National Health Insurance in Japan for Foreigners: Kokuho Enrollment, Cost & Coverage

Quick answer (30 seconds): If you have a residence card and live in Japan for three months or more, you must be covered by health insurance — either your employer's plan (社会保険 / shakai hoken) or National Health Insurance (国民健康保険 / Kokuho). If your employer does not enroll you (students, freelancers, the self-employed, part-timers below the threshold, the unemployed), you join Kokuho yourself at your city/ward office, normally within 14 days of registering your address. Kokuho pays 70% of most medical costs (you pay 30%), premiums are based on your previous year's income (so your first year is often cheap), and a cap called kōgaku ryōyōhi protects you from huge hospital bills. From June 2027, unpaid premiums can also hurt your visa renewal — so this is not optional.

Disclaimer: This is general information, not legal, tax, or medical advice. Rules and amounts differ by municipality and change over time. Always confirm the latest details with your city/ward office (市区町村役所), the Ministry of Health, Labour and Welfare (厚生労働省), or the Immigration Services Agency (出入国在留管理庁) for your own situation.

Who has to enroll — and Kokuho vs. employer insurance

Japan has universal health coverage: everyone legally resident is expected to be in one public system. As an official source puts it, "Foreign residents who will be staying in Japan for three months or more have to subscribe to the National Health Insurance program."

Which system you're in depends on how you work:

	Employees' Health Insurance (社会保険 / shakai hoken)	National Health Insurance (国民健康保険 / Kokuho)
Who	Full-time company employees (and qualifying part-timers)	Everyone else: self-employed, freelancers, students, unemployed, part-timers below the threshold
How you join	Your employer enrolls you automatically	You enroll yourself at the city/ward office
Who pays the premium	Split ~50/50 with your employer	You pay the full premium
Premium based on	Your monthly salary	Your previous year's income + per-person + per-household amounts (set by your municipality)

Key point: you are never meant to be in both and never meant to be in neither. When your situation changes (you quit a job, graduate, start freelancing, or get hired full-time), you must switch within 14 days — Kokuho does not start or stop automatically.

What Kokuho covers

• 70% of most medical and dental costs are covered; you pay 30% at the clinic or hospital.
• The self-pay rate is 30% for ages 6–69. It is lower for young children (20% for pre-school age) and for people aged 70–74 (generally 20%), with separate late-life coverage from age 75.
• It covers illness, injury, most prescriptions, and childbirth-related care; it does not cover purely cosmetic treatment, routine checkups paid separately, a normal (non-complicated) delivery as a "medical" cost, or treatment abroad in the same way.

The cap that stops a bad month from bankrupting you: 高額療養費

If you have a big hospital bill, the High-Cost Medical Expense Benefit (高額療養費 / kōgaku ryōyōhi) caps how much you actually pay per month based on your income bracket — the rest is refunded or, with a Limit Application Certificate (限度額適用認定証) obtained in advance, never charged. This is one of the most valuable parts of the system and applies to Kokuho members too.

⚠️ 2026 update (now law): A revision passed in May 2026 raises these monthly caps in two stages, starting August 2026, while keeping low-income safeguards and adding a new annual out-of-pocket cap. The exact amounts depend on your income bracket, so check the current figures with the MHLW or your municipality before relying on a specific number.

How much does it cost?

Premiums are set by each municipality and calculated mainly from your previous year's income (including part-time income), plus a fixed per-person and per-household amount.

Good news for newcomers: if you had no Japanese income last year, your first-year premium is usually very low. The bill rises in your second year once you have a full year of Japanese income on record (the same reason your residence tax jumps in year two — see the related guide below).

Very rough, illustrative monthly ranges (real amounts vary a lot by city and household size):

Annual income (prior year)	Rough monthly premium
Up to ¥1,000,000	~¥2,000–5,000
¥2,000,000	~¥15,000–25,000
¥3,000,000	~¥25,000–35,000

Treat the table as a ballpark only. For an exact figure, ask your city/ward office — they can estimate your premium on the spot.

How to enroll (step by step)

1. Register your address first. When you move in, do your resident registration (転入届 / 住民登録) at the city/ward office. NHI enrollment happens at the same office, usually the same day.
2. Apply within 14 days of registering your address.
3. Bring your documents. Typically: residence card (在留カード), passport, My Number card/notice, and a personal seal (印鑑) if you have one.
4. Get your insurance card. You'll receive a health insurance card (保険証) or the equivalent linked to your My Number card. Show it at any clinic to pay only 30%.

🚨 Don't skip it to "save money" — it backfires. Enrollment is backdated to when you became eligible (your move-in/entry date), so if you join late you'll be billed retroactively for the missed months — you don't avoid the premiums, you just lose coverage in the meantime.

You'll usually need a Japanese bank account to set up premium payments by direct debit (口座振替) — set that up early (see the bank account guide below).

If you genuinely can't afford the premium

If your income is low, don't just stop paying — talk to the office. Options include:

• Statutory reductions for low prior-year income (a set percentage off the per-person/per-household portion), applied automatically when your income data shows you qualify.
• Reduction/exemption on application for sudden hardship (job loss, disaster, illness).
• Installment / payment plans (分割納付) so arrears don't balloon.

