Japan's Ministry of Health, Labour and Welfare is advancing significant healthcare cost reforms that will affect foreign residents, particularly those using elderly care services or managing chronic medical conditions. Two key proposals under consideration could reshape how expats and their families access and pay for healthcare in Japan's aging society. According to NHK, the ministry is examining changes to two critical systems: the High-Cost Medical Expense System's outpatient special provisions for those aged 70 and above, and the care management fees currently provided free to nursing home residents. These reforms reflect Japan's ongoing struggle to balance quality healthcare access with the financial pressures of a rapidly aging population. The High-Cost Medical Expense System, known as kōgaku-ryōyō-hi in Japanese, currently protects patients from catastrophic medical bills by capping monthly out-of-pocket expenses. For individuals aged 70 and older receiving outpatient treatment, a special provision offers lower payment caps compared to inpatient care. The ministry's specialist committee has now recommended reviewing these outpatient cap amounts, potentially increasing what elderly patients pay for regular clinic and hospital visits. This change could significantly impact expats who have aged into Japan's healthcare system or those caring for elderly family members. While specific new cap amounts have not been announced, the review suggests that outpatient costs for chronic condition management—such as diabetes, hypertension, or heart disease—may increase for those over 70. Foreign residents should note that Japan's national health insurance system applies equally to all enrolled residents regardless of nationality, meaning these changes will affect expats in the same way as Japanese citizens. The second major proposal concerns care management services, or "care management" in the long-term care insurance system. Currently, professional care managers who assess needs and create care plans for elderly individuals receive payment directly from the insurance system, making the service free for users. The ministry is now considering charging fees for these services specifically for residents of paid nursing homes (yūryō rōjin hōmu). This proposal targets a perceived inequity in the current system. Nursing home residents, who already pay facility fees, receive the same free care management services as elderly people living independently at home. Ministry officials argue that those who can afford private nursing home fees should contribute to their care management costs. For expats considering nursing home options for themselves or family members, this could add another expense layer to already substantial facility fees. The timing of these reforms reflects broader concerns about Japan's social security sustainability. With the country's elderly population continuing to grow while the working-age population shrinks, the government faces mounting pressure to control healthcare and long-term care expenditures. The ministry has been conducting ongoing reviews of social security burden distribution across different demographic groups. For foreign residents in Japan, these proposals underscore the importance of understanding the national health insurance and long-term care insurance systems. All residents are required to enroll in these programs, and changes to cost structures will directly affect household budgets. Expats should monitor official announcements from the Ministry of Health, Labour and Welfare as these proposals move through the review process. While neither proposal has been finalized, the ministry's specialist committee recommendations typically influence eventual policy decisions. Foreign residents, especially those approaching retirement age or already receiving care services, should prepare for potential cost increases. Consulting with financial advisors familiar with Japan's healthcare system and reviewing current insurance coverage may help expats plan for these anticipated changes. As Japan continues balancing universal healthcare access with fiscal sustainability, expats should expect ongoing reforms to the systems they rely on for medical care and elderly support services.