- share of the bill you pay at the counter from age 6 to 69
- 30%
- to enroll after you register your address
- 14 days
- base monthly cap for a middle income since August 2026
- ¥85,800
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Health insurance in Japan is compulsory for anyone who lives in the country for more than three months. You join one of two public systems: your employer's plan (shakai hoken) if you work for a Japanese company, or National Health Insurance (NHI, kokumin kenko hoken) at your city or ward office if you are a freelancer, a student, a working holiday maker or out of work. Both pay 70% of medical bills, cap what you spend in a bad month, and cost a share of your income. Private insurance can sit on top, but it never replaces them.
This guide uses the 2026 rates published by the Japan Health Insurance Association, Tokyo's 23 wards, Fukuoka City and the Ministry of Health, Labour and Welfare, checked on 14 November 2026. Amounts are in yen, with dollars at about ¥160 to $1.
Who must join health insurance in Japan, and who cannot
The rule is set by your residence, not your nationality. Every foreign resident with a residence card and a registered address, staying more than three months, must be covered, and there is no choice to sign up or cancel. Toshima City spells out that a foreign insurance policy, a student policy or travel insurance does not exempt you.
| Your situation | Health insurance you join | Where |
|---|---|---|
| Employee of a Japanese company, full time | Employer plan (shakai hoken): Japan Health Insurance Association or a company society | Your employer enrolls you |
| Part-timer working at least three quarters of full-time hours, or 20 hours a week at a company with 51+ staff (the ¥88,000 pay test ended in October 2026) | Employer plan | Your employer enrolls you |
| Spouse or child of an employee, low income | Dependent on the employee's plan, no extra premium | Through the employer |
| Freelancer, remote worker paid from abroad, business owner without staff | National Health Insurance | City or ward office |
| Student, language school student, working holiday maker | National Health Insurance | City or ward office |
| Between jobs or retired, under 75 | National Health Insurance, or voluntary continuation of the old employer plan | City or ward office, or the old insurer |
| Digital nomad visa, medical stay visa, tourist or stay of three months or less | Not eligible. Private insurance only | Bought before you travel |
People aged 75 and over move to a separate system for older people. A dependent must live in Japan to be covered, so a spouse who stays at home in Canada or the UK is not on your Japanese plan. A worker sent by a foreign employer may be exempt for the first years if their country has a social security agreement with Japan that includes health insurance (the US agreement does, the UK one covers pensions only), with a certificate of coverage from home.
National Health Insurance vs shakai hoken: the two systems compared
Medical cover is identical in both: the same 30% co-pay, the same national price list and the same monthly cap. The differences are who pays and what you get when you cannot work.
| Point | Employer plan (shakai hoken) | National Health Insurance (NHI) |
|---|---|---|
| Run by | Japan Health Insurance Association (Kyokai Kenpo) or a company health insurance society | Your city, town or Tokyo ward |
| Premium | A percentage of standard monthly pay and bonuses, half paid by the employer | Flat amount per person plus a percentage of last year's income, all paid by you |
| Family | Low-income dependents covered free | Every household member pays the flat part |
| Sick pay | Sickness allowance of two thirds of daily pay, up to 18 months in total | None |
| Maternity | ¥500,000 birth grant plus maternity allowance of two thirds of pay | ¥500,000 birth grant, premiums waived for four months around the birth |
| Comes with | Employees' pension, deducted at the same time | National pension, paid separately |
How much health insurance costs in Japan in 2026
There is no single price. An employee pays a fixed rate of pay, an NHI member pays what their town charges on the income of the previous calendar year. The NHI year runs from April to March, and the bill usually arrives in June.
NHI premiums in Tokyo's 23 wards: a worked example
All 23 wards use the same scale. For fiscal 2026, Minato City lists three parts for a member under 40: a medical part of 7.51% of income and ¥47,600 per person, a part for elderly care of 2.80% and ¥17,600, and a new child support part of 0.27% and ¥1,873. Added up, that is a flat ¥67,073 a year per person plus 10.58% of last year's income after a ¥430,000 allowance. Members aged 40 to 64 add a nursing care part of 2.43% and ¥17,800. The yearly maximum is ¥960,000 under 40.
Take a single person under 40 who earned a ¥4 million salary in Japan last year and is now freelance or between jobs. After the employment income deduction, taxable income is ¥2,760,000. The ward charges 10.58% of ¥2,330,000, or ¥246,514, plus the flat ¥67,073. That comes to about ¥313,600 a year, or ¥26,100 a month ($163).
NHI premiums in a mid-sized city: Fukuoka
Fukuoka City sets lower rates but adds a charge per household. For fiscal 2026 its four parts for a member under 40 total 9.00% of income, ¥31,287 per person and ¥29,413 per household. The same single person on a ¥4 million salary last year pays ¥209,700 on income plus ¥60,700 of flat charges, about ¥270,400 a year, or ¥22,500 a month ($141). Every town publishes its own scale, so check yours on the city website before you choose where to live.
