'Kaigo Futan Navi' Releases 'Self-Pay Cap Checker' for Nursing Care Expenses ── AI Instantly Calculates Monthly Copayment Caps and Refunds for High-Cost Nursing Care Services Just by Entering Income Tier and Care Level
Mycat Inc. has released a 'Self-Pay Cap Checker' tool on its nursing care information site. By simply answering a few questions, users can instantly calculate their nursing care copayment limits and expected refunds, solving the problem of unclaimed benefits.
📋 Article Processing Timeline
- 📰 Published: April 3, 2026 at 19:00
- 🔍 Collected: April 3, 2026 at 10:31
- 🤖 AI Analyzed: April 21, 2026 at 04:05 (425h 34m after Collected)
Mycat Inc. (Headquarters: Meguro-ku, Tokyo) has released the 'Self-Pay Cap Checker' on its nursing care expense information service 'Kaigo Futan Navi' (https://kaigofutan.xyz). This tool allows users to check their maximum out-of-pocket limits for nursing care insurance services and estimated refund amounts from the High-Cost Nursing Care Service Expense system. Tool URL: https://kaigofutan.xyz/tools/cap-checker
### The Pitfall of the 'You Don't Get It Unless You Apply' System
In nursing care insurance, there is a system called 'High-Cost Nursing Care Service Expense' where the excess is refunded if the out-of-pocket amount for one month exceeds a certain limit. It is a similar mechanism to the high-cost medical care benefit system in medical insurance, but there is a crucial difference. That is, even if a notice arrives from the municipality, it will not be paid unless the user themselves or their family submits an application form. According to the Ministry of Health, Labour and Welfare's 'Report on the Status of Nursing Care Insurance Business', there are about 7 million people nationwide who are certified as requiring nursing care (Source: MHLW 'Report on the Status of Nursing Care Insurance Business' 2024). Not all of those who could be eligible for the High-Cost Nursing Care Service Expense are aware of the system and applying for it. The reality is that it is not uncommon, especially for families using nursing care insurance services for the first time, to continue paying the full out-of-pocket amount without knowing of the system's existence.
### Self-Pay Caps Change Significantly Depending on Income Tiers
The upper limit for High-Cost Nursing Care Service Expenses is divided into 5 tiers according to the household's income situation.
**Tier 1** (Welfare recipients, etc.): Individual 15,000 yen
**Tier 2** (Resident tax-exempt households with pension income etc. of 800,000 yen or less): Individual 15,000 yen / Household 24,600 yen
**Tier 3** (Resident tax-exempt households other than Tier 2): Household 24,600 yen
**Tier 4** (Resident tax-taxable households ~ taxable income less than 3.8 million yen): Household 44,400 yen
**Tier 5** (Taxable income 6.9 million yen or more): Household 140,100 yen
(Source: MHLW 'Copayment Limits for High-Cost Nursing Care Service Expenses')
The problem is that many people do not know which tier they fall into. There are multiple confusing factors, such as determining resident tax taxable/exempt status, the impact of household separation, and the difference between pension income and overall income.
### How the Tool Works
By simply answering step-by-step questions, this tool consistently performs everything from determining the user's income tier to calculating the expected refund amount.
**Step 1: Enter Basic Information**
- Household composition (Single, Couple, Other)
- Resident tax taxable/exempt
- Pension income (Estimated annual amount)
- Other income (Salary, Real estate, etc.)
**Step 2: Usage Status of Nursing Care Services**
- Care requirement level
- Types of services being used (Home-visit nursing care, Day service, Short stay, etc.)
- Monthly out-of-pocket amount (Estimate)
- Presence or absence of anyone in the same household using nursing care insurance
**Step 3: Check Results**
- Applicable income tier and self-pay upper limit
- Difference between the current monthly out-of-pocket amount and the limit (= Expected refund amount)
- Annual estimated refund amount
- Guidance on required documents for application and where to submit them
- Possibility of tier change due to household separation (Displayed only if applicable)
### Guidance on Combining with the High-Cost Medical and Nursing Care Combined System
For households where not only nursing care costs but also medical costs are high, there is a 'High-Cost Medical and Nursing Care Combined Medical Treatment Expense System' that pays out the excess amount when the annual self-payments for nursing care insurance and medical insurance are combined and exceed the limit. This is also an application-based system, and it cannot be used if you don't know about it. This tool provides an option to additionally input out-of-pocket medical expenses, and if there is a possibility of being eligible for the combined system, a message to that effect is displayed on the screen. It also guides users on the fact that the high-cost nursing care service expense of nursing care insurance and the combined high-cost medical and nursing care expense of medical insurance are separate systems, so individual applications are required for each.
