Getting health insurance in Japan: A complete guide

Heading to Japan? It’s worth getting your head around the Japanese healthcare system first. Especially as visiting a doctor in Japan is pretty common: people do it over four times as often as in the US. Part of the reason for this is an insurance system that’s straightforward and not overly expensive by international standards. Here’s our guide to what you need to know.

What kind of healthcare system does Japan have?

Japanese healthcare is universal and public: everybody in the country is entitled to state-run health insurance. People in Japan contribute to the healthcare system through paying regular premiums, either directly or through their employers, and also by paying 30% of their medical bills, up to a monthly cap. The 30% figure varies based on age and is lowered for those in financial difficulty.

30% of medical fees might sound like quite a lot. However, these fees are closely regulated by the state, with an eye on affordability, meaning that facing financial hardship because of healthcare costs is very rare.

For short-term visitors, international private insurance is the best option - the only option, in fact. Private policies also exist for those who want to be covered for the 30% per bill they have to pay under public insurance, and these policies can also cover certain other expenses. However, there’s no two-tier system of free-to-use or paid-for hospitals, as in many other countries. Anyone can go to any hospital and pay the same percentage of the cost.

Who needs to be covered by health insurance, by how much, and what’s actually covered?

Health insurance is mandatory so everyone needs to be covered.

Unlike in a lot of places, you needn’t spend ages picking out the right plan for you or selecting healthcare coverage based on your budget. The public system means that the same high level of care is available to all, with the premiums tied to income and the contributions to medical fees (copayments).

State coverage is pretty thorough. It should cover 70% of your bill from a hospital, or your bill for prescription drugs. If you go to a specialist’s clinic, which is roughly equivalent to seeing a GP, the same payment system applies. There’s an emphasis in Japan on preventive treatment: regular screenings are covered by state insurance. Injuries are paid for entirely by the person whose fault it was: either the patient themselves, or the person who caused it. Services that aren’t covered include inessential dental work and abortions.

How long can I be uncovered by health insurance?

Technically, you always have to be covered, although of course it always takes a little bit of time to get set up. You have to get Japanese health insurance if you’re planning to stay for more than three months. If you’re applying for National Health Insurance, you’ll need your residence card first, so it might even take a few months to get it sorted out.

Anyone who receives medical treatment without public health insurance has to pay all of their medical bills themselves. This isn’t as bad as it would be in some countries, because the fees are kept under control by the government. But still, you’ll probably want to make sure that you have some sort of alternative insurance policy in place for the beginning of your time in Japan.

Are there any penalties for not being covered by medical insurance?

Health insurance registration isn’t actively policed, but technically if you’re found not to have insurance, you may be charged back payments to cover the whole time you’ve been in the country.

What’s the average cost of health insurance?

There are two basic types of public health insurance in Japan: Social Health Insurance (SHI, also called Employees’ Health Insurance) and National Health Insurance (NHI). SHI is for most people with a full-time job, and is paid for through your salary check. NHI is for everyone else - students, freelancers and people with jobs that don’t do SHI. Either way, the copayment you pay for medical services is 30% of the bill.

There’s a monthly cap on the amount you can spend on medical bills each month, and the full cost above this cap is covered by the insurer. The cap varies depending on your circumstances: it’s JPY 80,100 for someone under 70 with a modest income, according to the Commonwealth Fund.

Under SHI, both you and your employer contribute to the monthly premiums you have to pay. Your employer’s insurance company decides the exact percentage of your salary: it’s generally around 5% each for you and your employer. On your payslip, this healthcare payment might be bundled in with your pension, so that a larger chunk comes out of your salary under the title ‘Social Insurance’.

NHI contributions are based on your previous year’s Japanese income, so your first year will be inexpensive. Each city can charge its own rate, so precise costs vary. The figure can also change based on the size of your family, as policies do generally cover dependants. The cost of NHI might end up being a little greater than with SHI.

Health insurance in Japan always ends up costing something, which is one reason why you’ll need to have access to your funds right from the beginning of your stay there. Wise can lend a hand: they can get your money from your home country into Japan at the mid-market rate you’ll find on Google or XE, rather than the higher ones that banks generally charge, and there’s only one simple and fair fee to pay. And with a borderless multi-currency account, you can keep your money in yen, and another 27 currencies should you wish to do so, even before you get set up with a Japanese bank account, meaning that you don’t have to worry about fluctuations in the ever-changing currency market.

What sort of insurance should I have?

There’s not a lot of choice involved, really - you'll have to get either SHI or NHI, depending on your employment status. Both these public schemes pay 70% of the bill in most cases - rising to 90% for retirees - and also offer a lump sum at childbirth, money towards funeral expenses, and various other benefits.

Social Health Insurance (SHI)

If you’re employed by a medium to large company, you should find yourself being signed up for Social Health Insurance (SHI). There are various subtly different types of SHI depending on which industry you work in, and the insurance is administered by a ‘society’ rather than directly by the government. However, this doesn’t really affect you as an employee. SHI is a statutory service, and its main benefits are the same across the board.

National Health Insurance (NHI)

If you don’t get SHI, you’ll need National Health Insurance (NHI) instead. Self-employed people need this sort of insurance, as well as students and people working for very small companies. While enrollment is mandatory for everyone, costs are generally charged only to the ‘head of the household’. The benefits are much the same as with SHI.

Nursing insurance

For those between 40 and 64, there’s another compulsory insurance cost: 1.65% of your income must go towards nursing insurance. Nursing care is available to those who need it aged 65 and above.

International health insurance

International insurance isn’t generally recognised in hospitals, so if you’re visiting, you’ll probably have to pay the full amount there and claim it back from your insurance company later - if it’s covered.

Private health insurance

Despite the thoroughness of the public system, private insurance remains fairly popular in Japan. However, it's limited in scope, because Japan doesn’t have a system of ‘private’ hospitals offering more bespoke care in the same way that many countries do. What private health insurance offers in Japan is generally a lump sum you receive if you’re in hospital for a certain period, or if you’re diagnosed with a serious condition. It can also offer money back on the 30% of bills you have to pay.

Do I need to choose a family doctor / GP?

The short answer is no. If you need to see a doctor, generally it’s best to head straight to a specialist at a clinic - there’s no real system of general non-specialists. You might well want to read up on the different specialists that might be on offer, though, and also consider whether you need to seek out an English speaker. Japan Health Info has a handy list of specialisms.

Are pre-existing conditions covered?

They are - under the public healthcare system, this isn’t a problem.

Are there any deductions I can make for medical expenses in my Japanese taxes?

Between certain limits, you can reduce your taxable income by the amount you pay in healthcare bills. You can’t actually claim any of your bills back from the state, though.

How do I sign up for medical insurance?

With SHI, you should be able to sit back and let a colleague handle it: your employer bears the brunt of the paperwork.

With NHI, on the other hand, you need to head down to your local city hall with your residence card and passport at the ready. You don’t need an appointment, and you don’t have to pay for registration upfront. If you move, you may need to do this all over again, as the system is run by the local administration.

The health card

Once you’re registered with one of the insurance schemes, you’ll receive a health card. Make sure you don’t forget to take it with you - if you do, you’ll be charged the full bill rather than 30% of it. You can then apply for a refund, but it’s a lot more efficient to carry your card around with you.

While the Japanese health insurance system might seem alien at first, there’s a lot to be said in its favour. For one thing, you don’t have to go through the tedious process of comparing a bunch of different insurance companies. Even more importantly, it certainly gets results - Japan boasts the world’s highest life expectancy, after all. And it does this with a system that doesn’t leave people with bills they can’t cope with. Good luck on your trip to Japan - and good health.