Guide

Japan Health Insurance for Foreigners: Which Plan Do You Need?

Last updated: March 2026 · Based on official sources

Japan has universal health insurance — every resident is required to be enrolled. With insurance, you pay only 30% of medical costs. Without it, you pay 100%, and even a routine doctor's visit can cost tens of thousands of yen.

The system can be confusing for newcomers because there are two separate types of health insurance, and which one you get depends on your employment status. This guide explains both, how to enroll, what it costs, and what it covers.

Important: Enrollment is mandatory

All foreign residents staying in Japan for more than 3 months must be enrolled in health insurance. Non-enrollment can result in backdated premium charges and may affect future visa renewals. From June 2027, visa renewal will be formally tied to insurance and pension compliance.

The Two Types of Health Insurance

Employee Health Insurance

社会保険 (Shakai Hoken)

  • Who: Full-time employees at companies
  • Enrollment: Your employer handles everything
  • Cost: Split roughly 50/50 with employer
  • Dependents: Spouse and children covered at no extra cost (if spouse earns under ¥1.3M/year)
  • Extras: Includes sick leave pay and maternity benefits

National Health Insurance

国民健康保険 (Kokumin Kenko Hoken / NHI)

  • Who: Self-employed, students, unemployed, freelancers
  • Enrollment: You enroll at your Ward Office (区役所)
  • Cost: You pay the full premium (income-based)
  • Dependents: Each person pays their own premium
  • Extras: No sick leave or maternity pay

Both types provide the same core benefit: you pay 30% of medical costs, insurance covers 70%. The difference is mainly in how you enroll, how premiums are calculated, and whether dependents are covered for free.

Which One Do You Get?

Your Situation Insurance Type Who Enrolls You
Employed full-time (Work Visa, SSW, HSP) Employee Health Insurance Your employer
Student NHI You, at the Ward Office
Working Holiday NHI You, at the Ward Office
Spouse (partner is employed) Dependent on spouse's plan Spouse's employer
Self-employed / Freelancer NHI You, at the Ward Office

How to Enroll in National Health Insurance (NHI)

If you need NHI, enrollment happens at the Ward Office (区役所) — typically during the same visit as your address registration. In many offices, staff will guide you to the health insurance counter after completing your residence registration.

What You Need

  • ☐ Residence Card (在留カード)
  • ☐ Passport
  • ☐ My Number (if you have it — not required for initial enrollment)

After enrollment, you will receive an insurance card (保険証) by mail within 1-2 weeks. Present this card at any hospital or clinic to receive the 70% coverage.

Note: Japan is transitioning from physical insurance cards to My Number Cards. Your My Number Card can now serve as your insurance card at most facilities.

How Much Does It Cost?

NHI Premiums

NHI premiums are calculated based on your income from the previous year and vary by municipality. As a newcomer with no previous Japanese income, your first-year premiums are typically very low — often around ¥10,000–15,000 for the year. Premiums increase significantly in your second year once your Japanese income is reported.

Approximate NHI Annual Premiums (varies by city)

  • Newcomer (no prior income): approximately ¥10,000–15,000/year
  • Annual income ¥3M: approximately ¥200,000–300,000/year
  • Annual income ¥5M: approximately ¥350,000–500,000/year
  • Maximum cap: approximately ¥1,060,000/year

Premiums are typically paid in 10 monthly installments (June–March).

Employee Health Insurance Premiums

If you are on Employee Health Insurance, premiums are automatically deducted from your salary. Your employer pays roughly half. The rate varies by insurer but is approximately 10% of your monthly salary (your share is about 5%).

Approximate Employee Share (Tokyo, 2025)

  • Monthly salary ¥200,000: approximately ¥9,900/month
  • Monthly salary ¥300,000: approximately ¥14,900/month
  • Monthly salary ¥500,000: approximately ¥24,800/month

Includes health insurance portion only. Pension is deducted separately.

What Is Covered?

