Health Insurance in Japan for Foreigners: Everything You Need to Know

While Japan boasts a world-class healthcare system, navigating the health insurance system in Japan can be a challenge for foreigners.

In this article, we will explore the various health insurance options available to foreigners in Japan, including what they cover, how much they cost, and how to pay the insurance premiums. 

Let’s get started.

Health insurance in Japan for foreigners (quick answer)

If you live in Japan for more than three months, you are legally required to enroll in public health insurance, regardless of nationality.

Most foreigners will be covered by one of the following:

• Employees’ Health Insurance (EHI)—for full-time employees working for Japanese companies

• National Health Insurance (NHI)—for self-employed individuals, students, freelancers, dependents, and those not enrolled in EHI

Japan’s public health insurance typically covers around 70% of medical costs, with patients paying the remaining 30% at the clinic or hospital. Coverage applies nationwide at licensed medical institutions.

Tourists and short-term visitors are not eligible for Japan’s public health insurance and should purchase private travel medical insurance before arrival.

Private health insurance in Japan is optional, not mandatory, and is usually used to supplement public coverage rather than replace it.

Which health insurance do foreigners need in Japan? (by visa status)

The type of health insurance you need in Japan depends primarily on your visa status and employment situation.

Below is a general guide for foreigners living in Japan for more than three months:

Important: Health insurance rules and premium calculations can vary by municipality, employment conditions, and income level. Local city offices can confirm which plan applies to your situation.

EHI vs. NHI: What’s the difference?

Japan’s public health insurance system has two main options for residents, including foreigners: Employees’ Health Insurance (EHI) and National Health Insurance (NHI). Which one applies depends on your employment status.

Which one is cheaper?

• EHI is often more cost-effective for salaried workers due to employer cost-sharing and added benefits.

• NHI costs vary widely and can be higher for higher earners or households with multiple members.

Eligibility criteria

Foreigners must have a residence card and have lived in Japan for more than three months to be eligible for the National Health Insurance (NHI). They must also not be eligible for the Employees' Health Insurance (EHI) or any other public health insurance program in Japan.

Enrollment process

If you are interested in enrolling in Japan's National Health Insurance program, here's what to know:

a. Required documentation

Foreigners must provide certain documents to enroll in Japan's National Health Insurance (NHI) program. These include a residence card, a health insurance card, and a passport. For those who are employed, a certificate of employment is also required.

b. Steps to enroll

The enrollment process for NHI involves visiting the local municipal office and submitting the required documents. The office will then provide an application form to be filled out.

Once the form is completed, the applicant will receive a health insurance card. The card will typically arrive within two weeks of the application being submitted.

Alternatively, many municipalities in Japan now add health insurance information to an individual's My Number Card.

Coverage and benefits

If you have enrolled in NHI, here's what to know about coverage.

General coverage

The National Health Insurance (NHI) program covers various medical services, including hospital stays, surgeries, dental appointments, and prescription medication.

However, it does not cover everything. For this reason, some foreigners choose additional or supplemental insurance.

Medical services not covered by NHI

NHI generally does not cover:

• Cosmetic or elective procedures (e.g., aesthetic surgery, non-medical dermatology)

• Advanced or experimental treatments not approved under Japan’s public system (自由診療)

• Routine health checkups, medical certificates, or preventive screenings

• Private hospital rooms or upgraded accommodation

• Certain dental and orthodontic treatments

• Some fertility treatments and non-medically required procedures

• Treatment received outside Japan

In these cases, patients must pay 100% of the cost out of pocket unless they have private insurance.

The NHI program is funded by the government and the individuals enrolled in the program, with the cost of premiums based on income.

Under the NHI program, foreigners can receive medical treatment at any medical facility in Japan. However, some medical facilities may not have English-speaking staff, making communication difficult for non-Japanese speakers.

Please refer to our guide on English-speaking hospitals in Tokyo.

Additional coverage options

In addition to the NHI program, several other insurance options are available to foreigners living in Japan.

Common reasons to apply for private insurance include:

• Lump-sum payouts during hospitalization or surgery

• Coverage for private rooms or extended hospital stays

• Overseas medical coverage and emergency evacuation

• Financial protection for services excluded from NHI

Some employers also offer employer-sponsored health insurance plans, which may provide additional coverage options beyond what is covered by the NHI program.

Foreigners living in Japan who plan to travel outside of Japan may also consider purchasing travel health insurance.

This type of insurance can provide coverage for medical treatment while abroad and emergency medical evacuation if necessary.

Important: Private insurance does not exempt residents from enrolling in NHI or EHI if they are eligible. Public health insurance enrollment remains mandatory under Japanese law.

See also: English-Friendly Insurance for Emergencies in Japan

Health insurance premiums: cost and payment

How much does health insurance in Japan cost for foreigners?

The cost of health insurance in Japan depends on your income, age, municipality, and the type of public insurance you are enrolled in. While exact amounts vary, most foreigners fall within the ranges below.

