Japanese healthcare is not free, but it is capped, and the cap is the part worth understanding before you need it. This guide covers what you will pay month-to-month in premiums, what happens when you visit a clinic, and exactly what to hand over at the counter.
Which system you are in
For most working-age residents, the main routes are:
- Employees' Health Insurance (健康保険 / Kenkō Hoken) when a workplace enrols you. Most companies enrol full-time employees; part-timers working above defined statutory hours are also covered. Eligible supported family members may be added as insured dependants at no extra premium. Premiums are split 50/50 with your employer and deducted automatically from salary.
- National Health Insurance (国民健康保険 / Kokumin Kenkō Hoken, commonly NHI or 国保) when you are not covered by another public medical-insurance route — you are self-employed, a student, freelancing, or between jobs. NHI has no premium-free dependant category; each eligible household member is enrolled and contributes. Learn how premiums are calculated in our Japan health insurance cost guide.
When you become eligible for National Health Insurance, notify the municipality within 14 days. Premiums commonly reflect prior-year income and municipal household rules, so they can change substantially at the next annual assessment.
NHI vs Employees' Health Insurance: how premiums compare
The biggest practical difference is cost structure. Employees' insurance is shared with your employer; NHI is paid entirely by you.
| Feature | Employees' Health Insurance (社会保険) | National Health Insurance (国民健康保険) |
|---|---|---|
| Who pays | You + employer (50/50 split) | You (full amount) |
| How calculated | % of your Standard Monthly Remuneration | Based on prior-year Japan income + household |
| Employee share (approximate) | ~4.9%–5.0% of gross salary | Varies by ward; typically 8%–12% of prior income |
| Dependants | Spouse/children at no extra cost | Each member pays separately |
| Year 1 for new arrivals | Based on actual salary from start | Very low — no Japan income on record yet |
| Year 2 onwards | Set each October based on April–June earnings | Jumps after first tax return is filed |
| Copay at clinic | 30% (working-age adults) | 30% (working-age adults) |
Approximate NHI premiums by income level
These are indicative annual NHI premium figures for a single adult (no dependants) in a typical metropolitan ward. Each municipality calculates its own rates, so your actual bill will differ — but these give you the right order of magnitude.
| Prior-year Japan income (taxable) | Approximate annual NHI premium | Monthly equivalent |
|---|---|---|
| ¥0 (new arrival, Year 1) | ¥20,000–¥60,000 | ~¥2,000–¥5,000 |
| ¥2,000,000 | ¥160,000–¥200,000 | ~¥13,000–¥17,000 |
| ¥3,000,000 | ¥230,000–¥280,000 | ~¥19,000–¥23,000 |
| ¥5,000,000 | ¥380,000–¥430,000 | ~¥32,000–¥36,000 |
| ¥8,000,000+ | ~¥700,000 (capped) | ~¥58,000 |
NHI premiums are capped annually (around ¥700,000–¥1,040,000 depending on the component), so very high earners do not pay unlimited amounts.
What you actually pay at the clinic (the 30% rule)
Most working-age insured patients pay 30% of covered care at the counter. The remaining 70% is reimbursed directly to the clinic by your insurer. Cost-sharing differs for:
- Children (0–5): 20% — and many municipalities fully subsidise this to 0%.
- Ages 6–69: 30% standard.
- Ages 70–74: 20%, unless income exceeds the "general income" threshold, in which case 30%.
- Ages 75+: Enrolled in Latter-Stage Elderly Medical Insurance (後期高齢者医療); most pay 10%.
Prescriptions are dispensed at a separate pharmacy, not the clinic, and billed by the pharmacy at the same copay percentage.
The cap that matters: high-cost medical expense benefit (高額療養費)
The high-cost medical expense benefit (高額療養費 / Kōgaku Ryōyōhi) limits eligible insured out-of-pocket costs in any single calendar month. The cap is calculated on a sliding scale by income. Non-covered services, meal charges, and certain room upgrades are outside the calculation — it is not a cap on every yen on a hospital bill, but it covers the majority of standard treatment costs.
