Health insurance in Japan for foreigners: how it works and what it costs

One of the first questions any foreigner asks when moving to Japan is: how does healthcare work here? Do I have to pay? How much? What happens if I get sick?

The short answer is: Japan has a universal mandatory health system, it works well, and it isn’t expensive once you understand how it’s structured. We’ve been here for years with a family, have used the system with both children and adults, and this guide covers what we’ve learned first-hand.

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The basic principle: universal mandatory coverage

Japan has a universal health coverage system — every registered resident, Japanese or foreign, is required to have health insurance. It isn’t optional. If you have a residence card (在留カード) and are registered at the municipal office, you’re subject to this requirement.

The system splits into two main blocks depending on your employment situation:

• 社会保険 (Shakai Hoken) — employer insurance, for salaried employees
• 国民健康保険 (Kokumin Kenko Hoken, or “kokuho”) — national insurance, for everyone else

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Employer insurance (社会保険)

If you work for a Japanese company full-time (or part-time above certain thresholds), your employer automatically enrolls you. You don’t have to do anything.

Employer insurance covers three things in one package:

• 健康保険 — health insurance
• 厚生年金 — employee pension (see our guide to Japan’s pension system for foreigners)
• 雇用保険 — unemployment insurance

The health premium is split 50/50 between employee and employer. The national average rate in 2026 is 9.90% of gross salary — you pay half, roughly 4.95%. If you’re 40 or over, long-term care insurance (介護保険) adds 1.62%, also split equally.

Practical example: on a gross annual salary of ¥5,000,000, the employee pays approximately ¥247,500 per year in health insurance (about ¥20,600 per month). The employer pays the same. Use the Japan net salary calculator to see the exact breakdown for your salary.

Your immediate family (spouse and children) can be added as dependents at no extra cost — a significant advantage over the national insurance.

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National insurance (国民健康保険)

If you’re self-employed, freelance, a student, or haven’t yet found stable employment, the national insurance (kokuho) applies. Also if you leave a job and don’t qualify for employer unemployment insurance.

Kokuho is managed by your municipal office and the price varies by:

• Your income from the previous year
• The number of people in your household
• The municipality where you live

Unlike employer insurance, there’s no company paying half — you bear the full cost.

Approximate 2026 figures (Tokyo/Kanagawa, single adult):

Annual income	Approximate monthly premium
¥0 (no income)	¥2,000-4,000 (reduced minimum)
¥2,000,000	~¥15,000-18,000
¥4,000,000	~¥30,000-35,000
¥6,000,000	~¥45,000-50,000
¥8,000,000+	~¥60,000-65,000 (near the maximum cap)

Figures vary by municipality. Check with your local office for your exact amount.

One important difference from employer insurance: under kokuho, each household member pays separately, including children. There’s no concept of a free dependent. For larger families, the cost can be significant.

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What the insurance covers: the 30% system

Regardless of which type of insurance you have, the principle is the same: insurance covers 70% of the cost of any medical procedure. You pay the remaining 30%.

This means a doctor’s visit costing ¥3,000 costs you ¥900. A ¥100,000 hospitalisation costs you ¥30,000. It’s a fixed, predictable co-payment system.

There are monthly maximum out-of-pocket limits (高額療養費制度) that protect against very high expenses. If your medical costs in a given month exceed a certain threshold (around ¥80,000-100,000 for average incomes), the excess is reimbursed by the insurance. In practice, a serious operation rarely costs more than ¥100,000 out of pocket for someone on average income.

What insurance doesn’t cover:

• Routine health check-ups (健康診断) — though many employers pay for these
• Cosmetic dental treatments
• Some fertility treatments
• Non-approved medications
• Private hospital room (if you choose one)

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Children’s coverage: better than you’d expect

This is the point that surprises foreign families most: in the majority of Japanese municipalities, children have additional health coverage subsidised by the local government that essentially eliminates medical costs.

The programme is called 子ども医療費助成 (Kodomo Iryōhi Josei) and varies by municipality, but in many of the largest (Tokyo, Yokohama, Osaka) it covers up to age 15-18 with zero or near-zero co-payment. In practice, with three children in Yokohama, doctor visits, paediatric A&E and children’s medications cost us very little.

