Two expats comparing Japanese health insurance options 

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Health insurance in Japan: Your 2026 guide

In Japan, health insurance is mandatory for all residents, including expats. This means health insurance for foreigners in Japan works much the same way as it does for citizens. 

The good news is this: Healthcare in Japan is very high quality. In 2025, 80% of residents were satisfied with the availability of quality healthcare, much higher than the [OECD average of 64%](https://www.oecd.org/en/publications/health-at-a-glance-2025_15a55280-en/japan_319bfc39-en.html). At the same time, life expectancy in Japan is 84.1 years, three years higher than the OECD average. 

Expats in Japan can look forward to excellent quality healthcare, as well as affordable costs and universal access. However, there are challenges. Crucially, most healthcare providers communicate in Japanese by default. If you don’t speak the language, this can make navigating the healthcare system in Japan a particular challenge. 

In this article, we discuss this in detail. Keep reading to find out how the system works and how expats can best navigate it. 

## How does healthcare in Japan work?

Japan has a universal healthcare system, funded primarily through mandatory public health insurance. This means all residents (including expats) must have health insurance. 

There are two main healthcare systems. The first is for employees (Kenkō-Hoken). The second is for self-employed, retirees, and other non-working residents (Kokumin-Kenkō-Hoken). Both systems are also heavily subsidized by public funds from the government.

The government also regulates the price of healthcare treatment. This means costs are relatively consistent across the country. However, fully private healthcare providers have more flexibility to set their own costs. It is important for expats to be aware of this distinction, since private providers are more likely to communicate in English.

Mandatory public insurance is charged as a monthly premium. If you’re an employee, it’s provided by your employer, and the premium is deducted from your monthly salary. The cost is decided based on your annual income.

For most residents, mandatory public insurance covers 70% of up-front healthcare costs. But this split isn’t the same for everybody. For instance, it covers 80% of costs for children under the age of three, and 90% for most retirees over 75. 

The remaining costs consist of a co-payment. This means you will usually pay 30% of your healthcare costs up-front when you receive treatment. However, you can also buy additional private health insurance to cover these out-of-pocket expenses. Unlike public insurance, this is optional. 

For expats, there are a few additional requirements to be aware of. When you arrive in Japan, you must register as a resident within 14 days of arriving. This applies to all expat residents, [regardless of your visa type](https://feather-insurance.com/en-ww/blog/international-health-insurance-visa-seekers). The only exception is if you’re staying for less than three months. In this case, you’re not considered a resident.

## Types of healthcare in Japan

Traditionally, healthcare in Japan has involved a two-pronged system. Today, that system still stands. But since 2008, there has been an alternative system for over-75s: Long-life medical care. 

In practice, this means Japan has three major healthcare systems. The principle of all three is similar, but there are important differences to be aware of. Here is a brief overview of these three systems: 

### 1. Employee Health Insurance (EHI)

Employee health insurance (Kenkō-Hoken) is the default health insurance for anybody employed in Japan. In principle, it is similar to other employer-provided healthcare systems around the world. Under this system, your employer is responsible for registering you and providing the insurance. 

The average cost of the monthly premium [is 10%](https://pmc.ncbi.nlm.nih.gov/articles/PMC7930804/) of your salary. Your employer will contribute roughly half of these costs. 

### 2. National Health Insurance (NHI) (Kokumin-Kenkō-Hoken)

The next major healthcare system in Japan is National Health Insurance (Kokumin-Kenkō-Hoken). It is designed for anybody under the age of 75 who isn’t employed. This includes the self-employed, unemployed, students, and retired people – as well as their dependents. 

Since there’s no employer here, the whole cost is paid by the individual being insured. If this applies to you, you’re also responsible for registering and paying the premium. Like with EHI, these costs depend on your age and income.

By default, insurance is purchased and paid for on a family-by-family basis. This means the head of the household (usually the highest earner) pays the premium for the [whole family’s insurance](https://feather-insurance.com/en-ww/blog/international-health-insurance-families). This is calculated based on their salary. 

National health insurance in Japan is heavily subsidized by the government. This is because up-front premiums are lower than the combined employer and employee contributions under EHI. 

### 3. Long-life medical care

The third major public healthcare system (Kōki Kōreisha Iryō Seido) is designed for the oldest in Japanese society. It applies to residents over the age of 75, or anybody over 65 with a registered disability. 

In practice, long-life medical care is very similar to National Health Insurance. Participants pay a monthly premium, which provides universal access to Japanese healthcare. It is also funded through a co-payment model. 

However, there are a few practical differences. Most importantly, the co-payment is lower, at 10% for most over-75s – though higher co-payments still apply to those with higher incomes. There are also more generous caps on co-payment costs. In practice, this means healthcare costs for [retirees](https://feather-insurance.com/en-ww/blog/international-health-insurance-senior) are kept tightly under control. 

