Japan's Long-Term Care Insurance System (Kaigo Hoken)

Understanding society（社会の理解）· Material

介護保険制度のしくみ · Updated 26 October 2026

The 介護保険制度 is Japan's public long-term care insurance system, in force since 2000. Its basic idea is 介護の社会化: the burden of caring for older people is no longer carried by families alone, but shared by the whole of society through premiums and taxes. The 社会の理解 field almost always includes questions about this system, so understand the flow from insured person to payment.

Who is insured

The insurer （保険者） is the municipal government （市区町村）, not the national government. Insured persons （被保険者） are divided into two groups by age.

第1号被保険者 are all residents aged 65 and over. They can use services when they are certified as needing care or support, whatever the cause. 第2号被保険者 are residents aged 40–64 who are enrolled in health insurance; they can use services only when their care needs are caused by one of 16 specified diseases （特定疾病）, such as cerebrovascular disease or early-onset dementia （初老期における認知症）.

• 保険者 = 市区町村 (municipal government)
• 第1号被保険者： aged 65+, no condition on the cause
• 第2号被保険者： aged 40–64, only for the 16 特定疾病

The care-needs certification process （要介護認定）

To use services, the person applies for certification to the municipal government. An assessor makes a home-visit assessment （認定調査） covering 74 items about physical and mental condition and daily life, and the primary care doctor （主治医） writes a medical opinion （主治医意見書）.

Both are then reviewed by the certification committee （介護認定審査会）, which decides the level of need: 非該当 (independent), 要支援1–2 (needs support, using preventive benefits 予防給付）, or 要介護1–5 (needs care, using care benefits 介護給付）. The larger the number, the heavier the care needs. The certification is valid for a set period and can be renewed （更新） or reassessed for a level change （区分変更） if the condition changes.

• 認定調査： 74 items + 主治医意見書
• Decided by the 介護認定審査会
• Results: 要支援1–2 and 要介護1–5

The care plan （ケアプラン）

After certification, a care manager （介護支援専門員, usually called a ケアマネジャー） at a home care support office （居宅介護支援事業所） draws up a service plan （ケアプラン） based on the wishes of the user and their family. The cost of making this plan is fully covered by the insurance — the user pays nothing at all, and this often appears as a trick question.

For 要支援 users, a preventive care plan （介護予防ケアプラン） is made through the community comprehensive support center （地域包括支援センター）.

• The ケアマネジャー draws up the ケアプラン
• Cost of making the ケアプラン： free for the user (fully covered)

Types of services and user costs

Home services include home-visit care （訪問介護）, day care （通所介護 or デイサービス）, and rental of welfare equipment （福祉用具貸与）. Facility services include special nursing homes for older people （特別養護老人ホーム）, geriatric health services facilities （介護老人保健施設）, and 介護医療院. There are also community-based services （地域密着型サービス） such as small-scale day care and combined home-visit nursing and care.

In principle, users pay 10% of the service cost （1割負担）; higher-income users pay 20% or 30%. If total payments in a month exceed a ceiling, the excess is refunded through the high-cost care service benefit （高額介護サービス費）, so the household burden stays affordable.

• User share: in principle 1割 (10%), up to 3割 by income
• 高額介護サービス費 protects against monthly cost spikes

Community comprehensive support centers （地域包括支援センター）

Every area has a 地域包括支援センター as the first consultation point for residents aged 65 and over and their families. Its duties include general consultation, care prevention （介護予防）, rights protection including support for the adult guardianship system （成年後見制度）, and support for ケアマネジャー. The centers are run by municipal governments, sometimes through designated operators, and serve as the base for multidisciplinary staff such as social workers （社会福祉士）, public health nurses （保健師）, and chief care managers （主任介護支援専門員）.

• Main target: local residents aged 65+
• Four pillars: consultation, prevention, rights protection, professional support

Key terms

Frequently tested points

• The insurer is the 市区町村， not the national government or the prefecture.
• Category 2 insured persons (aged 40–64) are covered only when the cause is one of the 16 特定疾病.
• Making a ケアプラン costs the user nothing — an answer choice that mentions a plan fee is usually wrong.
• The 認定調査 has 74 items, and the final decision rests with the 介護認定審査会， not with the doctor or the assessor.

Independent study material for the Japanese national Certified Care Worker exam (介護福祉士国家試験). Official terms and rules may change — always cross-check with the latest official sources.