Japan – Health Insurance

Is health insurance mandatory for expats in Japan?

Japanese law requires every person who resides in the country for three months or more — including foreign nationals on long-term visas — to be enrolled in a public health insurance scheme. This obligation applies across visa categories: whether you hold a work, student, spousal, or long-term resident visa, you must participate in either Social Health Insurance or National Health Insurance (NHI).

There are two principal branches of public health insurance in Japan. Company employees join Employees’ Health Insurance (Kenko Hoken), while those who are self-employed, students, unemployed, or retired typically belong to National Health Insurance (Kokumin Kenko Hoken). Your employment situation — not the type of visa you hold — determines which branch applies to you.

If you work 30 or more hours a week, your employer is obliged to enrol you in Shakai Hoken (employee social insurance). At larger organisations, part-time workers logging 20 or more hours per week over a period of two months or more and earning at least ¥88,000 monthly may also qualify for inclusion.

The consequences of failing to comply with the enrolment requirement are serious and are becoming more stringent. Non-enrolment can lead to financial penalties and complications at visa renewal. From June 2027, immigration authorities will check whether foreign residents have been keeping up with their NHI and pension premium payments; those found to be in arrears may be refused a visa renewal or change of status.

While enrolment is compulsory for most residents, bilateral social security agreements between Japan and certain other countries may create limited exemptions. If your home country has concluded such an agreement with Japan, contact the relevant authority in your country of origin to find out whether an exemption might apply in your case.

How does the public health system in Japan work?

Japan operates what is known as the Statutory Health Insurance System (SHIS) — a hybrid structure that combines elements of government oversight with contribution-based funding. Rather than resembling the UK’s NHS, in which most care is free at the point of use and financed through general taxation, or the predominantly private US model, Japan’s arrangement is closest to the French social insurance approach: residents contribute premiums calculated on their income and then share the cost of treatment through co-payments when they actually use services.

The Ministry of Health, Labour and Welfare establishes a single national fee schedule that applies to all medical services and medications. Every procedure, consultation, and prescription is assigned a point value, where one point equals ¥10. This means that the regulated price for any given service is the same whether you attend a neighbourhood clinic or a large metropolitan hospital. Providers bill on a fee-for-service basis but are prohibited from charging above the regulated rates, which keeps costs both predictable and broadly affordable.

Japan’s public health insurance system encompasses three distinct schemes: National Health Insurance (NHI), employment-based health insurance, and the health insurance programme for the advanced elderly. Residents who have reached the age of 75, or those aged 65 or over with a registered disability, are enrolled in the Long Life Medical Care System rather than the general schemes.

Employees’ Health Insurance is funded jointly by the employer and the worker: the employer covers half the premium, while the employee’s half is taken directly from their monthly salary. The scheme generally reimburses around 70% of eligible medical costs, leaving the insured person responsible for the remaining 30%. Premium levels depend on earnings, and the enrolment process is typically managed by the company’s human resources department, which also arranges the issue of an insurance card.

National Health Insurance provides cover for self-employed individuals, students, the unemployed, retirees under 75, and their dependants. Like Employees’ Health Insurance, NHI generally covers approximately 70% of eligible medical costs. Premiums are determined by age and the previous year’s declared income. Residents enrol directly at the Residential Affairs or Citizens Affairs Division of their local city or ward office.

Japan does not operate a mandatory general practitioner gatekeeping system, so residents can book specialist appointments without first obtaining a referral. The government does, however, discourage self-referral to large multi-specialty hospitals by imposing additional charges for first consultations at such facilities, nudging patients towards smaller clinics for routine care.

How do expats register for public health coverage in Japan?

Employees of Japanese companies will generally have their Employees’ Health Insurance enrolment handled by the HR department. If you are self-employed, a student, unemployed, or otherwise ineligible for employer-based cover, you must register for NHI under your own initiative. Foreign residents must visit their local city or ward office within 14 days of taking up residence to complete the NHI application. Always consult the Ministry of Health, Labour and Welfare (MHLW) website or your local municipal office for up-to-date documentation requirements, as these can differ between municipalities.

