Health Insurance in Japan for Foreigners: Which One You Need, What It Costs, and How to Enroll (2026)
If you live in Japan for three months or longer, you have to be in public health insurance. There is no opt-out, and travel insurance or a policy from home doesn’t count. Which system you join is decided for you: Employee Health Insurance (社会保険, Shakai Hoken) if you work full-time for a company, National Health Insurance (国民健康保険, NHI) if you’re self-employed, a student, between jobs, or on a working holiday.
Both pay 70% of your bill at any clinic or hospital in Japan. You pay 30% at the counter, with a monthly cap if something serious happens. What differs is the price and who does the paperwork: employees pay about 5% of salary through payroll and the company handles enrollment; NHI members pay a premium set by their city or ward based on last year’s income—around ¥20,000 a month on a ¥3 million income in Tokyo—and enroll themselves at the ward office.
This guide covers who needs which system, what you’ll actually pay, how to enroll, what changed with the My Number insurance card, and what happens if you let premiums slide.
Do Foreigners Need Health Insurance in Japan?
Yes. Anyone with a residence status of more than three months—work visa, student, dependent, working holiday, spouse—is required to join one of the two public systems. It is not tied to nationality or to how long you plan to stay beyond that.
Three things catch new arrivals out:
- Travel or home-country insurance doesn’t replace it. You can keep a private policy on top, but you still have to enroll and pay premiums here.
- Enrollment isn’t optional even if you’re healthy. NHI premiums are billed from the month you registered your address, not from the day you turn up at the ward office. If you enroll late, you can be billed for up to two years of back premiums at once.
- Unpaid premiums will soon affect your visa. The government has announced that from June 2027, unpaid national health insurance and pension premiums will be taken into account when you apply to renew or change your residence status. Pay on time, or talk to the ward office about a payment plan before it becomes a problem.
If you’re between systems—say you’ve left a job and haven’t found the next one—you still need cover for the gap. See “When your situation changes” below.
The Two Systems at a Glance
| Employee Health Insurance (社会保険) | National Health Insurance (国民健康保険) | |
|---|---|---|
| Who joins | Full-time company employees, and part-timers working 20+ hours a week at companies with 51+ staff | Everyone else: self-employed, freelancers, students, working holiday, job seekers, retirees |
| Who enrolls you | Your employer, when you start | You, at your city or ward office, within 14 days of registering your address |
| How the premium is set | A percentage of your salary, split 50/50 with your employer | Set by your municipality from last year’s income, plus a flat per-person amount |
| How you pay | Deducted from your payslip | Bills or bank debit, monthly or in instalments |
| Family | Spouse and children earning under about ¥1.3 million a year are covered at no extra cost | Each family member is a member and adds to the bill |
| Co-pay at the doctor | 30% | 30% |
| Sick pay / maternity pay | Yes (傷病手当金, 出産手当金) | No (childbirth lump sum only) |
| Childbirth lump sum | ¥500,000 | ¥500,000 |
| Run by | Japan Health Insurance Association (協会けんぽ) or your company’s health insurance society | Your city or ward |
Employee Health Insurance (Shakai Hoken)
If you’re hired full-time by a Japanese company, you’ll be enrolled in Employee Health Insurance—usually together with the employee pension—from your first day. Your employer files the paperwork, and your card (or your My Number card registration) follows within a few weeks. There’s nothing for you to do except tell HR if you have a spouse or children to add as dependents.
What it costs. Premiums are a percentage of your standard monthly salary, and your employer pays half. For companies in Tokyo covered by the Japan Health Insurance Association, the 2026 rate is 9.85%, so your share is about 4.9% of gross pay. From age 40 you also pay half of the long-term care premium (1.62% in 2026), and from April 2026 a small child-support levy (0.23%, also split) was added. On a ¥400,000 monthly salary that works out to roughly ¥20,000 a month for health insurance if you’re under 40. Company-run health insurance societies (健康保険組合) set their own rates, usually a little lower.
What you get beyond the 30% co-pay. Employee insurance pays a sickness allowance (傷病手当金) of about two-thirds of your salary for up to 18 months if you can’t work because of illness or injury, and a maternity allowance (出産手当金) for leave around childbirth. Neither exists under NHI, which is the main reason employee insurance is the better deal even though it isn’t optional. Routine health checks aren’t covered by the insurance itself; companies are required to provide them separately.
