Japanese Health Insurance for Foreign Residents: NHI vs Employee Insurance, Costs and How to Enroll

Who has to join Japanese health insurance?

Japan runs a universal public health insurance system, and joining it is not optional. If your status of residence allows you to stay in Japan for more than three months, you must enroll in one of the public programs from the start of your stay, whatever your nationality or visa type. There is no three-month waiting period: you have to file for National Health Insurance within 14 days of registering your address. ^[7] The main exception is for people covered by a social security agreement between Japan and their home country, which can exempt certain workers posted from abroad. ^[1] Enrolling is not only a legal duty: without insurance you pay the full price of every visit, and a single night in the hospital can cost more than a year of premiums.

Two systems, one set of benefits

There are two routes into the system. Which one you use depends on how you work, not on where you come from.

• Employees' Health Insurance (健康保険) is arranged through your employer, either with the Japan Health Insurance Association (協会けんぽ) or with a company health insurance society (組合). All incorporated companies, and sole proprietors with five or more regular staff, must enroll their regular employees regardless of nationality. Part-timers are included when they work at least three-quarters of full-time hours. At employers with 51 or more insured employees, anyone who works 20 hours or more a week and earns at least ¥88,000 a month is also covered, unless they are a student. The ¥88,000 wage test is scheduled to be abolished in October 2026, and the employer-size threshold falls to 36 employees in October 2027 before being phased out in stages. ^[1][2][8] Your employer handles the paperwork and pays half of the premium. ^[1]
• National Health Insurance (国民健康保険, often called kokuho) is for everyone else: the self-employed, freelancers, students, working-holiday makers, job seekers and employees whose workplace is not covered. You enroll yourself at the ward or city office of the municipality where you register your address, normally at the same counter where you file your move-in notice. ^[1]

The benefits are almost identical in both systems. The differences lie in who pays the premium and how it is calculated.

How much do you pay at the counter?

With either insurance, working-age adults pay 30% of the standardized price of consultations, tests and prescribed medicine, and the insurer pays the rest. ^[1] Children below school age pay a smaller share, and people aged 70 to 74 pay 20% unless their income is at working-age levels, in which case they remain at 30%. ^[3] Every municipality goes further and subsidizes children's medical costs so that families pay little or nothing, most commonly until the end of the fiscal year in which the child turns 18, although the age limit and any fixed fee differ locally; ask at the child-welfare counter of your local office. ^[9]

The monthly cap on big bills

A 30% share could still be crushing after surgery or a long hospital stay, so Japan caps what you pay in any calendar month through the High-Cost Medical Expense Benefit (高額療養費制度). Once your out-of-pocket payments for covered treatment in one month pass a ceiling, the insurer refunds the excess. The ceiling depends on your age and income bracket. The caps were revised in August 2026, when a new annual ceiling for long-term patients was added. For a person under 70 in the standard income bracket (annual income of roughly ¥3.7 to ¥5.1 million), the ministry's own example puts the share of a ¥1 million bill at around ¥93,000. ^[4] If you know a large bill is coming, ask your insurer or the hospital in advance about having the ceiling applied at the counter, so that you do not have to pay first and claim a refund later.

Premiums: how much and how they are set

Employees' insurance: the premium is a percentage of your salary, shared equally with your employer and deducted from your pay before you receive it. ^[1]

National Health Insurance: each municipality sets its own rates, so the same income produces different bills in different cities. The premium is calculated from your income and rises with the number of family members enrolled. ^[1] Because the income part is based on the previous year's income reported in Japan, newcomers with no Japanese income record typically pay only the basic per-person portion in their first year and see a jump in the second year. If you cannot pay, go to the office and ask about a reduction rather than ignoring the notices: arrears are pursued, and large or long-standing unpaid premiums count against you when you renew or change your status of residence or apply for permanent residence. ^[10]

Family members

Under employees' insurance, a spouse, children and other close relatives who live in Japan and depend on your income can be added as dependents at no extra premium. The main condition is income: a dependent's annual income must generally be under ¥1.3 million, with higher limits for people aged 60 and over and for student-age dependents aged 19 to 22. It must also be less than half of yours. ^[1][5] National Health Insurance has no dependent status; every family member is enrolled individually and counted in the premium. ^[1]

What does health insurance not cover?

Public insurance pays for treatment that is medically necessary. It does not cover:

• cosmetic procedures, including cosmetic dentistry and orthodontics for appearance;
• some dental materials and implants, which are offered as private options;
• routine health checkups, adult vaccinations and most cancer screening, although employers and municipalities often subsidize these separately;
• the extra charge for a private or semi-private hospital room (差額ベッド代);
• normal childbirth, which is not classified as an illness, although a separate lump-sum allowance is paid;
• drugs and treatments not approved for insurance in Japan, including many that are approved abroad.

Ask before you agree to anything described as 自由診療 (private treatment): the whole bill, not just 30%, will be yours.

Your insurance card and the My Number card

Japan has moved from plastic insurance cards to the My Number card. Conventional cards have not been issued since December 2, 2024, and the old cards stopped being valid after December 1, 2025. ^[6] There are now two ways to prove that you are insured:

• My Number card registered as an insurance card (マイナ保険証). You register once, at a clinic card reader, a convenience-store kiosk or through the Myna Portal app, and then hold the card to the face-recognition reader at reception. With your consent, the doctor can see your past prescriptions and health checkup results. ^[6]
• Eligibility certificate (資格確認書). If you do not have a My Number card, or have not registered it, your insurer sends you this paper certificate free of charge, with no application needed. It works like the old card. ^[6]

Foreign residents can apply for a My Number card as soon as their address is registered; ask at the same counter when you file your move-in notice.

What to show at reception

Present your My Number card or eligibility certificate at reception at every visit. ^[6] If you forget it, you may be asked to pay 100% and then bring the card back, usually within the same month, for a refund. You pay after the consultation, and smaller clinics often take cash only. To find a clinic where English or Chinese is spoken, use our hospital finder; for what happens at the pharmacy afterward, see our medicine guide.

Students, working-holiday makers and short-term visitors

Students with Student status of residence join National Health Insurance at the city office. Many municipalities apply reductions for people with low or no income, so declare your situation when you enroll. Working-holiday makers also join National Health Insurance unless a Japanese employer places them on employees' insurance. Tourists and business visitors are not residents and cannot join; they pay the full cost of any care, so travel insurance with medical coverage is essential. ^[1]

When you leave Japan

Coverage ends on the day you lose your registered address in Japan. Before departure, file your move-out notice at the city office and return your National Health Insurance eligibility certificate, if you were issued one, at the same time; premiums are settled up to that month, and any overpayment is refunded to a Japanese bank account. Employees' insurance ends with your job, and your employer collects your eligibility certificate (and those of your dependents), if any were issued.