1. Register your residential address. Within 14 days of arriving in Japan, you must register your address at your local municipal office — commonly referred to as a city hall or ward office. Bring your passport and residence card. Completing this step adds you to the official resident register and is a prerequisite for NHI enrolment.
2. Gather the required documents. You will typically need a valid form of identification (your passport and residence card), your My Number (individual number), and, if you are switching from employment-based insurance, a certificate of insurance termination (資格喪失証明書). The precise documents required can vary by municipality and personal circumstances, so it is worth checking with the relevant counter in advance.
3. Visit the National Health Insurance counter at your local city or ward office. Proceed to the Residential Affairs or Citizens Affairs Division and complete the enrolment application at the service counter. Many larger offices provide forms in several languages to assist foreign residents.
4. Submit proof of income. NHI premiums are calculated on the basis of your income from the previous year and the number of dependants in your household, with discounted rates for low-income households. If you have just arrived in Japan and have no prior Japanese income record, the office will generally use an estimated figure for your first year. It is important to report your actual income accurately at all times.
5. Receive your insurance card (or My Number Card activation). After enrolment, you will be issued a health insurance card (健康保険証) to present at medical facilities as proof of coverage. The Ministry intends the My Number Card to serve as the standard health insurance identifier going forward, with the expectation that it will facilitate smoother access to patient health records and prescription histories across providers. Note that as of 2 December 2024, new traditional health insurance cards are no longer being issued; the My Number Card has become the primary identifier. Residents who have not yet obtained a My Number Card may still access insured treatment by presenting a separate certificate confirming enrolment in a public scheme.
6. Set up premium payments. NHI members receive payment slips from their city or ward office at several points throughout the year. Payments can be made at convenience stores, bank counters, municipal offices, or via automatic bank transfer. Enrolling in automatic bank withdrawal is particularly advisable for expatriates who may be unfamiliar with Japan’s billing schedules, as it significantly reduces the risk of missed payments.
7. Use your coverage immediately upon enrolment. When attending a hospital or clinic, present your insurance card at reception. You pay only your applicable share — usually 30% — at the point of care, and NHI settles the remainder directly with the provider. Processing your enrolment typically takes one to two weeks from the date of application.

What costs are involved in the public health system in Japan?

Participation in Japan’s public health insurance involves two distinct categories of expenditure: regular premiums to maintain your membership, and co-payments made at the time of receiving treatment. Both figures vary depending on the scheme you belong to and your level of income. Premium rates are reviewed annually, so always confirm the latest figures with your local municipal office or the MHLW.

For Employees’ Health Insurance (EHI/Shakai Hoken): Your premium is proportional to your salary, and your employer contributes half while the other half is deducted from your monthly pay. By way of illustration, an employee in Tokyo earning ¥400,000 per month would pay approximately ¥20,460 per month as their half of a combined premium of roughly ¥40,918, based on 2025 rates.

For National Health Insurance (NHI): NHI premiums are structured in three components: the basic (medical) portion, the support portion directed towards elderly insurance funding, and the long-term care portion applicable to members aged 40 to 64. Each component carries both an income-based levy and a flat per-person charge. The total premium for a household is the sum of these elements, and the rates are determined independently by each city or ward and revised each year.

To give a concrete sense of the scale involved (based on 2025 rates in Tokyo): in Setagaya Ward, the medical portion is levied at approximately 7.71% of income, the support portion at 2.20%, and the long-term care portion at 1.72% (for those aged 40 to 64), in addition to flat per-capita charges. As an illustrative example, a single person earning ¥3,000,000 annually in Tokyo would pay around ¥331,380 per year in NHI premiums — roughly ¥27,615 per month — as of 2025. Since rates differ across municipalities, it is worth checking with your local ward office or using the online premium calculators that many local governments provide.

Co-payments at the point of care: The standard co-payment is 30% of the regulated fee for patients aged 6 to 69. Children under 6 generally pay 20%, those aged 70 to 74 pay 20% (rising to 30% for high earners), and those aged 75 and over pay 10% (or 30% if they exceed the high-income threshold). These rates remain in effect as of 2025.