### Recommended for the Following People
**Case 1: Those whose parents have just started receiving nursing care**
Immediately after starting to use nursing care insurance services, the reality is that people are often overwhelmed with explanations from care managers and are not aware of the self-pay limit system. By checking with this tool in the first month of using nursing care services, you can utilize the system from the very first month.
**Case 2: Those who feel their monthly nursing care costs are high**
Those who feel that 'nursing care costs are squeezing the household budget' can use this to first grasp their own limit. If it exceeds the limit, it becomes subject to a refund, potentially leading to a burden reduction of several thousand to tens of thousands of yen per month.
**Case 3: Household separation**
### The Pitfall of the 'You Don't Get It Unless You Apply' System
In nursing care insurance, there is a system called 'High-Cost Nursing Care Service Expense' where the excess is refunded if the out-of-pocket amount for one month exceeds a certain limit. It is a similar mechanism to the high-cost medical care benefit system in medical insurance, but there is a crucial difference. That is, even if a notice arrives from the municipality, it will not be paid unless the user themselves or their family submits an application form. According to the Ministry of Health, Labour and Welfare's 'Report on the Status of Nursing Care Insurance Business', there are about 7 million people nationwide who are certified as requiring nursing care (Source: MHLW 'Report on the Status of Nursing Care Insurance Business' 2024). Not all of those who could be eligible for the High-Cost Nursing Care Service Expense are aware of the system and applying for it. The reality is that it is not uncommon, especially for families using nursing care insurance services for the first time, to continue paying the full out-of-pocket amount without knowing of the system's existence.
### Self-Pay Caps Change Significantly Depending on Income Tiers
The upper limit for High-Cost Nursing Care Service Expenses is divided into 5 tiers according to the household's income situation.
**Tier 1** (Welfare recipients, etc.): Individual 15,000 yen
**Tier 2** (Resident tax-exempt households with pension income etc. of 800,000 yen or less): Individual 15,000 yen / Household 24,600 yen
**Tier 3** (Resident tax-exempt households other than Tier 2): Household 24,600 yen
**Tier 4** (Resident tax-taxable households ~ taxable income less than 3.8 million yen): Household 44,400 yen
**Tier 5** (Taxable income 6.9 million yen or more): Household 140,100 yen
(Source: MHLW 'Copayment Limits for High-Cost Nursing Care Service Expenses')
The problem is that many people do not know which tier they fall into. There are multiple confusing factors, such as determining resident tax taxable/exempt status, the impact of household separation, and the difference between pension income and overall income.
### How the Tool Works
By simply answering step-by-step questions, this tool consistently performs everything from determining the user's income tier to calculating the expected refund amount.
**Step 1: Enter Basic Information**
- Household composition (Single, Couple, Other)
- Resident tax taxable/exempt
- Pension income (Estimated annual amount)
- Other income (Salary, Real estate, etc.)
**Step 2: Usage Status of Nursing Care Services**
- Care requirement level
- Types of services being used (Home-visit nursing care, Day service, Short stay, etc.)
- Monthly out-of-pocket amount (Estimate)
- Presence or absence of anyone in the same household using nursing care insurance
**Step 3: Check Results**
- Applicable income tier and self-pay upper limit
- Difference between the current monthly out-of-pocket amount and the limit (= Expected refund amount)
- Annual estimated refund amount
- Guidance on required documents for application and where to submit them
- Possibility of tier change due to household separation (Displayed only if applicable)
### Guidance on Combining with the High-Cost Medical and Nursing Care Combined System
For households where not only nursing care costs but also medical costs are high, there is a 'High-Cost Medical and Nursing Care Combined Medical Treatment Expense System' that pays out the excess amount when the annual self-payments for nursing care insurance and medical insurance are combined and exceed the limit. This is also an application-based system, and it cannot be used if you don't know about it. This tool provides an option to additionally input out-of-pocket medical expenses, and if there is a possibility of being eligible for the combined system, a message to that effect is displayed on the screen. It also guides users on the fact that the high-cost nursing care service expense of nursing care insurance and the combined high-cost medical and nursing care expense of medical insurance are separate systems, so individual applications are required for each.
### Recommended for the Following People
**Case 1: Those whose parents have just started receiving nursing care**
Immediately after starting to use nursing care insurance services, the reality is that people are often overwhelmed with explanations from care managers and are not aware of the self-pay limit system. By checking with this tool in the first month of using nursing care services, you can utilize the system from the very first month.
**Case 2: Those who feel their monthly nursing care costs are high**
Those who feel that 'nursing care costs are squeezing the household budget' can use this to first grasp their own limit. If it exceeds the limit, it becomes subject to a refund, potentially leading to a burden reduction of several thousand to tens of thousands of yen per month.
**Case 3: Household separation**