Your first year: why NHI is cheap at the start
A newcomer has no Japanese income on record for the previous year, so the income part is zero and you pay only the flat part: ¥67,073 in Tokyo, ¥60,700 in Fukuoka for one person. File the short income report at the NHI counter, even with no income, and a household whose income was ¥430,000 or less gets a 70% reduction of the flat part, which brings Tokyo down to about ¥20,100 a year. Depending on the town and the reduction, newcomers usually pay between about ¥1,700 and ¥5,600 a month. The jump comes in your second June, when the bill is based on a full year of Japanese earnings. The same timing applies to residence tax, as our guide to Japan tax for foreigners explains.
Employee contributions: Kyokai Kenpo rates for Tokyo
Most foreign employees of small and mid-sized companies are in the Japan Health Insurance Association. Its fiscal 2026 health rate for Tokyo is 9.85%, applied since March 2026 pay, plus a child support levy of 0.23% since April 2026. Both are split half and half, so the employee pays 4.925% plus 0.115%. From 40 to 64 you add half of the 1.62% nursing care rate. Rates differ slightly by prefecture, and large companies with their own insurance society often charge less.
On standard monthly pay of ¥300,000, the deduction is about ¥15,100 a month ($95) for an employee under 40, and the employer pays the same again. Pension and employment insurance come on top. Our page on average salaries in Japan shows the full payslip from gross to net, and the cost of living in Japan puts these amounts in a monthly budget.
What Japanese health insurance covers: the 30% co-pay
Public insurance pays for treatment of illness and injury at clinics, hospitals and pharmacies across Japan, including specialists, prescriptions, hospital stays and most dental care. You pay a share at the counter and the insurer pays the rest.
- 30% from the start of primary school to age 69.
- 20% for children before primary school. Most towns then pay that share too, so care for children is often free or nearly free.
- 20% from 70 to 74, or 30% with taxable income of ¥1.45 million or more.
- From 75: 10%, 20% or 30% depending on income, in the system for older people.
Prices are fixed by the national fee schedule, so the same treatment costs the same in Sapporo or Osaka, and you can see any doctor without a referral. Large hospitals add a fee of several thousand yen if you arrive without a letter from a clinic, so start at a local clinic. Our overview of healthcare in Japan explains how to find one with an English-speaking doctor.
Dental care, check-ups and what is not covered
Dental treatment is covered at the same 30%: check-ups for a problem, fillings, extractions, root canals, standard crowns and basic dentures. Implants, adult orthodontics, whitening and most ceramic work are private, and a dentist will tell you before starting which option is outside insurance.
Also outside insurance: a normal childbirth, routine health checks and most vaccines, cosmetic treatment, and the extra charge for a private or two-bed hospital room. Employers must offer a yearly health check to their staff, and towns offer NHI members aged 40 to 74 a free or low-cost check.
High-cost medical expense benefit: the monthly cap in 2026
The 30% has a ceiling. Under the high-cost medical expense benefit (kogaku ryoyohi), what you pay in one calendar month at one provider is capped by income bracket. The caps rose on 1 August 2026, and a yearly cap was added. The table shows the scale for under-70s from August 2026 to July 2027, published by the Ministry of Health. A second step is planned for August 2027.
| Annual income (guide) | Monthly cap, months 1 to 3 | From the 4th month in 12 | Yearly cap (August to July) |
|---|---|---|---|
| About ¥11.6 million or more | ¥270,300 + 1% of costs above ¥901,000 | ¥140,100 | ¥1,680,000 |
| About ¥7.7 to 11.6 million | ¥179,100 + 1% of costs above ¥597,000 | ¥93,000 | ¥1,110,000 |
| About ¥3.7 to 7.7 million | ¥85,800 + 1% of costs above ¥286,000 | ¥44,400 | ¥530,000 |
| Up to about ¥3.7 million | ¥61,500 | ¥44,400 | ¥530,000 |
| Exempt from residence tax | ¥36,900 | ¥24,600 | ¥290,000 |
Employees are placed by standard monthly pay (¥280,000 to ¥500,000 for the middle bracket), NHI members by last year's income after the ¥430,000 allowance. A worked case: a one-week hospital stay billed at ¥1 million costs a middle-income patient ¥300,000 at 30%, but the cap is ¥85,800 plus 1% of ¥714,000, so ¥92,940 ($581). Show your My Number card at admission and agree to share your data, and the hospital charges only the capped amount. Otherwise you pay 30% and claim the difference from your insurer.
Childbirth and maternity: the ¥500,000 birth grant
A normal birth is not treated as an illness, so it is not covered at 30%. Instead, both NHI and employer plans pay a childbirth lump sum of ¥500,000 ($3,125) per baby, the amount since April 2023. It is usually paid straight to the hospital, and you settle only the difference. A caesarean section and complications are covered as medical treatment, under the monthly cap.