A high-cost protection mechanism caps monthly out-of-pocket spending. For most non-elderly insured individuals, total out-of-pocket costs in a given month are capped at approximately ¥80,100 plus 1% of costs exceeding ¥267,000, based on 2025 figures. Once a member reaches this monthly ceiling, any further eligible costs for that month are either not charged or reimbursed. The exact cap is calculated according to income bracket. Always verify the current threshold with the MHLW or your ward office, as the figures are subject to periodic revision.

Late payment of premiums attracts interest charges — approximately 2.4% annually for the first three months of arrears, rising to 8.7% thereafter. Arranging automatic bank payments from the outset is strongly recommended.

What does public health cover in Japan include and exclude?

All schemes under the SHIS provide the same core benefits package, which encompasses hospital care, primary and specialist consultations, mental health treatment, approved prescription medications, home-care services provided by medical institutions, hospice care, physiotherapy, and dental treatment. The inclusion of both dental and psychiatric care within the standard package is notable — many comparable public systems worldwide treat these as separate or excluded categories.

Covered services include:

• Consultations with doctors, inpatient hospital care, surgical procedures, prescription drugs, and routine dental work such as fillings and extractions. Standard diagnostic services including emergency treatment, X-rays, and laboratory testing are also included.
• Medically necessary psychiatric treatment is covered under the public scheme, though finding care delivered in a language other than Japanese may require additional research and effort.
• NHI members aged 40 to 74 are eligible to receive health check-up vouchers covering screening for conditions such as diabetes and high blood pressure.
• NHI members also qualify for a lump-sum benefit of JPY 500,000 in connection with pregnancy and childbirth, including cases of stillbirth or miscarriage.

What is not covered, or only partially covered:

• Glasses and contact lenses are not covered under the public scheme, except when recommended by a physician for children under nine. General optometry services performed by non-physicians are likewise excluded.
• Elective and cosmetic procedures, including plastic surgery, most orthodontic work such as braces, and non-prescription medications, fall outside the coverage.
• Advanced dental treatments — implants, cosmetic procedures — are generally not covered. Vaccines not on the national immunisation schedule, including most travel vaccinations, as well as the majority of vision and hearing aids, are also excluded.
• Although psychiatric treatment is covered, the availability of providers is limited and consultations are typically brief and medication-focused. Psychotherapy and psychological counselling are not reimbursed by public insurance; private sessions typically cost ¥10,000 or more.
• Routine preventive health checks and normal childbirth are not covered through the standard insurance co-payment mechanism, but separate municipal subsidy programmes are in place to offset these costs.
• Charges for private hospital rooms and certain premium branded medications are generally borne entirely by the patient.

Unlike some public health systems that operate lengthy waiting lists, Japan generally allows patients to attend any clinic — with or without a prior appointment — without being tied to a single registered practice. However, foreign residents often find that navigating municipal NHI registration in Japanese, or interpreting a medical bill itemised in Japanese medical coding, can present a considerable challenge.

What are the advantages of international private health insurance for expats in Japan?

Private health insurance can be taken out in Japan to supplement the benefits already provided by the public system. International health insurance policies are a particularly popular option among expatriates because they offer broad, portable coverage that extends globally. Even with solid public coverage in place, there are several strong reasons why expats consider adding private or international plans.

Access to services in your preferred language: Navigating a hospital where most staff communicate primarily in Japanese can be a stressful experience for foreign residents. Many international insurance plans provide access to direct billing arrangements at international clinics staffed by multilingual personnel, and include 24/7 multilingual assistance hotlines that can make a meaningful difference when you are unwell and under pressure.

Coverage for gaps left by the public system: Private insurance is frequently used as a top-up for private room charges, access to international medical facilities, or treatment received outside Japan. Areas where NHI and EHI coverage falls short — such as optical care, advanced dental treatment, psychotherapy, and repatriation — are common motivations for taking out supplementary cover.

Global portability: For expatriates who travel frequently or spend time in multiple countries, an international health insurance policy provides continuous cover wherever they go. Japan’s public insurance is only valid within Japan; any treatment received abroad must be funded entirely by the patient unless international cover is in place.

Medical evacuation and repatriation: Many private international plans for expatriates include direct billing with partner hospitals, round-the-clock emergency helplines, and provisions for medical evacuation and repatriation. Neither NHI nor EHI offers these benefits, making private cover especially valuable for anyone in a remote area or with complex medical needs.

