Japan.