You’ll see the deduction on your payslip under 健康保険—our guide to reading a Japanese payslip explains each line.
National Health Insurance (NHI / Kokumin Kenko Hoken)
NHI covers everyone the company system doesn’t: freelancers and business owners, students, working holiday makers, people between jobs, and dependents of NHI members. You enroll at your city or ward office, and the ward bills you directly.
How the premium is calculated. Each municipality sets its own rates, but the structure is the same: an income-based part (a percentage of last year’s taxable income) plus a flat per-person part, split into a medical portion, a support portion for elderly care, and—from age 40—a long-term care portion. Rates differ by ward, but only by around 10%, so Tokyo’s 23 wards look similar.
Using Nerima Ward’s 2026 rates as a Tokyo example, for a single person under 40:
| Last year’s salary | NHI premium per year | Per month |
|---|---|---|
| ¥3,000,000 | about ¥235,000 | about ¥19,600 |
| ¥4,000,000 | about ¥314,000 | about ¥26,000 |
| ¥6,000,000 | about ¥483,000 | about ¥40,000 |
Compare that with employee insurance at the same salary and you’ll see why NHI feels expensive: you’re paying the whole premium yourself, not half.
Your first year is cheap. Premiums are based on the previous year’s income in Japan. If you’ve just arrived and had no Japanese income last year, you pay only the flat part—typically under ¥7,000 a month in Tokyo, and less if you file a simple income declaration and qualify for a reduction. The bill jumps in your second year once your first year’s income is on record, so budget for it.
Reductions. Households with low income get an automatic 20%, 50% or 70% reduction on the flat part. Students, people who left a job involuntarily, and people whose income has dropped sharply can apply for further reductions—ask at the counter, because none of this is applied unless the ward knows your situation.
Paying. You’ll receive payment slips for the year, usually split into ten instalments from June. You can pay at a convenience store or bank, or set up a direct debit, which is the easiest way to avoid a missed payment showing up later. NHI premiums are fully deductible on your tax return—see our guide to filing taxes as a foreign resident.
Freelancers: your NHI payment record is also one of the documents landlords ask for—see how to rent an apartment in Japan as a freelancer.
What You Pay at the Doctor
With either system you show your insurance card (or My Number card) at reception and pay 30% of the bill. Children under school age and people over 70 pay less. A normal clinic visit with a prescription usually comes to ¥1,500–4,000.
The monthly cap. If you’re hospitalised or need expensive treatment, the High-Cost Medical Expense system (高額療養費) caps what you pay in a calendar month. The caps were raised in August 2026. For someone earning ¥3.7–7.7 million a year, the cap is now ¥85,800 plus 1% of costs above ¥286,000 in a month; below ¥3.7 million it’s a flat ¥61,500. From 2026 there is also an annual ceiling (¥530,000 for the middle bracket), so a long treatment can’t keep costing you the monthly cap indefinitely.
You don’t have to pay first and claim later: if you use your My Number card as your insurance card, the cap is applied at the hospital counter automatically. If you don’t, ask your insurer for a Limit Application Certificate (限度額適用認定証) before a planned hospital stay.
What isn’t covered. Normal pregnancy and childbirth (covered instead by the ¥500,000 lump sum), health check-ups, vaccinations for travel, cosmetic treatment, orthodontics and some dental crowns, private-room charges in hospital, and hospital meals beyond the standard charge. This is the gap that private insurance is designed for—see below.
How to Enroll and What to Bring
Employee insurance: nothing to do. Your company enrolls you. If you have family to add, give HR their names, dates of birth and, for a spouse, income details.
NHI: go to the National Health Insurance counter at your city or ward office within 14 days of registering your address (most people do both on the same visit). Bring:
- Residence card (在留カード)
- Passport
- My Number card or notification, if you have one
- If you’ve just left a job: the certificate showing your employee insurance ended (資格喪失証明書)
You’ll leave with your membership confirmed the same day; the card or certificate arrives by post. If you already have a My Number card, ask the counter to link it as your insurance card while you’re there. Most ward offices will want a Japanese phone number on the form—see how to get one cheaply.
