・I have struggled with mental health issues for many years, first visiting a mental health clinic and starting day care at age 26, and have been involved with medical and welfare services for nearly 30 years.
・Age 26, started mental health outpatient treatment.
・Around age 30, diagnosed with schizophrenia.
・At age 46, started Xeplion injections. At age 48, started Xeplion TRI injections.
・At age 49, achieved remission.
・At age 52, succeeded in getting a job in the headquarters office of a major tire brand under the employment quota for persons with disabilities.
・I will share my story based on what I learned during that time.
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・The Medical Expense Support System is actually also a measure against high medical costs. This is because there are caps on the amount you pay for fixed-rate expenses when using long-acting injectable drugs that cost 130,000 yen or 50,000 yen per dose.
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・Services covered by the Medical Expense Support System include medical examinations, medication costs at pharmacies, day care, psychiatric home nursing, and medical counseling.
・You can use these services after registering at the disability support counter at your local municipal office.
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・Regarding counseling, the applicability of the support system differs between medical counseling and general counseling. Please be sure to check with your doctor or the hospital reception desk.
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・The Medical Expense Support System is a public medical expense subsidy system that reduces the out-of-pocket medical costs for those who require continuous outpatient medical care for mental disorders or specific physical disabilities.
Normally, medical expenses that require a 30% co-payment under health insurance are reduced to 10% in principle.
1. Main Types
Medical Expense Support is divided into the following three categories:
1. Outpatient Mental Health Care: For those who need to continue outpatient treatment due to a mental disorder (e.g., schizophrenia, manic-depressive illness, epilepsy, etc.)
2. Rehabilitation Medical Care: For holders of a Physical Disability Certificate, medical care to reduce disability or restore function (e.g., hemodialysis, artificial joint replacement, etc.)
3. Developmental Medical Care: Medical care for children with physical disabilities to restore or remove functional impairments
2. Benefits and Features
* Medical expenses reduced to 10% co-payment: Out-of-pocket expenses for outpatient visits, medication, day care, home nursing, etc., are generally 10%.
* Setting of monthly payment caps: A cap is set on the monthly payment amount based on income (e.g., 2,500 yen to 20,000 yen per month for tax-exempt households or those with income).
* Application possible without a disability certificate: If you have a medical certificate (specified format), you can apply regardless of whether you have a certificate.
3. Eligible Persons
* Those who require long-term outpatient treatment for mental disorders or epilepsy.
* *Inpatient medical expenses are not covered.
4. Application and Renewal Methods
* Application counter: Disability Welfare Division or Health and Welfare Division of your municipality.
* Required documents:
* Application form
* Medical certificate by a designated physician (for outpatient mental health care)
* Health insurance card
* My Number verification documents
* Documents confirming income (tax certificate, etc.)
* Expiration date: Generally 1 year. To continue using the service, you must complete renewal procedures starting 3 months before the expiration date.
5. Points to Note
* Applicable only to designated medical institutions: Limited to hospitals and pharmacies designated by prefectures or government-designated cities.
* Treatment unrelated to mental disorders is not covered: Cold medicine or treatment for unrelated illnesses is not covered.
* There is a screening process: After application, the local government will decide on the provision of benefits through a screening process.
For details, please consult the disability welfare counter of your local municipality.
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・Regarding counseling, whether the Medical Expense Support System applies depends on whether it is conducted as “insurance-covered medical treatment” or “self-pay treatment.”
1. Cases where the system applies (10% co-payment)
If it is insurance-covered counseling conducted by a doctor during consultation hours, it is covered by the system, and the out-of-pocket expense is 10% (and up to the monthly cap).
* Outpatient psychotherapy: Psychotherapy conducted by a doctor during a regular consultation.
* Specific psychotherapy: “Cognitive therapy/cognitive behavioral therapy,” etc., systematically implemented by a doctor for specific disorders (depression, panic disorder, etc.).
2. Cases where the system does not apply (full out-of-pocket expense)
Self-pay counseling conducted over time by a psychologist (certified public psychologist, clinical psychologist, etc.) at a hospital or counseling room is not covered by the Medical Expense Support System.
* Reason: Because the Medical Expense Support System is a system that reduces “medical expenses covered by public health insurance,” it cannot be used for self-pay treatment that is not covered by insurance.
* Market rate: It is common for it to cost several thousand yen to 10,000 yen for 50 minutes per session, and this is entirely out-of-pocket.
3. Options if you want to keep costs down
If the cost of self-pay counseling is a burden, considering the following public or low-cost services is one way.
* Public health centers/Mental health and welfare centers: You may be able to receive consultations from experts for free.
* University psychological clinical centers: As training institutions for clinical psychologists, they often accept consultations at relatively low costs (from 3,000 yen per session, etc.).
* Local government telephone/SNS consultations: There are also an increasing number of free consultation counters that can be used anonymously.
First, I recommend directly confirming with the reception desk or your attending physician at the hospital you are currently visiting whether “the counseling you are receiving (or want to receive) is covered by insurance (eligible for Medical Expense Support).”
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・Let’s definitely use the Medical Expense Support System, which also serves as a measure against high medical costs!
Daisuke Kudo
#MedicalExpenseSupport
#PersonWithMentalDisability
#MentalHealth
