National Health Insurance in Japan for residents

As of July 2026. Premiums and some procedures vary by municipality — confirm with your own city/ward office.

Japan has universal health coverage, and if you live here you’re part of it. If your job doesn’t provide health insurance, you enrol in National Health Insurance (国民健康保険, NHI) at your city or ward office. Here’s how it works.

Enrolment is mandatory

“Foreigners registered as residents in Japan must also enroll in the NHI if they will not enroll in any other public health insurance.” (Toshima City, official English)

Residents staying more than 3 months who aren’t on an employer’s health insurance must join, generally within 14 days at the municipal NHI counter. Enrolling late can mean back-payment of premiums (up to two years) and paying full costs while uninsured. If you’re employed and covered by company insurance (社会保険), you use that instead.

What you pay at the counter

“When you receive treatment, pay 30% of the medical expenses… at the medical institutions. The remaining expenses will be paid by [the municipality].” (Toshima City, official English)

So you generally pay 30% and the insurer covers 70%. Young children pay about 20%, and people aged 70–74 pay 20% (or 30% for higher-income earners). From age 75, you move to the separate Late-Stage Elderly Medical system rather than National Health Insurance.

Many municipalities further subsidise children’s medical costs (often making them free or near-free), so your actual out-of-pocket can be lower than the statutory rate — check your own city’s child medical-support scheme.

Premiums: income-based, and not free

“This is calculated per household unit based on last year’s income amount and the number of people in the household.” (Toshima City, official English)

Each municipality sets premiums combining an income-based portion (from the prior year) and a per-capita portion, so the amount varies by city and household. Budget for it — NHI is not free.

The safety net: High-Cost Medical Expense benefit

If your co-payments in a single month exceed a ceiling set by your age and income, the excess is reimbursed by the insurer under the High-Cost Medical Expense benefit (高額療養費). With an eligibility certificate obtained in advance, you can instead pay only up to the cap at the counter. Non-covered items (such as hospital meal charges) are excluded.

FAQ

General information, current as of July 2026, not medical or financial advice. Premiums and procedures vary by municipality — confirm with your city/ward office via the sources below.