What are persons in the earlier stage of old age?

Elderly persons aged 65 through 74 are referred to as “persons in the earlier stage of old age.”
Since most persons in the earlier stage of old age enroll in National Health Insurance (specific to their municipality) after retiring from their company due to mandatory retirement, etc., the elderly-person medical care costs paid by National Health Insurance are higher than those of other medical care insurers.
To eliminate this imbalance of medical care cost payment, a system has been introduced to adjust the payment according to the percentage of persons in the earlier stage of old age covered by each insurer.
Under this system, adjustments are made based on a comparison of the percentage of persons in the earlier stage of old age covered by each insurer and the average percentage of such persons covered by all insurers. Health insurance societies and other insurers with low percentages of persons in the earlier stage of old age then cover payments for persons in the earlier stage of old age.
Note that elderly persons aged 75 or above are enrolled in the “Medical Care System for the Advanced Elderly,” an independent system.

Health insurance system overview

Financial adjustment system for the medical care costs of persons in the earlier stage of old age

• *Created based on March 2022 health department elderly-person medical care section explanatory materials (meeting of the Manager of the Nationwide Elderly-Person Medical Care and National Health Insurance Supervisory Department and the Secretary General of the regional alliance for the medical care of the advanced elderly
• *The above values are based on the fiscal 2022 budget.

Overview of cost-payment adjustments between insurers

• *The above values are the percentages of persons in the earlier stage of old age covered. Created based on the fiscal 2020 Advanced Elderly Support Payment Collection Amount, etc. Decision Situation (Health Insurance Claims Review & Reimbursement Services (HICRRS))