Your Insurance Card in 2026
Japan stopped issuing the old plastic health insurance cards in December 2024, and the last of them expired in 2025. Today there are two ways to prove you’re insured:
- My Number card registered as your insurance card (マイナ保険証). Register once—at a hospital’s card reader, a convenience-store kiosk, or through the Mynaportal app—and the same card works for every doctor, pharmacy and hospital, applies cost caps automatically, and carries your prescription history.
- A Qualification Certificate (資格確認書). If you don’t have a My Number card, or haven’t registered it, your insurer sends you this paper certificate automatically. It works exactly like the old card.
If you change jobs or move from employee insurance to NHI, your My Number card registration carries over; only the underlying membership changes. Keep your residence address up to date, because the ward posts notices to it.
When Your Situation Changes
You leave a job. Your employee insurance ends the day after you leave. You have two options: join NHI at the ward office within 14 days, or stay on your old plan for up to two years under “voluntary continuation” (任意継続)—you must apply within 20 days, and you’ll pay both halves of the premium. Voluntary continuation is usually cheaper than NHI in the first year after a high salary; NHI is usually cheaper the year after. Ask the ward for a quote before you decide. Changing jobs? Our job-change checklist covers the insurance, pension and residence-card steps in order.
You start a company job. Tell the ward office once your employee insurance card arrives so they can close your NHI account—it doesn’t close automatically, and you’ll keep being billed until it does.
You move. Employee insurance: tell HR. NHI: register your move-out at the old ward and your move-in at the new one; your NHI transfers with your address.
You leave Japan. File a move-out notice (転出届) at the ward office before you go. NHI ends on that date, and you’ll settle any remaining premiums (or receive a refund for overpayment) at the counter. The full departure checklist—lease, taxes, pension refund—is in our guide to leaving Japan.
Other Premiums You’ll See on Your Payslip or Bill
Long-term care insurance (介護保険). From the month you turn 40, a long-term care premium is added to your health insurance—about 0.8% of salary for employees, or an extra per-person amount and income-based portion under NHI. It funds nursing care services for people who need them from age 65 (or from 40 for specified age-related conditions). You can’t opt out, and there’s nothing to claim until you need care.
Late-stage elderly medical care (後期高齢者医療制度). At 75 everyone moves out of NHI or employee insurance into a separate system with a 10% co-pay (20–30% for higher incomes). Premiums are deducted from pension payments. If you’re reading this as a working-age resident, it’s a line on your future, not your present.
Do You Need Private Insurance on Top?
For most people, no. Public insurance covers the big risks, and the monthly cap means a hospital stay won’t ruin you. Private cover makes sense in three situations: you’re self-employed and would lose income during a long illness (NHI has no sickness allowance); you want a private room or access to treatments outside the public system; or you have dependents whose costs would continue if you couldn’t work.
If you do buy a policy, buy it for those specific gaps rather than as a substitute for the public system—it can’t be one, and the premiums for comprehensive cover in Japan rise steeply with age.
FAQs About Health Insurance in Japan
Do foreigners need health insurance in Japan?
Yes. Anyone with a residence status of three months or longer must join either National Health Insurance or Employee Health Insurance. Travel insurance or a policy from your home country doesn’t replace it.
How much is health insurance in Japan per month?
Employee Health Insurance: roughly 5% of your gross salary (your employer pays the same again). NHI: based on last year’s income and your ward—about ¥20,000 a month on a ¥3 million salary in Tokyo, and under ¥7,000 in your first year if you had no Japanese income the year before.
What happens if I don’t enroll?
You pay the full bill at the doctor in the meantime, you can be charged up to two years of back premiums when you do enroll, and from June 2027 unpaid premiums can count against you when you renew your residence status.
Does Japanese health insurance cover dental?
Yes, for standard treatment: check-ups, fillings, extractions, root canals and basic dentures at 30%. Whitening, orthodontics, implants and some ceramic crowns are full price.
I lost my insurance card. What do I do?
Employee insurance: tell HR and they’ll request a replacement. NHI: go to the ward office with your residence card. If you use your My Number card as your insurance card, there’s nothing to replace—just keep using it.
Is private health insurance necessary in Japan?
Not for most people. It’s worth considering if you’re self-employed and need income protection during illness, or if you want cover for private rooms and treatments outside the public system.
Once your paperwork is sorted, finding a home is next. Aikagi helps English-speaking residents find and rent apartments across Tokyo, Kanagawa, Saitama, and Chiba.