Health insurance in Japan
A plain-English walk-through of how Japan's healthcare coverage works — what residents pay, what visitors should expect, and how to actually use your insurance card at a clinic.
1. The two public systems
Practically every legal resident of Japan is covered by one of these:
Employee Health Insurance (健康保険・社会保険)
Run through your employer if you work for a company in Japan. Premiums are roughly 10% of your monthly salary, split 50/50 between you and your employer (so about 5% comes out of your paycheque). Coverage extends to dependents — a non-working spouse and children can be added at no extra premium.
National Health Insurance — NHI (国民健康保険・国保)
Run by your city or ward office. This is the default for the self-employed, freelancers, students, retirees, and most foreign residents who aren't company employees. Premiums are calculated from last year's income, so your first year in Japan is usually very cheap. You enrol at your local city hall (市役所) or ward office (区役所), not online.
2. What you actually pay
Many municipalities heavily subsidise child healthcare on top of this — in much of Tokyo, Osaka, Fukuoka, and elsewhere, medical visits are effectively free for children up to 15 or 18. Ask at your city office about the local children's medical certificate (子ども医療証).
The high-cost benefit (高額療養費制度)
If your 30% co-pay for a single month exceeds a ceiling tied to your income (often around ¥80,000 for an average earner), the excess is reimbursed. For planned hospitalisations, ask your insurer for a Limit-Application Certificate (限度額適用認定証)in advance — the cap is then applied at the cashier so you never have to front the difference.
3. For long-term foreign residents
If your residence card (在留カード) is valid for more than three months, you are legally required to enrol in either Employee Health Insurance through your job or NHI through your local city office. There is no “opt-out” using overseas private insurance.
How to enrol in NHI
- Go to your city or ward office within 14 days of moving in.
- Bring your residence card, My Number notification, and proof of address (your residence registration is usually enough).
- You'll receive a paper insurance card (保険証) by mail, usually within 1–2 weeks. Carry it with you.
- Premiums are billed quarterly or monthly — pay at any convenience store, by bank transfer, or via direct debit.
My Number Card as your insurance card
Since late 2024 the paper insurance card is being phased out in favour of using your My Number Card (マイナンバーカード) as your insurance card at clinics that have a card reader. Both still work during the transition, and a paper certificate is still issued on request.
4. For visitors and short-term travellers
If you're in Japan on a tourist visa, business trip, or any stay of 90 days or less, you are not covered by the public system. You can still see any doctor — the clinics on Healthtomo welcome international patients — but you'll pay the full price at the counter.
What to expect to pay (typical ranges, no insurance)
Cash, card, or wire?
Most multilingual urban clinics accept Visa, Mastercard, and JCB — but smaller neighbourhood clinics and many dental practices are still cash-only. If the listing on Healthtomo doesn't spell it out, ask when you book.
5. What insurance covers — and what it doesn't
The public system covers medically necessary care defined by the national fee schedule. That includes most GP and specialist visits, hospitalisation, prescription medicines, rehabilitation, mental-health consultations, and diagnostics like blood work and imaging.
Generally not covered (you pay 100%)
- Cosmetic procedures and aesthetic dermatology.
- Most LASIK and refractive eye surgery.
- Routine dental whitening, orthodontics for adults, and most implants.
- Optional vaccines for travel (rabies, yellow fever, etc.).
- Health checks (人間ドック) and most company physicals — these are considered preventive, not treatment.
- Childbirth itself — but a flat ¥500,000 lump-sum benefit (出産育児一時金) is paid out and usually covers a normal delivery.
- Experimental and most non-approved drugs.
6. Special situations worth knowing
Pregnancy and maternity
Pregnancy isn't classed as an illness, so prenatal check-ups are paid out of pocket — but every municipality issues a stack of pregnancy check-up vouchers (妊婦健診受診券) that cover most of the cost, plus the ¥500,000 lump-sum benefit at delivery. Pick up your maternity handbook (母子手帳) at the city office as soon as your pregnancy is confirmed.
Mental health
Psychiatry, psychotherapy, and prescribed medication are all covered at the standard 30%. For ongoing treatment of conditions like depression or anxiety, ask about the Self-Reliance Support Medical Subsidy (自立支援医療) — it caps your co-pay at typically 10%.
Long-term care (介護保険)
Once you turn 40 you also start contributing to long-term care insurance, which kicks in at 65 (or earlier with certain conditions) for in-home and facility care.
Forgotten your card?
Most clinics will ask you to pay 100% upfront and refund the insurance portion later in the same month if you bring the card back — or, if too much time has passed, you can claim reimbursement directly from your insurer with the receipt.
Emergencies
Dial 119 for an ambulance or fire, 110 for police. Ambulance transport is free regardless of insurance status. For non-emergency medical advice in English, the AMDA International Medical Information Center can route you to a multilingual clinic.
7. Useful Japanese at the clinic
8. How Healthtomo helps
Every clinic listed on Healthtomo confirms which insurance schemes it accepts and whether it sees self-pay international patients. Use the “Insurance accepted” filter on search to narrow down, and check the clinic's detail page for fee notes and what to bring.
This guide is for general orientation only and is not legal, tax, or medical advice. Premium rates, co-pay percentages, and benefit caps change periodically and vary by municipality and income. For your specific situation, confirm with your employer's HR, your local city or ward office, or the insurer printed on your card. Last reviewed May 2026.