National Health Insurance in Japan: How Residents Enroll and Use It

A clear, friendly overview of Japan's National Health Insurance, from signing up at the ward office to showing your card at the clinic.

Published October 20, 2026 at 3:16 PM JST | By Tokyo Paul

Quick answer: National Health Insurance (kokumin kenko hoken) is the public insurance that covers Japan residents who are not enrolled in an employer plan. Foreign residents who are registered with a municipality and stay beyond three months generally join at their city or ward office, within 14 days. Members typically pay 30 percent of medical costs at the clinic, while the insurer covers the rest.

Japan has universal health coverage, which means that residents are expected to be in one public system or another. For many newcomers, that system is National Health Insurance, often shortened to NHI or kokuho. It is run by local governments, so the details can differ slightly from one city to the next. This guide explains who joins, how enrollment works, what the card looks like today, how costs and premiums are structured, and what to do when your situation changes. Treat it as a friendly map, and confirm the final details with your own city or ward office.

What is National Health Insurance in Japan?

National Health Insurance is the public insurance program for people who are not covered by an employer-based plan. Wikipedia describes it as one of the two main statutory types, alongside Employees' Health Insurance, and notes that members must leave NHI if they join the employer-based system.

In practice, NHI commonly serves people such as freelancers, self-employed residents, students, part-time workers without employer coverage, retirees and people between jobs. Full-time employees of many companies are enrolled in their workplace plan instead, and their enrollment is handled through the company.

Because municipalities administer NHI, the application counter, the premium amount and some of the extra benefits are set locally. That is why every city office publishes its own guide, often in English as well as Japanese.

Who needs to enroll?

Foreign nationals who are registered as residents of a Japanese municipality and who have a status of residence for more than three months generally need to be in a public health insurance system. Funabashi City's English pamphlet explains that all residents in Japan must be in a public system, and that foreign nationals staying more than three months on a residence visa must join either NHI or their workplace insurance.

Short-term visitors on a tourist stay are not part of this system, which is why travel insurance is recommended for visitors. Some residents are covered by other programs instead, such as an employer plan, a plan for older seniors, or public assistance, and those residents do not join NHI.

Eligibility has some details that depend on your status and age. If you are unsure, the insurance counter at your city or ward office can confirm which program fits your situation.

How do you enroll in National Health Insurance?

Enrollment takes place at the NHI counter of your city or ward office, usually right after you register your address. Municipal guides explain that the application should be made within 14 days of the event that triggers it, such as moving into the municipality or leaving an employer's plan.

Bring your residence card, along with your passport and, if you have one, your My Number card or notice. Funabashi's pamphlet also mentions that an income declaration may be requested, particularly in the first year or when your income is not reported by an employer. Staff at the counter can tell you exactly what is needed on the day.

Many municipalities offer interpretation or multilingual guides, and some offices have English forms. It is a good idea to ask about those options when you call or visit.

What does it cost?

Premiums are calculated by the municipality, and the method is described in city guides. They generally combine an income-based portion, which uses your previous year's income, with flat per-person and per-household amounts. Adults between 40 and 64 pay an additional portion that supports long-term care insurance.

Bills usually arrive in June, and many cities allow payment in ten monthly installments from June to March, or as a lump sum. The head of the household is normally responsible for paying for all members. Automatic bank transfer is widely recommended because it keeps payments on time without effort.

Premiums can apply from the month your eligibility begins, even if you register later, and Toshima City notes that they may be charged retroactively for up to two years. Low-income households may qualify for a reduction, and each city explains how to apply. Because amounts vary so widely, ask your office for an estimate.

How much do you pay at the doctor?

Members typically pay 30 percent of medical costs at the clinic or hospital, while the insurance covers the remaining 70 percent. Children under six pay a reduced share of 20 percent, according to city guides, and members aged 70 to 74 pay either 20 or 30 percent depending on income. People aged 75 and older move to a separate medical system for older seniors.

There is also a monthly cap on out-of-pocket costs for expensive treatments, known as a high-cost medical care benefit. The cap depends on age and income, and city guides such as Shizuoka's list the brackets. This benefit gives families a helpful safety net during major treatment.

NHI also supports some other benefits, such as a lump-sum birth allowance, a funeral allowance and health checkups for people aged 40 and over. The details vary by municipality, so it is worth reading your city's guide.

What does the card look like now?

Japan has been moving away from separate paper or plastic health insurance cards. According to the nippon.com summary, the government stopped issuing new traditional cards in December 2024, and patients are now expected to show a My Number card that has been registered for health insurance use, or a certificate of eligibility called shikaku kakunin-sho.

If you do not have a My Number card, or you have not registered it, your insurer sends a certificate of eligibility, and you do not usually need to apply. If you do have a registered My Number card, you can use it at participating clinics and pharmacies, often at a card reader with face recognition.

Registration can be done at a terminal at a medical institution or pharmacy, at certain ATMs or through the My Number online portal. Many residents find it convenient to keep the card in their wallet, and some people keep the certificate as a backup.

How do you use your insurance at a clinic or pharmacy?

Show your card or certificate at reception when you arrive, and the clinic will calculate your share. Bring your residence card if you are asked for identification. If you visit without proof of insurance, you may be asked to pay the full cost yourself, so ask your city office what to do if a card is lost or delayed.

At the pharmacy, show your card again and hand over the prescription from the clinic. The pharmacy will charge your share of the cost, and medicine is usually dispensed on the spot. Keep your receipts, since some medical expenses can matter at tax time, and ask your tax office if you are unsure.

Coverage applies to treatment of illness and injury, necessary medicine and hospital stays. Cosmetic procedures and care when you are not ill or injured are generally not covered, as the Funabashi pamphlet explains.

What if your situation changes?

Update your insurance whenever something important changes, and do it quickly. Shizuoka's guide explains that you should notify the NHI office within 14 days when you leave Japan, move to another municipality, join an employer's plan or otherwise stop being eligible, and return your insurance certificate.

If you start a new job with employer insurance, withdraw from NHI so that you are not billed twice. Funabashi's guide warns that premiums continue until you complete the withdrawal. If you move within the same city, you will exchange your card or update your address at the counter.

Keeping up with payments is also important, and city offices are generally helpful when someone has difficulty. If you have a hard time paying, ask the counter about reductions or payment options early rather than waiting.

Frequently Asked Questions

Do foreigners have to join National Health Insurance in Japan?

Foreign residents registered with a municipality and staying more than three months generally must be in a public health insurance system. If you are not covered by an employer plan, that is usually NHI. Confirm your own situation at your city or ward office.

How much do you pay at the doctor with National Health Insurance?

Members typically pay 30 percent of the cost at the clinic. Children under six pay a reduced share, and older members pay 20 or 30 percent depending on income. There is also a monthly cap for expensive treatment. Your city's guide has the exact figures.

How soon do you have to enroll in National Health Insurance?

Municipal guides say applications should be made within 14 days of the triggering event, such as moving into a city or leaving an employer's plan. Go to the insurance counter of your city or ward office and bring your residence card.

Keep Exploring

More guides from Tokyo Paul: Moving to Japan: Residence Card, Address Registration and the First Visit to City Hall, My Number and the My Number Card: What Residents Should Know and Moving to Tokyo: A First-Month Checklist for Newcomers.