To activate this coverage you need to apply at the municipal office after registering your child as a resident. It isn’t automatic — you have to request it explicitly. The process is simple and free.

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How to see a doctor: local clinic vs hospital

The Japanese system has a logic worth understanding before you need it.

For any non-urgent consultation: go to a local クリニック (clinic) or 診療所 (practice). These are small specialist medical centres — there are internal medicine clinics, paediatric clinics, dermatology clinics, etc. They’re fast, affordable, and found in every neighbourhood. A consultation with insurance typically costs ¥500-2,000 co-payment.

For emergencies or serious cases: go directly to hospital A&E (救急). No referral needed for emergencies.

What to avoid: going directly to a large hospital (総合病院) for a routine consultation without a referral. Many hospitals charge a surcharge for walk-in consultations of ¥5,000-7,000 on top of the normal co-payment. They also tend to have longer waits than local clinics.

What if I don’t speak Japanese? Most major cities have clinics with English-speaking doctors. The JMDC app and the Japan Health Info website have listings by area. At regular Japanese-only clinics, Google Translate in camera mode works surprisingly well for reading forms and documents.

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Japan vs other Western countries: two systems, two trade-offs

This is the comparison many Western expats wonder about but few articles explain honestly.

In Spain (and much of Western Europe) healthcare is free at the point of use — you pay nothing when you visit the doctor or hospital. It’s a tax-funded system and highly valued. The price paid is waiting time: waiting lists for specialists or scheduled surgeries can run to months or years depending on the region and specialty.

In Japan you pay 30% of each medical act, but access is fast. A specialist consultation is typically available within days, not weeks. Scheduled surgeries happen within weeks, not months.

My first-hand experience: two years ago a doctor identified a basal cell carcinoma — something requiring surgical removal. It wasn’t urgent, but even so the surgery appointment was for the following month. I was admitted one night, operated on, and discharged the next day. In Spain, with the same urgent diagnosis, the surgical wait could easily have been several months.

Neither system is objectively better. It depends on what you value: if you rarely need medical care, a free-at-point-of-use system is clearly more advantageous. If you have children or conditions requiring regular follow-up, the speed of access in Japan has real value.

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What happens if you don’t have insurance

Not having insurance in Japan is not a legal option if you’re a resident. If you’ve been without registration in any system, the municipal office can claim back premiums retroactively for up to two years, with penalties.

If you’ve recently arrived and haven’t enrolled yet, do it as soon as possible at the municipal office. The process takes less than an hour and you get your insurance card on the spot or by post within a few days.

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For tourists: what to do if you need a doctor

Tourists don’t have access to Japan’s public health system. If you need medical care while visiting, you pay 100% of the cost.

What we recommend:

• Travel insurance with medical coverage — essential. The insurance on your credit card sometimes covers this; check before you leave.
• International clinics in major cities have English-speaking staff and experience with tourists. More expensive but easier without Japanese.
• Public hospital A&E accepts anyone regardless of insurance, but you’ll pay the full cost.

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FAQ

Do foreigners have to enrol in health insurance? Yes, if you have a residence card and are registered at the municipal office. Coverage is universal and mandatory.

How long does it take to get the insurance card? With employer insurance, HR handles it — you typically have the card within 2-3 weeks. With kokuho, you apply at the municipal office and the card arrives by post within about a week.

Can I use the insurance from day one? From the moment you receive the insurance card, yes. If you see a doctor before receiving it but have already enrolled, you can present the card later to be reimbursed for the difference.

Are medications covered? Prescribed medications are covered at 70%, the same as consultations. Over-the-counter medications are not covered.

Is there dental insurance? Basic dental treatments are covered (extractions, standard fillings, functional orthodontics in serious cases). Cosmetic treatments and higher-quality prosthetics are not covered.

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Information updated June 2026. Employer insurance rates are reviewed annually in March. Kokuho premiums vary by municipality — check with your local office for your exact figures.