The ceiling is assessed per calendar month, so treatment spanning the end of a month can be split across two monthly ceilings rather than one. If your total medical spending for the year still exceeds ¥100,000, you can also claim an income tax rebate through the medical expense tax deduction (Iryōhi Kōjo).
You can apply in advance for a limit-applicable certificate (限度額適用認定証) — or use your My Number Card, which can do the same job automatically at participating facilities — so the hospital bills you only the capped amount directly, instead of you paying the full sum upfront and reclaiming it.
What if you join NHI mid-year?
If you leave a job, your Employees' Health Insurance ends on your last day of employment (or at month-end, depending on insurer rules). You have two options:
- Join National Health Insurance: Go to your ward office within 14 days. Bring your residence card and proof your previous insurance ended (e.g. a withdrawal notice or the 健康保険喪失証明書). The ward will enrol you retroactively, and backdated premiums will be billed.
- Continue previous Employees' Insurance (任意継続 / Ninin Keizoku): Within 20 days of leaving the company, you can elect to continue the same coverage for up to 2 years — but you now pay both halves (yours and your former employer's). This can be cheaper than NHI if your NHI calculation is based on a high prior-year income.
What coverage actually includes
Standard public insurance covers a broad range of services, including:
- GP visits, specialist referrals, emergency treatment, hospitalisation
- Prescription medication (formulary drugs at 30% copay)
- Dental care — basic extractions, fillings, root canals (cosmetic work such as implants or ceramic crowns is typically not covered)
- Mental health sessions with a licensed psychiatrist or clinical psychologist (at a registered clinic) — see our guide to therapy and mental health services in Japan
- Maternity care: childbirth itself is not classified as an illness and so is not covered under the standard 70% scheme, but the Childbirth Lump-Sum Grant (出産育児一時金, currently ¥500,000) is paid for each birth. Pregnancy check-ups before delivery receive municipal subsidies. See our overview of statutory healthcare benefits for the full list.
What to hand over at reception
Japan stopped issuing old health-insurance cards on 2 December 2024, and their remaining validity ended by 1 December 2025. Instead:
- Register your My Number Card for insurance use and tap it at the facility reader. A supported iPhone works only at facilities equipped for smartphone use, or
- Use the Eligibility Confirmation Certificate (資格確認書) that your insurer issues automatically and free of charge, for the time being, if you do not have a valid Myna insurance card
Bring it every time. Turning up without proof of insurance usually means paying the full 100% on the day and reclaiming it afterwards.
At the counter (useful phrases)
- 保険証を持っています。 — Hokenshō o motte imasu. — I have my insurance card.
- 初めてです。 — Hajimete desu. — This is my first visit here.
- 英語が話せる先生はいますか？ — Eigo ga hanaseru sensei wa imasu ka? — Is there a doctor who speaks English?
- 限度額適用認定証はどこで申請できますか？ — Gendogaku tekiyō ninteishō wa doko de shinsei dekimasu ka? — Where can I apply for a limit-applicable certificate?
- 国民健康保険に加入したいです。 — Kokumin Kenkō Hoken ni kanyū shitai desu. — I would like to join National Health Insurance.
Where to confirm this
- Ministry of Health, Labour and Welfare: National Health Insurance
- Ministry of Health, Labour and Welfare: 資格確認書 issuance
- Ministry of Health, Labour and Welfare: high-cost medical expense reform
- Our detailed guide to Japan health insurance premiums and costs
- Our guide to statutory healthcare benefits
- Your city or ward office, or your employer insurance association, for your own ceiling and premiums
Guides are dated rather than undated: last reviewed 13 September 2026. This is an organisational aid, not legal or immigration advice — always confirm anything consequential with your ward office, the Immigration Services Agency, or a qualified professional.