Japanese healthcare is not free, but it is capped, and the cap is the part worth understanding before you need it.
Which system you are in
There are two, and you do not choose:
- Employees Health Insurance (健康保険) if you work for a company that enrols you. Premiums are deducted from salary and your employer pays roughly half.
- National Health Insurance (国民健康保険) for everyone else — self-employed, students, between jobs. You enrol at your city or ward office, and premiums are calculated on last year income.
Enrolment is compulsory, and it happens at the same counter and on the same 14-day clock as registering your address. Because National Health Insurance premiums are based on the previous year income, a new arrival first-year premiums are often very low — and rise sharply in year two.
What you actually pay
At the counter you pay 30% of the cost for most adults. Children and older patients pay less. A GP visit typically lands somewhere in the low thousands of yen, and prescriptions are charged separately at the pharmacy.
The cap that matters
The high-cost medical expense benefit (高額療養費) limits what you pay in a single calendar month, on a sliding scale by income. Above that ceiling, the insurance covers the rest. This is the mechanism that stops surgery or a long admission from being financially catastrophic, and it is the reason medical debt of the kind familiar elsewhere is rare here.
Two practical points. The ceiling is assessed per calendar month, so treatment spanning the end of a month can be counted across two ceilings rather than one. And 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 — so the hospital bills you the capped amount directly instead of you fronting the full sum and reclaiming it.
What to hand over at reception
Japan stopped issuing the old paper insurance card in December 2024. You will not receive one. Instead:
- Register your My Number Card as your insurance card and tap it at the reader in the clinic entrance, or
- Ask your insurer or city office for a Certificate of Eligibility (資格確認書), which is posted to you and is accepted at the counter
Bring it every time. Turning up without proof of insurance usually means paying the full 100% on the day and reclaiming it afterwards, which is a form you did not want and a queue you did not need.
At the counter
- 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?
Where to confirm this
- Ministry of Health, Labour and Welfare — the insurance systems and the high-cost benefit
- Your city or ward office, or your employer insurance association, for your own ceiling and premiums
Guides are dated rather than undated: last reviewed 6 August 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.