Health Insurance in Japan Explained: Costs, Coverage, and Enrollment for Foreigners (2025)

Quick Facts (FY2025)

National health insurance (NHI) premiums are assessed per household. In Tokyo the annual premium is capped at about ¥920,000 (medical portion) + ¥170,000 (long-term care portion) for a household – ¥1,090,000 total. Patients typically pay 30% co-payment for care (children and seniors pay less). You must register with NHI within 14 days of losing other insurance or moving to a new municipality. High-cost medical expenses are capped at roughly ¥80,100 per month for most non-elderly (plus 1% of costs above ¥267,000). Late payment of premiums incurs interest (~2.4% per year for the first 3 months, ~8.7% thereafter).

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How National Health Insurance Works in 2025

Japan's universal healthcare system dates back to 1961. NHI covers everyone not insured by employer-based plans or the elderly system. Since April 2018, prefectures (with their cities/wards) co-administer NHI, receiving government subsidies as needed. Enrollees pay premiums based on income and number of people in the household. When visiting a hospital or clinic, show your health insurance card (保険証) at reception – you pay only your share at the counter, and NHI pays the rest directly to the provider.

Covered Services	Examples	Not Covered (Out-of-Pocket)	Examples
Standard medical care (in/outpatient)	Illness/injury treatments, surgery, prescriptions, emergency care	Non-essentials	Cosmetic surgery, most herbal remedies, orthodontic appliances
Hospitalization and surgery	Hospital ward fees (excluding private-room upgrades)	Private-room charges, TV fees	Private room upgrades, spa treatments
Prescribed medicine	Drugs dispensed at pharmacies or hospitals	Over-the-counter drugs	Cough syrup without prescription
Dental care (basic)	Fillings, extractions (some advanced work limited)	Elective dentistry	Cosmetic veneers

Special cases	Examples	Excluded	Examples
Childbirth	Lump-sum allowance ("出産育児一時金")	Not covered:	Infertility treatments, male vasectomies
Preventive care	Childhood immunizations (national schedule)	Not covered:	Travel vaccines, vitamin therapy
Rehabilitation, home nursing	Post-stroke rehab, home care (as prescribed)	Not covered:	General fitness programs, massages

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Premium Breakdown

NHI premiums consist of three "portions": the basic (medical) portion, the support portion (for the elderly insurance fund), and the long-term care portion (for ages 40–64). Each portion has an income levy and a per-capita levy. In other words, each household's premium is calculated based on: (Total income levy) + (Per-person levy). The rates are set by each city or ward and updated each year. In Tokyo (e.g. Setagaya Ward), 2025 rates are roughly 7.71% of income for the medical portion, 2.20% for support, and 1.72% for care (40–64), plus flat per-person charges (≈¥47,300 + ¥11,000 + ¥16,800 respectively). After calculating each portion, if any exceeds its cap (e.g. medical portion max ¥660,000) it is cut off and not counted. For example, Setagaya's 2025 cap is ¥660,000 (medical) + ¥260,000 (support) + ¥170,000 (care) = ¥1,090,000 total.

Premium Example (Tokyo, 2025):
A household earns ¥4,000,000/year. If one adult (age 28) with no dependents: annual premium ≈¥737,000. If a family of 3 (two adults + one child, combined income ¥4,000,000): each adult still pays a share, and adding per-capita levies for 3 people yields roughly ¥570,000–¥600,000 (approximate). (Exact amounts vary by municipality and deductions.)

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NHI Eligibility: Who Must Enroll and Exemptions

All Japan residents not covered by other health insurance must enroll in NHI at their local government office. In practice this means: Japanese citizens and foreigners with valid visas (residence permits) of ≥1 year, unless they are already insured by an employer or the late-stage elderly system. Those excluded from NHI include: people already insured under an employer or seaman's plan, the late-elderly (75+) plan, welfare recipients, and foreigners without a valid visa or with a residence period <1 year. (Foreign residents hospitalized as visitors for acute care are also excluded.) In 2024–25 there are policy discussions about extending coverage to all long-term foreign residents, but as of 2025 the above eligibility rules apply.

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How to Enroll (Step-by-Step)

1. Gather documents: You will need proof of identity (passport, residence card), your My Number (individual number), and if switching from employment insurance, the "資格喪失証明書" (certificate of insurance termination). If you moved from another city, bring your "転出証明書" (move-out certificate).
2. Submit within 14 days: Go to your ward office or municipal office as soon as possible after the qualifying event (leaving a job, moving in, age 65+ leaving company plan, etc.). The law requires notification within 14 days of that event; late filing means you remain uninsured (pay all medical costs yourself) for any delay period.
3. Fill out enrollment form: Complete the official NHI join form (often called 「国民健康保険加入届」) provided by the office. Your city will calculate your premium based on last year's income.
4. Receive insurance card: Once processed (usually immediately or within days), you'll receive a 国民健康保険証 (NHI card). Start using it at medical institutions right away.