This matters for more than your budget — see the visa section next.

Why paying matters now: the 2027 visa rule

Historically, immigration and your municipality's insurance records were separate systems. That wall is being removed. There are two separate changes to know about (both still being finalized — verify against the Immigration Services Agency before relying on the details):

1. Visa renewals & changes of status (from June 2027). From June 2027, people who are delinquent on National Health Insurance / pension premiums and ignore repeated payment demands can, in principle, be refused a renewal or change of status of residence.

• National Health Insurance payment data will be linked to immigration screening (municipal systems are being upgraded during FY2026), so an officer can check your payment status on the spot.
• It is aimed at malicious cases — long-running or large unpaid amounts and ignoring reminders. The exact thresholds (how long, how much) will be set later by ordinance, so a routine short delay is not the target.
• Your current status matters: paid up, on an installment plan, or formally exempt keeps you clear. Involuntary non-payment (illness, job loss) is not the target.

2. Permanent-residency revocation (2024 law, targeted for 2027). A 2024 amendment to the Immigration Act adds grounds to revoke permanent residency for willful non-payment of public dues (taxes, pension, health insurance). It is aimed only at malicious cases (involuntary hardship is excluded); the government is targeting 2027, with the Immigration Services Agency's operational guidelines due in autumn 2026.

Bottom line: keep your premiums current (or formally on a plan/exemption), and keep the receipts/records — they may be requested at renewal.

When you leave Japan

Kokuho does not end automatically. Before you go, unenroll (脱退) at your city/ward office, return the insurance card, and settle any remaining premiums. If you leave without doing this, you can be billed for months you're no longer in the country. (If you also paid into pension, look into the Lump-sum Withdrawal Payment separately.)

Kokuho vs. private / expat health insurance

For most residents, public insurance (Kokuho or shakai hoken) is mandatory and sufficient — private plans don't replace it. Private or expat health insurance is mainly worth considering if you:

• are in Japan short-term / not yet eligible for Kokuho,
• want English-language support, direct billing, or coverage that travels with you, or
• want to top up costs Kokuho doesn't cover.

If that's you, compare a few supplemental or expat plans before deciding — but for residents it is an add-on, never a replacement for public insurance.

FAQ

1. I'm a student / freelancer. Do I really have to join? Yes. If you live in Japan 3+ months and your employer doesn't enroll you in shakai hoken, Kokuho is mandatory — not optional.

2. What if I never go to the doctor? You still must enroll and pay. Premiums fund the system whether or not you use it — and skipping enrollment means retroactive back-billing plus, from 2027, possible visa consequences.

3. How much will I pay in my first year? Often very little, because premiums are based on last year's income and most newcomers had no Japanese income then. The amount rises in year two.

4. Does Kokuho cover dental and childbirth? Standard dental treatment: yes (you pay 30%). Pregnancy/childbirth: prenatal care and complications are covered, and there's a separate childbirth lump-sum grant; a normal delivery itself is handled differently. Confirm specifics with your municipality.

5. I changed jobs / quit. What happens to my insurance? You must switch yourself within 14 days — from shakai hoken to Kokuho (or vice versa). There's no automatic gap-free transfer; an uncovered gap can mean retroactive premiums later.

Sources

• Study in Japan (MEXT/JASSO, official) — Insurance: https://www.studyinjapan.go.jp/en/life/insurance/
• MHLW (厚生労働省) — Application of National Health Insurance to foreign nationals: https://www.mhlw.go.jp/web/t_doc?dataId=00ta3349&dataType=1&pageNo=1
• Meguro City (目黒区, official) — NHI enrollment for foreign nationals: https://www.city.meguro.tokyo.jp/kokuho/kurashi/kokuho/kanyu-gaikoku.html
• Kariya City (刈谷市, official) — NHI for foreign residents (retroactive enrollment): https://www.city.kariya.lg.jp/kurashi/hokennenkin/kokuho/1006949/1003219.html
• MHLW (厚生労働省) — Medical-insurance reform law passed May 2026 (High-Cost Medical Expense caps raised in stages from August 2026): https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/iryouhoken/newpage_00014.html
• MHLW — High-Cost Medical Expense Benefit (current figures): https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/iryouhoken/juuyou/kougakuiryou/index.html
• MHLW + Immigration Services Agency — unpaid NHI/pension to affect visa renewal/change from June 2027 (reported by NHK): summary https://coki.jp/article/news/62332/
• Immigration Services Agency (出入国在留管理庁) — status-of-residence renewal/change guidelines: https://www.moj.go.jp/isa/applications/resources/nyuukokukanri07_00058.html

Related guides

• Open a Japanese bank account as a foreigner — needed for direct-debit premium payments
• Can't pay your Japanese pension? Exemptions explained — the same "talk to the office, don't ignore it" logic
• The 2026 pension-and-visa problem — how unpaid public dues connect to your visa
• First week in Japan checklist — where NHI fits in your setup

Last updated: 2026-06-19