Japan has one of the best healthcare systems in the world — and as a foreigner living here, you’re required to join it. That’s actually a good thing, because it’s genuinely excellent value.
Here’s how it all works.
Is Health Insurance Mandatory for Foreigners?
Yes. If you live in Japan for more than 3 months, you must join the national health insurance system. No exceptions.
There are two types:
| Type | Who it’s for |
|---|---|
| Employee Health Insurance (健康保険) | People employed full-time at a company |
| National Health Insurance (国民健康保険) | Self-employed, part-time workers, students |
If you work full-time at a Japanese company, your employer will enroll you automatically. You don’t have to do anything.
How Much Does It Cost?
Employee Health Insurance:
- About 10% of your monthly salary
- Split 50/50 between you and your employer
- So you pay roughly 5% of your salary per month
That’s a pretty good deal when you think about it — your employer covers half.
National Health Insurance:
- Based on your previous year’s income
- Typically ¥2,000–¥20,000 per month
What’s Actually Covered?
Japanese health insurance covers 70% of most medical costs. You pay the remaining 30%.
Covered:
- Doctor visits
- Hospital stays
- Surgery
- Prescription medicine
- Dental (basic treatments)
- Mental health
Not covered:
- Cosmetic procedures
- Some dental treatments (implants, whitening)
- Private hospital rooms
That 30% you pay sounds like a lot, but in practice most clinic visits cost under ¥1,500 out of pocket. It’s very manageable.
How to Actually Use It
It’s simpler than you’d think:
- When you visit a clinic or hospital, show your insurance card (保険証)
- You pay 30% of the treatment cost at checkout
- That’s it
Example:
- Doctor visit total cost: ¥3,000
- You pay: ¥900 (30%)
- Insurance pays: ¥2,100 (70%)
How to Get Your Insurance Card
If employed: Your company HR department will issue your card within a few weeks of starting. Just ask HR when to expect it.
If self-employed or a student: Go to your local City Hall (市役所). Bring your residence card, passport, and My Number card. Register for National Health Insurance and your card will arrive within 1–2 weeks.
What If You Go to the Doctor Without a Card?
You’ll pay 100% of the cost upfront. Keep the receipt — you can claim reimbursement later at City Hall. But it’s a hassle, so always bring your insurance card.
The High-Cost Medical Expense System (高額療養費)
Here’s something that really sets Japan’s system apart: if your monthly medical bills get very high, Japan reimburses anything above a set monthly limit.
For most people earning standard income, that limit is around ¥87,000/month.
So even major surgery — even a hospital stay of weeks — is capped at a manageable cost. You won’t get a catastrophic medical bill here the way you might in the US.
Summary
- Health insurance is mandatory for all residents
- You pay 30% of most medical costs
- Get your card from your employer (if employed) or City Hall (if self-employed)
- Major expenses are capped through the high-cost expense system
- Japan’s system is excellent value — use it without worry