The long-term care insurance program

Who is eligible for long-term care insurance?

Insured persons aged 40 or older are eligible for long-term care insurance. These individuals are categorized as shown below by age, etc. In contrast to health insurance, this program lacks the category of “dependents”. All members are considered insured persons.

• *In some cases, persons aged 40 or older are exempt from long-term care insurance. See the Procedures page for more information.

The long-term care insurance system

• ** The copayment for a category 1 insured person with total income of 1.6 million yen (2.8 million yen if the sole source of income is pension benefits) or more will be 20%. However, the copayment will be 10% if the total of pension income and other total income for category 1 insured person(s) in the same household is less than 2.8 million yen for a single person or less than 3.46 million yen for two or more persons.
• ** Every year, persons identified as needing assistance or needing long-term care are issued a Long-term Care Insurance Copayment Certificate indicating applicable copayment rates.

Long-term care insurance premiums

As outlined below, the amount of long-term care insurance premiums and how to collect it collected vary by category of insured person.

Long-term care insurance premiums for a category 1 insured person

Long-term care insurance premiums for category 2 insured person

Details of long-term care insurance services

As shown below, long-term care insurance services include “services provided at home”, “services provided at care facilities”, and “locality-oriented services”.

Services provided at home

• Services provided on visits to the patient at home or elsewhere Long-term care on a visitation basis, nursing on a visitation basis, bathing service on a visitation basis, rehabilitation on a visitation basis, instructions for medical care at home
• Services provided at care facilities
  Long-term care at care facilities, rehabilitation at care facilities, short-term stay for livelihood care, short-term stay for medical and long-term care, therapy for persons staying at specified facilities
• Services providing a care environment
  Lending of welfare appliances, aid for purchases of welfare appliances, allowances for modifying homes

Services provided at care facilities

These services are available only for those judged as needing long-term care.

• Note: As a general rule, new patients accepted for inpatient care at special nursing homes for the elderly will be restricted to those in the category of persons needing long-term care 3 and above.

• Welfare facilities for the elderly requiring long-term care (special nursing homes for the elderly)
• Health facilities for the elderly in need of long-term care (health services facility for the aged)
• Long-term care medical treatment facility (medical treatment beds for long-term inpatients)

Locality-oriented services

This is a framework for providing a wide range of flexible services to enable those who need long-term care to continue living in their familiar home communities. These services are operated by individual municipal governments. In principle, they are available for use only by residents of the municipality.

• Small-scale multifunctional long-term care at home
• Group homes for elderly persons with acknowledge Syndrome
• Daytime services available for dementia patients
• Nighttime long-term care on visitation basis
• Daily Life Long-Term Care for a Person Admitted to a Community-Based Specified Facility
• Admission to a Community-Based Facility for Preventive Daily Long-Term Care of the Elderly Covered by Public Aid
• Nursing on a visitation basis of regular rounds and on-demand response
• Nursing and small-scale multifunctional domiciliary care services (combination services)

For what types of long-term care services is a category 2 insured person eligible?

Category 2 insured persons aged 40-64 are eligible to receive long-term care services under long-term care insurance only if they suffer from one of the following specified diseases and disorders. Category 1 insured persons aged 65 and above are eligible to receive the services whatever the condition or disorder.

1. Pre-acknowledge syndrome
2. Cerebrovascular disease
3. Amyotrophic lateral sclerosis (ALS, or Lou Gehrig's Disease)
4. Parkinson's disease-related conditions
5. Spinocerebellar degeneration
6. Multiple system atrophy
7. Diabetic nephropathy, diabetic retinopathy, diabetic neuropathy
8. Arteriosclerosis obliterans
9. Chronic obstructive pulmonary disease
10. Degenerative joint disease with pronounced deformation of both knee or hip joints
11. Rheumatoid arthritis
12. Ossification of posterior longitudinal ligament
13. Stenochoria of the spinal canal
14. Osteoporosis involving bone fractures
15. Progeria
16. Terminal cancer