National Health Insurance in Japan for residents

Updated 3 September 2026 to reflect the High-Cost Medical Expense ceilings that took effect in August 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 inNational 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.

Shinjuku City sets out the same structure and adds what the premium is actually made of: premiumscomprise a medical portion, support portion, and Long-Term Care Insurance portion, eachdetermined by adding together an income-based amount from the previous year and per-capita amount. Two practical consequences follow from “previous year’s income”:

• Your first year in Japan is normally assessed on income you did not earn here, so the bill is often much smaller than it will be in year two. Do not treat year one as the steady-state cost.
• The Long-Term Care Insurance portion is added only for household members aged 40–64, so the same income can produce different bills at different ages.

Neither city publishes a rate table in English; the yen rates and the annual cap are set each June by your own municipality and published on its Japanese-language page. Ask the NHI counter for your household’s figure rather than relying on another city’s numbers.

The safety net: High-Cost Medical Expense benefit

The 30% co-payment is not the real ceiling on what you can be charged. If your co-payments exceed a limit set by your age and income, the excess is reimbursed under theHigh-Cost Medical Expense benefit (高額療養費, kōgaku ryōyōhi). With an eligibility certificate obtained in advance — or by using a My Number health card at a participating hospital — you pay only up to the limit at the counter instead of claiming it back. Non-covered items such as hospital meal charges and private room fees are excluded.

The limits that apply now (August 2026 – July 2027, under 70)

These ceilings were revised in August 2026, and an annual ceiling was introduced for the first time. The figures below are the table published by the Ministry of Health, Labour and Welfare. “Multiple occurrence” is the lower limit that applies from the fourth month in any 12 months in which you hit the cap.

Patient share is 30% (20% before compulsory school age). People aged 70 and over have a separate table with an outpatient-only ceiling. The income brackets are matched to your health-insurance standard monthly remuneration or, for NHI, to your assessed income — the yen figures above are the national statutory limits and do not vary by city.

Worked example. On ¥1,000,000 of treatment in one month, the counter charge at 30% is ¥300,000. In the ¥3.7M–¥7.7M bracket the ceiling is ¥85,800 + 1% × (¥1,000,000 − ¥286,000) = ¥92,940. The ministry uses this same case in its own explainer, and states the result rounded:Under the system from August 2026, a person under 70 earning roughly ¥3.7M–¥5.1M a year who receives ¥1,000,000 of treatment has their own payment held to about ¥93,000. (MHLW — translated; the Japanese reads 「令和８年８月からの制度においては、70歳未満・年収約370万円～約510万円の方であれば、医療費100万円の治療を受けた場合、自己負担は約9.3万円まで抑えられます。」) The ¥92,940 above is that same figure before rounding. The difference against the ¥300,000 counter charge is refunded, or never charged if you presented a certificate.

The new annual ceiling. The ministry describes it as: even if your monthly payments accumulate,once the annual ceiling is reached, no further payment for medical expenses is required (translated from the Japanese). The “year” for this purpose runs from August to the following July, not the calendar or tax year. It is aimed at people who need long-term treatment but never hit the monthly cap often enough to qualify for the multiple-occurrence reduction.

A further revision is scheduled for August 2027, subdividing the income brackets. Check the ministry’s page or your insurer before relying on these figures for a future treatment.

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.