Japan National Health Insurance for Foreigners

You’ve just landed in Japan and you’re wondering how to stay healthy without breaking the bank. You’re not alone. National health insurance in Japan for foreigners can cover about 70% of most medical costs⁴. Here’s what you’ll learn: who needs to enroll, how to sign up, what’s covered (and what’s not), plus smart tips for filling the gaps. Ready to unlock stress-free healthcare? Let’s dive in.

What Is Japan’s National Health Insurance?

Hook: Imagine paying a fraction of your hospital bill—sounds great, right?

Context: National Health Insurance (NHI) is a public program managed by your local ward or city office. It’s designed to keep medical costs affordable for everyone residing in Japan more than three months.

Detailed Explanation: Enrollees pay monthly premiums based on income and household size. When you visit a clinic or hospital, you’ll only pay 30% of the total cost at the counter (70% is covered). Low-income households may see coverage up to 90%¹. But note, dental work beyond basic care and psychiatric sessions often require out-of-pocket fees.

“NHI ensures that even those on tight budgets can access essential treatments without financial hardship.” – Ministry of Health, Labour and Welfare

Real Example: A friend from Canada enrolled in Tokyo’s NHI last spring. His monthly premium is around ¥18,000 (about $165 USD). He pays ¥3,000 when he sees a doctor for a cold, instead of the full ¥10,000 fee.

Actionable Takeaway: Check your local ward office website for exact premium tables and book an appointment to register within 14 days of moving in.

Who Needs to Enroll?

Hook: Are you here short-term or planning to stay?

Context: By law, anyone holding a resident status (work visa, student visa, spouse visa) and staying longer than 90 days must join NHI². Short-term tourists cannot enroll.

Detailed Explanation:

• Students and researchers: automatic eligibility when you register your address.
• Employees: some companies pay part of your premiums under Japan Health Insurance Foreigners Guide.
• Spousal or dependent visa holders: enroll individually.

You might be wondering: what about digital nomads? Sadly, Japan’s NHI isn’t available for purely short-term, remote-work stays. You’ll need a private plan (see next section).

Actionable Takeaway: Verify your visa status and register at your city hall within two weeks of your move.

How to Register for NHI: Step-by-Step

Hook: Ready to tick this off your to-do list?

1. Gather documents: residence card, passport, and proof of address (lease agreement or moving-in notice).
2. Visit your local ward/city office’s insurance counter.
3. Fill out the NHI enrollment form (available in English at most offices).
4. Submit and await your NHI card (shahoken) in 2–4 weeks.
5. Set up automatic premium payments (recommended).

Actionable Takeaway: Block off at least an hour for your city-hall visit and double-check opening hours.

Coverage, Premiums, and Costs

Hook: How much will you really pay?

Premiums depend on your previous year’s income and municipality. In 2025, Tokyo’s range is roughly ¥11,000–¥25,000 per person per month (about $100–$230 USD)⁴.

• Standard coverage: 70% of outpatient and inpatient costs.
• Low-income subsidies: up to 90% coverage.
• Dependents under 20 or over 75: special rates apply.

Actionable Takeaway: Use your NHI card every time you visit any medical facility—even pharmacies. It works for prescription drugs, too.

Alternatives & Complementary Insurance

Hook: NHI is great, but holes remain.

Context: If you travel often, seek dental treatment, or need medical evacuation, consider a private plan.

Options:

• International private insurance: $55–$70/month for digital nomads³.
• Supplemental “kakari‐keihi” riders: fill gaps in dental and mental-health coverage.
• Group plans via university or employer: often discounted rates.

Expert Insight: “A private policy can safeguard you against unexpected high-cost emergencies abroad,” says a broker at Global Health Insurance Inc.

Actionable Takeaway: Compare quotes from at least three providers. Look for evacuation and repatriation clauses.

Future Trends & Policy Updates

Japan’s ageing population is driving premium hikes and digitalization of NHI cards—by 2026, most municipalities will issue e-cards you can store on your phone (no more plastic!). Meanwhile, proposed reforms may adjust coverage percentages for high-income earners.

Actionable Takeaway: Stay informed through your ward office newsletter or the Ministry of Health, Labour and Welfare website.

FAQ

1. Can tourists use NHI?

No. Only residents with a valid visa longer than 90 days can enroll.

2. What do I do if I lose my NHI card?

Report to your ward office immediately; replacement cards take about one week.

3. Does NHI cover pregnancy and childbirth?

Yes. Most prenatal and delivery costs are covered at 70%, with additional lump-sum allowances available.

4. Can I opt out if I have private insurance?

No. Enrollment in NHI is mandatory if you meet the residency criteria.

Conclusion

National health insurance in Japan for foreigners offers peace of mind and substantial savings—covering roughly 70% of most medical bills. You’ve learned what NHI is, who must enroll, how to sign up, and where gaps may appear. Next steps:

1. Gather your residence card and proof of address.
2. Register at your local ward or city office within two weeks.
3. Research a supplemental private plan if you travel frequently.

Take action today to avoid costly back-payments tomorrow. With NHI in your pocket, you can focus on enjoying life in Japan—minus the insurance worries.