2026-06-19·6 min

Health Insurance in Japan for Expats: Complete Guide 2026

Shakai hoken or kokumin kenko hoken: how Japanese health insurance works for foreigners, what it covers, and how to enrol within 14 days of arrival.

Japan has one of the best healthcare systems in the world, built on a mandatory insurance model that covers every resident, including foreign nationals. Understanding how it works before you arrive saves time and avoids costly gaps in coverage.

The two systems

Every resident in Japan must be covered by one of two systems:

1. Shakai hoken (employee health insurance)

If you are employed full-time by a Japanese company, your employer automatically enrols you in shakai hoken. Contributions are deducted directly from your salary, split between you and your employer. This is the most common situation for expats on a working visa.

2. Kokumin kenko hoken (national health insurance)

If you are self-employed, on a working holiday visa, a student, or your employer does not offer shakai hoken, you must enrol yourself in the national health insurance scheme at your local ward office.

How much does national health insurance cost?

Premiums for kokumin kenko hoken are calculated based on your income from the previous year. For a newly arrived expat with no prior Japanese income history, the minimum premium applies.

Estimates for a single person:

New arrival with no Japanese income history: 2,000 to 5,000 JPY/month
Annual income of 3 million JPY: approximately 15,000 to 20,000 JPY/month
Annual income of 5 million JPY: approximately 25,000 to 35,000 JPY/month

The premium covers the policyholder and dependants (non-working spouse, children).

What is covered

With either shakai hoken or kokumin kenko hoken, you pay 30% of medical costs. The insurance covers the remaining 70%.

What is covered:

GP and specialist consultations
Hospitalisations
Prescription medications
Dental care (partially)
Standard medical tests and procedures

Monthly cost ceiling (kogen ryoyo seido): if your out-of-pocket medical costs in a single month exceed a set threshold (approximately 80,000 to 90,000 JPY for an average income), the insurance covers the excess. This protects against catastrophic expenses.

What is not covered:

Cosmetic dental treatments
Glasses and contact lenses (except for medical conditions)
Some travel vaccines
Private clinic consultations outside the network

How to enrol in national health insurance

Go to your local ward office (kuyakusho), to the national health insurance counter.

Documents needed:

Your Residence Card (zairyu card)
Your passport
Your registered Japanese address
Your My Number (if you have received it)

Timing: you must enrol within 14 days of arrival or of losing other coverage (such as leaving a shakai hoken-covered job). Late enrolment results in paying backdated premiums from the date you should have enrolled.

What you receive: a health insurance card (hoken-sho) sent by post within 2 to 3 weeks. Present this card at every medical appointment.

Using your insurance in daily life

At the clinic: show your insurance card at reception. You pay 30% of the consultation cost at the end of the visit.

Real cost of a GP visit: with insurance, a standard consultation typically costs 1,000 to 3,000 JPY depending on the tests performed.

At the pharmacy: prescription medications are also reimbursed at 70%. Over-the-counter medications are not reimbursed.

At the hospital: for hospitalisations, the monthly cost ceiling applies. In practice, even a week-long hospital stay remains manageable with insurance.

Supplementary insurance

Like a complementary mutuelle in France, many residents in Japan take out private supplementary insurance to cover their remaining 30% out-of-pocket share. Companies such as AIA, AXA Japan, and MetLife Japan offer supplementary plans from 2,000 to 5,000 JPY/month.

Useful if you have chronic health conditions or plan to stay several years.

What to do if you fall ill before your insurance card arrives

If you need a doctor before receiving your insurance card, you pay 100% of the consultation cost. Keep all your receipts. Once your card arrives, you can claim reimbursement of the 70% covered portion at your ward office.

Planning your move to Tokyo? Book a free consultation to secure housing before you arrive and start your administrative setup on the right foot.

Frequently Asked Questions

Is health insurance mandatory for foreigners living in Japan?+

Yes. All residents of Japan, including foreigners with a residence card, must enroll in a health insurance plan. Most employees are enrolled in Shakai Hoken (employer-sponsored insurance). Self-employed individuals, freelancers, and those between jobs enroll in Kokumin Kenko Hoken (National Health Insurance) at their local ward office.

How much does health insurance cost in Japan for foreigners?+

For employer-sponsored insurance (Shakai Hoken), premiums are shared 50/50 with your employer, typically costing you 5-10% of your monthly salary. National Health Insurance premiums are income-based: roughly 5-10% of your previous year's income, with a maximum of around 1,000,000 JPY/year. New arrivals with no prior income pay a minimum of 20,000-30,000 JPY/year.

What does Japanese health insurance cover?+

The standard plans cover 70% of all approved medical costs at registered clinics and hospitals (you pay 30%). Dental, vision, and some preventive care have limited coverage. Prescription drugs at registered pharmacies are also covered at 70%. Most expats find the coverage comprehensive for everyday and emergency medical needs.

Can I use my home country health insurance in Japan instead?+

No. Foreign insurance plans are not accepted at Japanese hospitals for standard billing. You must enroll in the Japanese system. Some expats hold both Japanese public insurance and private international insurance for overseas travel coverage or for private hospital rooms, but Japanese public insurance is required by law.

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