National Health Insurance (NHI) costs

• Premiums are calculated by your local municipality based on your previous year’s income

• Most foreigners pay approximately ¥10,000–¥30,000 per month

• Students and low-income residents often qualify for reduced premiums

• Premiums are paid directly by the individual (monthly or in installments)

Employees’ Health Insurance (EHI) costs

• Total premiums are usually around 9–10% of your gross salary

• The cost is split equally between employer and employee

• Enrollment and payroll deductions are handled by the employer

• EHI includes additional benefits such as sick leave allowances and maternity benefits

Out-of-pocket medical costs (copay)

• Public health insurance generally covers about 70% of approved medical expenses

• Patients typically pay 30% at the clinic or hospital

• Monthly caps apply for high medical expenses, which can significantly reduce costs in serious or long-term cases

• Children, seniors, and low-income residents may pay less than 30%, depending on eligibility

Private health insurance costs (optional)

• Private insurance premiums vary widely depending on coverage and provider

• These plans are typically used to supplement, not replace, public insurance

• Common reasons for private insurance include lump-sum hospitalization payouts or overseas coverage

Important: Premium rates and reduction programs differ by municipality and may change annually. Your city or ward office can provide the most accurate calculation for your situation.

How are premiums calculated?

The cost of health insurance in Japan is based on an individual's income. The National Health Insurance (NHI) premium is calculated based on the previous year's income tax return.

The premium is usually paid monthly, and it is determined by multiplying the standard monthly premium rate by the individual's income. The standard monthly premium rate is adjusted annually.

For example, if an individual's income is 4 million yen per year, the monthly premium for NHI would be around 16,000 yen per month. However, this amount can vary depending on the individual's age, location, and other factors.

Private health insurance premiums are usually higher than NHI premiums and can vary depending on the type of coverage and the insurance company.

How do I pay for my health insurance premiums in Japan?

The National Health Insurance premium can be paid in a variety of ways, including at convenience stores, banks, or through automatic bank transfers.

It is important to note that the individual is responsible for paying the premium, and failure to pay can result in the suspension of coverage.

👉 How to Pay National Health Insurance in Japan

👉Forgot to Pay Japan NHI? Here’s What Happens

Frequently asked questions

What is Japan’s public health insurance program?

Japan’s public health insurance program is a universal system that ensures all legal residents have access to affordable medical care. It consists primarily of National Health Insurance (NHI) and Employees’ Health Insurance (EHI). Under this system, insurance typically covers about 70% of approved medical expenses related to injury and illness, with patients paying the remaining portion as hospital fees at the time of treatment.

How do foreigners enroll in the public health insurance program?

Foreign residents staying in Japan for more than three months must enroll in the public health insurance program. Enrollment is handled either by an employer (for EHI) or at the local city office through the national health insurance division for NHI. Required documents usually include a residence card and passport.

What is a health insurance card, and how is it used?

A health insurance card proves your enrollment in Japan’s public health insurance program. You must present it from the first visit at clinics, hospitals, and pharmacies to receive insured treatment. Without the card, patients may be required to pay full hospital fees upfront and seek reimbursement later.

What medical costs are covered under public health insurance?

Japan’s public health insurance program covers medically necessary treatment for injury and illness, including doctor visits, hospital care, surgery, prescription medication, and most dental treatment. Patients generally pay about 30% of hospital fees, while the remaining cost is covered by insurance.

Are hospital fees the same everywhere in Japan?

Hospital fees under Japan’s public health insurance program are standardized nationwide for insured treatment. This means costs for treating the same injury or illness are generally consistent across hospitals, although fees may increase for private rooms or uninsured services.

Do I need to report changes to my city office?

Yes. Changes such as moving to a new address, changing employment status, or leaving Japan must be reported to your city office or employer. These updates ensure your enrollment in the public health insurance program remains accurate and uninterrupted.

How can international students enroll in the National Health Insurance in Japan?

Foreign students who plan to stay in Japan for over three months can enroll in the National Health Insurance program. They can apply for it at their local municipal office by presenting their residence card and a school enrollment certificate. The premium for National Health Insurance is based on the previous year's income, so students with low income may pay a lower premium.

What are the different types of health insurance available to foreigners in Japan?

Foreigners in Japan can choose between National Health Insurance and private health insurance. National Health Insurance is mandatory for all residents in Japan, including foreigners who plan to stay for more than three months. Private health insurance is optional but can provide additional coverage for medical expenses that National Health Insurance does not cover.

How is the National Health Insurance premium calculated for foreigners living in Japan?

The National Health Insurance premium for foreigners living in Japan is based on their previous year's income.

What is the average cost of health insurance for foreigners in Japan?

The cost of health insurance for foreigners in Japan varies depending on their income and the type of insurance they choose. National Health Insurance premiums are based on income. Private health insurance premiums vary depending on the coverage and provider.

Are tourists eligible for any form of health insurance while visiting Japan?

Tourists visiting Japan are not eligible for National Health Insurance. However, they can purchase travel insurance that covers medical expenses and emergency medical evacuation.

What are the consequences for foreigners who fail to pay their health insurance premiums in Japan?

Foreigners who fail to pay their health insurance premiums in Japan may face penalties, such as suspension of coverage or fines. If they fail to pay, their coverage may be canceled, and they may be required to pay the total cost of medical treatment out of pocket.

In closing

In conclusion, obtaining health insurance in Japan is mandatory for all residents, including foreigners. The National Health Insurance system covers everything categorized as a medical treatment. Private insurance is also available but not mandatory.

The cost of health insurance in Japan varies across plans and policies. Generally, 70% of the costs associated with healthcare services are covered, and the remaining 30% is the patient's financial responsibility. However, paying less than 30% is possible, depending on one's financial circumstances.