Maternity planning: Comprehensive private plans often incorporate maternity benefits, though these typically come with waiting periods. Combining the public lump-sum maternity allowance with private maternity cover can meaningfully reduce both the financial and logistical burden of having a child in Japan.

It is worth noting, however, that private insurance operates rather differently in Japan compared to countries where private hospitals maintain entirely separate fee structures. Most Japanese hospitals and clinics operate within the national fee schedule, so private insurance in Japan tends to function primarily as a supplement rather than a pathway to a completely distinct tier of care.

How do international private health insurance plans work in Japan?

Expatriates can purchase private health insurance on top of their public coverage to fill gaps such as private room fees, international medical evacuation, or treatment at foreign-language clinics. It is important to understand, however, that holding private insurance does not exempt a long-term resident from the legal obligation to maintain public scheme membership. Private insurance supplements NHI or EHI — it cannot legally replace them.

Two broad types of private plan are available to expatriates in Japan. Local Japanese private insurance products typically offer a lump-sum payment triggered by a specified period of hospitalisation or a serious diagnosis. Policyholders usually pay their full medical bill upfront and then submit a reimbursement claim. International Private Medical Insurance (IPMI) plans, by contrast, generally operate on a broader inpatient and outpatient model and may include direct billing arrangements with selected hospitals and clinics.

When evaluating private plans, the following factors deserve careful attention:

• Inpatient vs outpatient cover: Confirm whether everyday outpatient visits — GP consultations, specialist appointments — are included, not only extended hospital stays.
• Pre-existing conditions: Some policies impose waiting periods of 15 to 30 days for declared pre-existing conditions. Unlike NHI, which does not risk-price premiums, private insurers typically apply exclusions or waiting periods for conditions disclosed at the time of application.
• Geographic coverage limits: If you are primarily based in Japan but travel within the Asia-Pacific region, an IPMI with “Asia-only” or “worldwide excluding USA” coverage may offer a good balance between breadth and cost.
• Direct billing networks: Some international clinics in Japan offer direct billing with particular insurers; others operate on a pay-then-claim basis. Confirm this detail before seeking treatment and keep your private policy documents accessible.
• Dental and vision riders: Private plans may offer optional dental riders, but cosmetic work is almost universally excluded. Scrutinise exactly which dental services are included before committing to a policy.

Well-known international insurers such as Cigna, AXA, and Aetna offer plans tailored to expatriates in Japan. Most foreign nationals with legal residency are eligible to apply, though conditions vary by provider. As a rough guide, private top-up plans begin at around ¥3,000 per month for basic cover and can reach ¥15,000 or more per month for comprehensive packages that include dental and vision benefits. Verify current premiums directly with the insurer, as costs are influenced by age, coverage level, and selected plan options.

What should expats watch out for with health insurance in Japan?

Japan operates a well-structured healthcare system, but a number of pitfalls regularly catch expatriates by surprise. Familiarising yourself with these issues from the start will spare you unnecessary expense and inconvenience.

Missing the 14-day enrolment deadline: Some new arrivals are unaware that NHI enrolment is compulsory and delay registering. The consequence can be a retrospective premium bill covering every month since your residency began, because enrolment is backdated to your move-in date. Registering within the 14-day window avoids this problem entirely.

Gaps when changing between schemes: Moving between insurance schemes — for example, when starting or leaving a job, or reaching the age of 75 — requires timely paperwork. Any delay can leave you temporarily without a valid insurance card. Notify your municipal office immediately whenever your employment situation changes. If you relocate to a different city or ward, note that your records do not transfer automatically; you will need to re-register at your new local office.

Employer non-compliance: A minority of employers mislead foreign employees, claiming that insurance enrolment is unnecessary or only available to full-time workers. If you work 30 or more hours per week for a qualifying employer, you have a legal right to be enrolled in Shakai Hoken. Review your contract carefully and do not rely solely on your employer’s assurances.

Assuming home country insurance covers you in Japan: Newly arrived residents or tourists sometimes expect their domestic health insurance to be valid in Japan. It is not. Anyone without travel insurance who needs medical treatment in Japan is liable for 100% of the cost at the time of the appointment. Public insurance from another country carries no legal standing within Japan’s healthcare system.

