Health Insurance in Japan for Foreigners

Quick summary

• All residents of Japan (including foreigners with Resident Registration) must enroll in public health insurance — it's the law.
• Two main systems: Shakai Hoken (employee insurance via your company) or Kokumin Kenko Hoken / NHI (self-enroll at ward office).
• 70% of medical costs are covered at qualifying clinics — you pay only 30% at the counter (10% for ages 70+, 20% for 75+ depending on income).
• High-Cost Medical Care Benefit (Kogaku Ryoyohi): monthly self-pay cap of ~¥80,100 + 1% (for average-income earners) — protects against catastrophic costs.
• Coverage includes dental, prescriptions, hospital stays, mental health, and many specialist services.

The two main schemes

Long-term care insurance (Kaigo Hoken) is added from age 40, increasing the premium by ~1.6%.

Enrollment when you arrive

• Working for a Japanese company: your employer enrolls you in Shakai Hoken automatically — typically deducted from your first paycheck.
• Self-employed / freelancer / unemployed: enroll in NHI at your local ward office within 14 days of arrival. Bring your Residence Card and passport.
• Spouse / dependents: a non-working spouse and young children can be covered as dependents under Shakai Hoken at no additional cost.
• Switching: when you change jobs or become self-employed, you must actively switch — the ward office and your new employer handle the paperwork.

What's covered (and what's not)

Covered (70%)

• Doctor visits, specialist consultations
• Hospital stays (room & meals subsidized but with daily cost share)
• Prescription medications (most)
• Dental care (most procedures)
• Mental health and psychiatric care
• Maternity care during pregnancy and childbirth (with the ¥500,000 Childbirth Lump Sum)
• Childhood vaccinations (varies by ward)

NOT covered (100% self-pay)

• Cosmetic surgery and elective procedures
• Experimental or advanced ("Sentan Iryo") treatments
• Private room hospital fees ("Sashigaku Bed Charge")
• Most LASIK eye surgery, fertility treatments (some now partially covered)
• Dental aesthetic work (whitening, orthodontics for cosmetic reasons)

High-Cost Medical Care Benefit (Kogaku Ryoyohi)

This is the unsung hero of Japan's system: even if you have a catastrophic illness, your monthly out-of-pocket is capped based on income.

Pre-apply with a "Limit Certificate" (Genddo-gaku Tekiyo Nintei-sho) so you only pay the cap at the hospital. Otherwise, claim a refund later.

Cost examples

• Doctor visit: ¥1,500-3,000 out-of-pocket (clinic) / ¥3,000-5,000 (hospital)
• Dental cleaning: ¥3,000-5,000
• Standard delivery (childbirth): ¥0 after lump-sum (¥500,000 from insurance directly to hospital)
• Appendectomy (3-night hospital stay): ¥80,000-150,000 → capped at ¥80,100 with Kogaku Ryoyohi
• Cancer treatment (yearly): typically capped at ¥1M-1.5M with monthly cap + multi-month application

Should you buy private insurance?

For most foreign residents, Japanese public insurance is sufficient. However, consider supplementary private insurance if:

• You want private room access during long hospital stays (~¥10,000-30,000/day)
• You travel internationally and want global coverage
• You want income protection during illness (Disability/Income Protection insurance)
• You want death benefit for family (Term Life or Whole Life)
• You worry about cancer requiring expensive non-covered treatments

Note: Many international expatriate insurance policies are now considered "supplementary" — you still need to be enrolled in Japanese public health insurance.

When you leave Japan

• Cancel coverage: return your insurance card to ward office (NHI) or via your employer (Shakai Hoken) before leaving.
• Get refund of unused premiums: monthly NHI premiums are not pro-rated, but if you over-paid in a year, you can claim a partial refund.
• Final medical bills: settle before leaving; otherwise your Tax Representative (Nozei Kanri-nin) must handle.
• Documentation: keep records of major medical expenses for tax deductions in home country if applicable.

Common questions

Q. Can I skip Japanese health insurance if I have travel insurance?

No. If you have Resident Registration (Juminhyo), you must enroll in public health insurance. Travel insurance is supplementary at best.

Q. Are my dependents (family abroad) covered?

Dependents living abroad can be covered under Shakai Hoken if certain conditions are met (you must regularly support them, and they must not have substantial income).

Q. What about prescription costs?

Prescriptions are also covered at 70%. You pay 30% at the pharmacy. Most chronic medications are very affordable (¥1,000-3,000/month typically).

Related guides

• National Pension for Foreigners
• Departing Japan Checklist
• Visa Status & Tax