If you’re living in Japan or planning to stay long-term, one of the most important things to understand is how the Japanese health insurance system works. With universal coverage, world-class healthcare, and reasonable costs, Japan offers one of the most accessible and efficient health systems in the world.
In this guide from Real World Japan, we break down how insurance works, what it covers, and what you need to do as a resident or expat.
What Is Japan’s Health Insurance System?
Japan has universal health care, which means everyone — including foreigners living in Japan — must enroll in a public health insurance plan. If you’re staying in Japan for more than 3 months, you’re legally required to join the system.
There are two main types of public health insurance:
- Shakai Hoken (社会保険) – for company employees
- Kokumin Kenkō Hoken (国民健康保険) – for freelancers, part-timers, students, and the unemployed
Let’s take a closer look at both.
1. Shakai Hoken: Employee’s Health Insurance
If you’re working full-time for a Japanese company, chances are you’ll be enrolled in Shakai Hoken automatically.
What’s Covered?
- 70% of medical and dental costs
- Hospitalization and outpatient care
- Prescriptions
- Some maternity and mental health services
- National pension (bundled)
Cost:
- Premiums are split 50/50 between you and your employer.
- Typically around 7–9% of your monthly salary.
You’ll also get coverage for dependents (your spouse and children).
2. Kokumin Kenkō Hoken: National Health Insurance
If you’re self-employed, a student, part-time worker, or unemployed, you’ll need to register for National Health Insurance at your local city or ward office.
What You Need to Know:
- You pay the full premium yourself.
- Costs are based on your previous year’s income.
- Can be as low as ¥20,000/year if you have little to no income.
Example:
A language student or freelance web designer earning modest income might pay around ¥2,000–¥5,000/month.
What’s Actually Covered?
No matter which plan you’re on, public health insurance in Japan generally covers:
✅ 70% of most doctor visits, check-ups, and treatments
✅ Dental care, including fillings and cleanings
✅ X-rays, MRIs, blood tests, and surgeries
✅ Prescription medications
✅ Mental health services
✅ Preventive care (like cancer screenings)
You pay 30% of the total cost at the clinic or hospital. Children and seniors usually pay only 10–20%.
The Insurance Card (健康保険証)
Once you’re enrolled, you’ll receive a Health Insurance Card (Hokenshō). This little card is your golden ticket to affordable medical care in Japan. Bring it with you to every appointment.
If you forget your card, you might be charged 100% up front — so don’t leave home without it!
Worried About Big Bills?
Japan has a safety net called the High-Cost Medical Expense Benefit (高額療養費制度). If your out-of-pocket costs in a given month are very high (due to surgery, hospitalization, etc.), you can apply for a partial refund.
What About Tourists?
If you’re visiting Japan for a short time, you are not eligible for public health insurance.
Healthcare in Japan is high quality but expensive for non-residents. A simple clinic visit can cost ¥10,000+ without insurance. So if you’re traveling, always buy travel insurance before your trip.
How to Enroll in Health Insurance in Japan
Here’s what to do if you’re staying long-term:
Step-by-Step:
- Register your address at your city or ward office within 14 days of moving.
- Ask about enrolling in either National Health Insurance or confirm your Shakai Hoken status with your employer.
- Receive your insurance card in the mail.
- Start paying monthly premiums by bank transfer or at convenience stores.
If you delay enrolling or forget to pay premiums, you may owe back payments — so it’s better to register ASAP.
Final Thoughts from Real World Japan
Japan’s health insurance system may seem complex at first, but it’s reliable, affordable, and essential. Whether you’re working, studying, or freelancing here, being covered means you can live worry-free when it comes to your health.