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Coverage & Out-of-Pocket Medical Costs

Your co-payment depends on age: children under 6 typically pay 20%, those 6–69 pay 30%, ages 70–74 pay 20% (some higher-income seniors pay 30%), and 75+ pay 10%. (Municipalities may further reduce children's rates or co-pays.) Covered services include virtually all necessary medical and dental treatment, as noted above. Patients pay their share (30%, etc.) at the time of care; NHI covers 70% of costs. Services not covered (so paid fully by you) include most elective or cosmetic procedures, non-insured drugs, private-room charges, and convenience items (e.g. a private hospital room, travel vaccinations, etc.).

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Claiming High-Cost Medical Reimbursements

If you (or a family member) incur very high medical fees in one month, the 高額療養費制度 (High-Cost Medical Expense Benefit) will cap your out-of-pocket. For example, a typical earner under 70 pays ¥80,100 + 1% of costs over ¥267,000 in a month. Any excess is reimbursed later. To make use of this in advance, you can apply for a 限度額適用認定証 (certificate of eligibility) and present it at the hospital. That way you need to pay only up to the capped amount (~¥80k) at the counter (instead of the full 30%). After your application is processed, the city will refund the excess portion of your bill (usually a few months later).

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Switching, Leaving, or Not Paying

If you start a job with social insurance, you must withdraw from NHI and switch to the company plan (notify within 14 days). Conversely, on leaving a job (losing those benefits), you must join NHI immediately. Failure to properly cancel NHI can create back-bills: if you keep using your health insurance card after joining another plan, you will owe the city those costs. If you leave Japan permanently (or deregister your residence), you should notify the office and can request a refund of any unspent premium (the city will usually transfer it to your bank account). If you simply stop paying without notice, penalties apply: interest accumulates on unpaid premiums and the municipality may seize assets or garnish income to collect the debt.

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Case Study – Self-Employed Foreigner in Shibuya

A 28-year-old self-employed individual in Shibuya earning ¥4,000,000/year would pay roughly ¥737,000 in annual NHI premiums (Tokyo rate). Suppose they visit a clinic and incur a ¥10,000 bill – they pay ¥3,000 (30% of ¥10k) at the counter. Now imagine a serious illness or injury with ¥1,000,000 in hospital charges in one month: their share would be ¥300,000. However, using the high-cost cap, they would only pay about ¥80,100 (plus any 1% over ¥267k). If they had the 限度額適用認定証, they'd pay only ~¥80k at the hospital, and the rest (≈¥220k) would be reimbursed later.

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FAQ

Q: Who must join National Health Insurance?
A: Anyone living in Japan who is not covered by another insurance (e.g. a company plan or late-elderly plan) must enroll in NHI through their ward office. This includes most self-employed, unemployed, students, and dependents of company workers.

Q: What's the standard co-pay and has it changed for 2025?
A: The standard patient co-payment remains 30% for ages 6–69. Children under 6 generally pay 20%, those 70–74 pay 20% (or 30% if high-income), and 75+ pay 10% (or 30% if high-income). These rates are unchanged in 2025.

Q: How are premiums calculated each year?
A: Premiums are calculated based on last year's income and household composition. The local government applies set tax rates to your income and adds flat charges per person. Most offices provide calculators or tables. (For example, in Tokyo a single person earning ¥4M pays ~¥737k.)

Q: What if I start a full-time job or retire?
A: If you gain employer insurance (社保), promptly withdraw from NHI to avoid double coverage. If you retire or lose employer insurance, you must re-enroll in NHI within 14 days. Notify your ward office and bring necessary documents (e.g. insurance termination certificate).

Q: When and how do I pay premiums?
A: Premiums are billed by your local government (often quarterly or monthly). You'll get a "納付書" (payment notice) or can pay via bank draft, ATM, or online. Pay by the due date (usually end of month). Late payments incur interest and may lead to enforcement.

Q: What if I cannot afford the premium?
A: Municipalities may offer hardship programs or payment plans. In emergencies (natural disaster, etc.) you can apply for partial exemption of co-pays. Contact your city's health insurance office for assistance – they can defer payments or reduce premiums in cases of financial hardship or natural disaster.

Q: Can I use my NHI in any hospital/clinic?
A: Yes. NHI is valid at virtually all medical institutions in Japan (they will verify your health insurance certificate). Always present your card at reception. Even if you lose your NHI card, you can still receive treatment by presenting a "資格確認書" temporarily; however you'll need to replace your card promptly.

Q: Who do I contact for help?
A: For official queries, visit your ward office or municipal office NHI department or their website. Shibuya Ward, for example, has detailed NHI information online. You can also consult English-language specialists (see resources below).

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Next Steps & Resources

Official information: Check the Ministry of Health's overview of the NHI system and your city's NHI portal. For example, Shibuya Ward's NHI "system overview" explains how the healthcare system works, and Shibuya also provides a multilingual NHI guide for residents.

Calculators & Tables: Some cities publish sample premium tables. (Setagaya City's 2025 table is one example.)

Foreign Resident Resources: If you are a foreign resident, refer to the Shibuya Handbook for NHI (English/etc.) and consider contacting community support centers.

English-Speaking Advisors: For personalized assistance, our English-speaking relocation consultants are ready to help explain NHI and assist with forms. Contact our relocation advisors to get expert guidance and ensure you're fully covered under Japan's health insurance system.