Covered (30% copay)

  • ✓ Doctor consultations
  • ✓ Hospital stays
  • ✓ Surgery
  • ✓ Prescription medications
  • ✓ Basic dental (fillings, extractions)
  • ✓ Maternity care (covered visits)
  • ✓ Mental health consultations
  • ✓ Rehabilitation

Not Covered

  • ✗ Annual health checkups (often employer-provided)
  • ✗ Cosmetic procedures
  • ✗ Advanced dental (implants, cosmetic orthodontics)
  • ✗ Glasses and contact lenses
  • ✗ Normal pregnancy and childbirth (lump-sum grant available instead)
  • ✗ Vaccinations (some subsidized)
  • ✗ Treatments not approved in Japan

High-Cost Medical Care Benefit (高額療養費制度)

Japan has a safety net for expensive medical care. If your out-of-pocket costs in a single month exceed a certain threshold, the excess is refunded. The threshold depends on your income:

  • Low income: monthly cap approximately ¥35,400
  • Standard income: monthly cap approximately ¥80,100 + 1% of costs above ¥267,000
  • High income: monthly cap approximately ¥252,600 + 1% of costs above ¥842,000

This means that even a major surgery or extended hospital stay will not financially ruin you. Apply through your insurer or at the ward office.

Using Your Insurance at Hospitals and Clinics

  1. Present your insurance card (or My Number Card) at the reception counter when you arrive.
  2. See the doctor. Japan operates on a walk-in system for most clinics — no appointment needed, though waits can be long.
  3. Pay your 30% copay at the payment counter after your visit.
  4. If you receive a prescription, take it to a nearby pharmacy (薬局 / yakkyoku). You pay 30% of the medication cost.

Tip: Clinics (クリニック) are generally for routine visits and are faster. Hospitals (病院) handle more serious cases and specialist referrals. For non-emergencies, start at a clinic.

Finding English-Speaking Medical Care

Most clinics and hospitals operate primarily in Japanese. However, several resources can help you find English-speaking medical care:

AMDA International Medical Information Center

Multilingual medical consultation hotline. Helps you find hospitals with foreign-language support and provides telephone interpretation.

Phone: 03-6233-9266

JMIP Certified Hospitals

Japan Medical Service Accreditation for International Patients. Hospitals with this certification meet standards for accepting foreign patients, including language support.

TELL Lifeline

English-language mental health support and counseling. Available for foreigners experiencing stress, anxiety, or other mental health concerns.

Phone: 03-5774-0992

What Happens If You Don't Enroll?

  • Backdated premiums: If you enroll late, you will be charged premiums going back to your date of entry into Japan. You cannot avoid payment by delaying enrollment.
  • Full medical costs: Without insurance, you pay 100% of all medical expenses.
  • Visa renewal impact: From June 2027, insurance and pension compliance will be formally checked during visa renewals.

Frequently Asked Questions

Can I use my home country's travel insurance instead?
Travel insurance from your home country does not substitute for Japan's mandatory health insurance. You are legally required to enroll in Japanese health insurance regardless of other coverage. However, supplementary private insurance can help cover gaps like dental implants, vision, or medical evacuation.
I'm a student — are my premiums reduced?
Yes. NHI premiums for students are typically very low because they are based on income from the previous year, and most students have little or no Japanese income. First-year premiums are often around ¥10,000–15,000 for the entire year. Some municipalities offer additional reductions for students.
What if I need emergency care before I have my insurance card?
Go to the hospital. Emergency care will not be refused. You may need to pay the full amount upfront, but you can submit receipts to your insurer for reimbursement once your enrollment is processed. Keep all receipts.
Can I cancel my health insurance when I leave Japan?
Yes. If you are leaving Japan permanently, notify your Ward Office (for NHI) or your employer (for Employee Health Insurance) before departing. For NHI, visit the ward office to file a withdrawal. Make sure all premiums are paid up to your departure date.
Is dental care covered?
Basic dental care is partially covered at the standard 30% copay — this includes fillings, extractions, basic crowns, and routine cleanings. However, cosmetic dental work, implants, and orthodontics are generally not covered.

Health insurance is just one step.

See all the steps you need to complete after arriving in Japan, in the right order for your visa type.

Get Your Checklist

Sources

  • Ministry of Health, Labour and Welfare (厚生労働省) — mhlw.go.jp
  • Japan Pension Service (日本年金機構) — nenkin.go.jp
  • Immigration Services Agency of Japan (出入国在留管理庁)

This guide is for informational purposes only and does not constitute medical or legal advice. Premiums and procedures vary by municipality and insurer.