Employees also receive a maternity allowance of two thirds of daily pay for the 42 days before and 56 days after the birth. NHI members get no allowance, but their premiums are waived for four months around the birth. A law passed in June 2026 will reform childbirth benefits, with free standard births as the stated goal, within two years. Until it takes effect, the ¥500,000 grant remains the rule, and a Tokyo hospital can cost more, so ask for the estimate early.
How to enroll in National Health Insurance: the 14-day rule
Employees do nothing: the company enrolls you and deducts the premium from your first salary. Everyone else enrolls at the ward or city office, usually the same morning you register your address.
- Register your address within 14 days of moving in, at the resident registration counter, with your residence card and passport.
- Go to the NHI counter in the same building and ask to join. Bring the residence card, passport and, if you are leaving an employer plan, the certificate of loss of coverage.
- File the income report for the previous year, even if you had no Japanese income. It unlocks the low-income reductions.
- Choose how to pay: bank transfer on the last day of the month, payment slips at a convenience store, or card and e-money in many wards.
- Register your My Number card as your insurance card, or wait for the eligibility certificate in the post.
Your cover starts from the day you moved in, not the day you enrolled, and so does the premium. Our guide on how to move to Japan places this visit in the order of your first weeks, with the bank account and phone contract that follow.
The My Number card as your health insurance card in 2026
Japan stopped issuing paper health insurance cards on 2 December 2024, and the last old cards expired on 1 December 2025. In 2026 you show either your My Number card registered for health insurance, which you link once at a clinic terminal, a convenience store machine or online, or the eligibility certificate (shikaku kakunin sho) that your insurer posts free of charge to members without that registration. The certificate has no end date for now, so a resident without a My Number card is still covered.
Unpaid NHI premiums: back payments and your visa
Late enrollment does not save money. The ward bills premiums back to the month you became eligible, for up to two years, and you pay the full cost of any treatment until you are enrolled. Unpaid bills lead to reminders, then seizure of wages, bank accounts or property. If you cannot pay, ask the NHI counter for an instalment plan before the arrears build up.
Immigration looks at this too. The Immigration Services Agency states that taxes and social insurance premiums must be paid for a change or renewal of status, and that unpaid amounts count against you and can lead to a refusal. For a permanent residency application in Japan, the record of payment dates is checked, so even a bill paid late and settled later counts. Paying by automatic bank transfer is the simplest protection.
Leaving Japan: how to cancel NHI and employer cover
For NHI, file your moving-out notice at the ward office up to 14 days before you leave, and return your eligibility certificate or notice of insurance details. Your membership ends on the day you leave, premiums are recalculated to that month, and you either pay the balance before you go or receive a refund. If you leave without the notice, you stay on the register and the premium keeps running.
An employee's cover ends the day after the last day of work. If you stay in Japan between jobs, you either join NHI within 14 days or keep your old plan for up to two years through voluntary continuation, applying within 20 days and paying both halves of the premium. Leaving workers can also claim part of their pension back, covered in our page on tax and the pension refund.
Health insurance for international students in Japan
A student staying three months or more must join NHI like any resident. There is no student discount, but most students had no Japanese income the year before, so they pay the flat part, cut by 70% once the income report is filed. In Tokyo's 23 wards that is about ¥20,100 a year. Universities often add accident insurance for campus activities, and the national pension has a student deferral you can ask for at the same office.
Private health insurance in Japan: when it is worth having
Once you are enrolled in the public system, private cover is optional. Feather, a German-based insurer for expats, says more than 70% of residents hold a supplementary policy. It pays for what public insurance leaves out:
- Medical repatriation or evacuation to your home country, which NHI does not cover, as the Dutch embassy reminds working holiday applicants.
- A private hospital room and the cash costs of a long stay, through Japanese policies that pay a fixed amount per day in hospital.
- Treatment at international clinics in English, which often charge above the public price list.
- Care outside Japan beyond the overseas refund, which pays only Japanese prices.
If you hesitate, start with the cap: for a middle income, the worst month costs around ¥86,000 to ¥93,000. A supplementary policy makes most sense for repatriation, family abroad or a long hospital stay, not for everyday care.
Digital nomads and stays under three months: private insurance only
Two groups cannot join the public system at all and must pay for private cover. Holders of the Japan digital nomad visa are not registered as residents, and the visa itself requires a private policy with at least ¥10 million of medical cover. Visitors and anyone staying three months or less are also outside the system, and a hospital can charge them the full price, sometimes more than the public rate, as our guide to travel insurance for Japan explains.
SafetyWing's Nomad Insurance Essential is one option for these stays. It can be bought for 5 to 364 days, covers unexpected illness and injury up to $250,000 per insurance period and medical evacuation up to $100,000, and excludes pre-existing conditions and maternity care. It does not replace NHI for a resident, and Japan's consulates, not the insurer, decide whether a policy meets the nomad visa rule. A working holiday visa holder can also use it for the weeks before enrollment and for repatriation, alongside NHI.