Confusing travel insurance with health insurance: Short-term travel medical policies are designed for emergencies and temporary stays, not for people living in Japan. They are not a substitute for — and will not satisfy the legal requirement to hold — a public health insurance scheme. If you are residing in Japan rather than visiting, a travel policy is fundamentally inadequate.

Losing your insurance card: Attending a medical facility without your insurance card means paying 100% of the treatment cost upfront. Reimbursement of the insured portion is possible afterwards, but it involves additional administrative effort. As the system transitions to My Number Card-based identification, keeping your My Number Card in a safe and easily accessible location has become increasingly important.

Expecting comprehensive talk therapy under public insurance: While psychiatric treatment is technically covered, the number of providers is relatively limited and consultations tend to focus on brief, medication-oriented appointments. Psychotherapy and counselling by psychologists sit outside the public coverage entirely. If ongoing mental health support is a priority, you should budget for private therapy — typically ¥10,000 or more per session — or look for an international insurance plan that includes mental health benefits.

Frequently asked questions about health insurance in Japan

Can I use my home country’s health insurance in Japan?

No. Health insurance issued by your home country has no validity in Japan. Visitors travelling short-term should carry adequate travel medical insurance. Anyone intending to live in Japan for more than three months is legally required to join either NHI or Employees’ Health Insurance — that obligation exists regardless of any foreign insurance policy you may hold.

Do I need private health insurance if I already have a work visa and employer-based cover in Japan?

Private cover is not a legal requirement for those enrolled in Employees’ Health Insurance. Nevertheless, many expatriates choose to maintain private insurance alongside their public coverage to access services such as optical care, advanced dental treatment, psychological therapy, and medical treatment abroad. While not obligatory, it provides peace of mind and a broader safety net for the areas where public cover falls short.

What happens if I do not enrol in NHI?

If you are not employed and choose to forgo NHI registration, enforcement has historically been inconsistent. However, if the gap is later identified, you may be required to pay premiums backdated to the start of your residency. From June 2027, the stakes are higher: outstanding NHI premium payments can be grounds for refusing a visa renewal or change of status application.

How long does it take to get my NHI insurance card after applying?

The processing period following application at the ward office is typically one to two weeks. If you need medical treatment during this interval, you may need to pay the full cost upfront and apply for reimbursement of the insured portion once your card is issued. Keeping a private or travel insurance policy active during this transitional period is a sensible precaution.

Is dental treatment covered under Japan’s public health insurance?

Yes, to a meaningful degree. Routine dental care — fillings, root canal treatment, and similar procedures — is covered under Japan’s public insurance, with patients paying the standard 30% co-payment. This makes everyday dental treatment genuinely affordable. However, cosmetic procedures such as orthodontic braces for aesthetic purposes, dental implants, and other elective treatments are excluded and must be paid for out of pocket.

Does Japan’s public health insurance cover maternity care?

Maternity support under the public system takes the form of a lump-sum benefit rather than coverage of individual consultations. NHI members receive a single payment of JPY 500,000 in connection with pregnancy and childbirth, as well as in cases of stillbirth or miscarriage. Routine prenatal appointments and uncomplicated childbirth are handled through separate local government subsidy programmes rather than the standard insurance co-payment structure. Check with the MHLW or your local office for the most current benefit amounts, as these may be revised over time.

Are there income-based reductions available for NHI premiums?

Yes. NHI premiums are assessed on the basis of your previous year’s income and household size, and reduced rates apply for lower-income households. Students in particular should ensure they file an income declaration form when enrolling, as this enables the municipal office to apply automatic discounts — often reducing the standard NHI premium by 70 to 90%. Contact your local ward office to determine whether you qualify for a reduction.

What is the My Number Card and do I need it for healthcare?

The My Number system, introduced in 2016, is Japan’s national identification framework. As of 2 December 2024, the production of conventional health insurance cards has been discontinued, and the My Number Card now serves as the principal means of proving insurance enrolment at medical facilities. Residents who have not yet obtained a My Number Card may still access insured care by presenting an official certificate of enrolment in a public scheme. It is strongly advisable to apply for and activate your My Number Card as soon as possible after arriving in Japan.