### 4. Supplementary private insurance

This is the first health insurance policy in this section that isn’t compulsory. Instead, residents can choose to take out a supplementary private health insurance policy. This is designed to cover co-payment costs. 

Even though it’s not compulsory, this option is very popular. In fact, [more than 70% of residents](https://www.commonwealthfund.org/international-health-policy-center/countries/japan) have some form of ‘secondary, voluntary private health insurance’ in Japan. 

Generally, private insurance policies pay out a fixed cost for each day of treatment. Any additional costs are paid out-of-pocket – though in practice, these will be limited. 

Here’s an important detail to understand: Private insurance is not a substitute for mandatory public insurance. Purchasing a private insurance policy does not enable you to opt-out of the public system; it can only be used alongside it. 

### 5. International health insurance in Japan

If you’re taking out a supplementary private insurance policy, you are free to choose your own provider and the terms of your policy. One of these options is [international health insurance](https://feather-insurance.com/en-ww/blog/international-health-insurance-guide). 

In practice, this is very similar to standard supplementary private insurance. Both are designed to cover co-payment expenses that aren’t paid by public insurance. 

But international health insurance also provides coverage for healthcare outside Japan. This is particularly useful for expats and anybody who spends significant time outside of the country. 

Like with standard private insurance, this cannot replace your mandatory public insurance. However, it can help cover the costs of co-payments. It also provides widespread healthcare coverage abroad. 

## Comparison: Which health insurance do you need?

When it comes to public health insurance, you generally don’t have much choice over the coverage you receive or the premium pay. This is not the case with private insurance.

Therefore, it’s helpful to understand how the different types of public and private health insurance in Japan compare. Here’s a quick overview of the main differences: 

|  | Public Health Insurance |  |  | Private Health Insurance\* |  |
| :---- | ----- | :---- | :---- | ----- | :---- |
|  | National Health Insurance | Employee Health Insurance | Long-Life Medical Care | Supplementary Private Insurance | International Health Insurance |
| Who pays? | You | You/employer (50/50) | You | You  | You  |
| Coverage area | Japan | Japan | Japan | Japan | Worldwide |
| Co-payment | 10%-30%\*\* | 10%-30%\*\* | 10%\*\*\* | Limited | Limited |
| Language | Japanese | Japanese | Japanese | Japanese | English/Japanese |
| Repatriation coverage | No | No | No | Not usually | Yes |

*\* Private health insurance options represent the coverage you’re most likely to receive in each option. In reality, terms will differ between regions and plans/providers. Check the details in your local area thoroughly before purchasing insurance.* 

*\*\* Standard co-payment is 30%, lower costs are available for young children.*

*\*\*\* Higher earners still pay 30% co-payment*

## How to choose the right healthcare plan in Japan

In Japan, your health insurance is decided by a mixture of your employment status, age, and personal choice. To help you understand how this works, here’s an overview of what the ideal situation might be for various different situations: 

* **Employed by a Japanese company:** Employee health insurance (EHI) is the required and default option. You may choose to purchase supplementary private insurance to cover co-payment costs. Alternatively, international health insurance can also be helpful if you regularly travel abroad.   
* **[Self-employed](https://feather-insurance.com/en-ww/blog/international-health-insurance-freelancer):** National Health Insurance (NHI) is mandatory. Again, you can choose to also purchase additional private or international health insurance.   
* **English teacher:** EHI is the default option. International health insurance can also be useful for English-speaking support and portable coverage.   
* **[International student](https://feather-insurance.com/en-ww/blog/international-health-insurance-student):** Students must enrol in NHI. Premiums are often reduced for low-income students. Many universities also offer additional group insurance. International health insurance is useful for students who travel back to their home country several times a year.   
* **[Digital nomad](https://feather-insurance.com/en-ww/blog/international-health-insurance-digital-nomad):** If you’re employed by a foreign organization, you are not entitled to EHI. Therefore, NHI is the default option.   
* **Short-term visitor/tourist:** This applies to anybody staying in Japan for less than three months. In this case, the standard public health insurance requirements do not apply. Therefore, travel health insurance in Japan or international health insurance is strongly recommended.  
* **Planning to leave Japan:** When you leave Japan, EHI and NHI coverage no longer applies. In this case, international health insurance can help provide coverage during the transition. 

To help you decide which is the right option for you, here are some key questions it’s helpful to ask: 

* **Are you enroled in NHI or EHI?** In Japan, you must be covered by public healthcare. Most people will be covered by either EHI or NHI.   
* **Do you need English-speaking medical support?** English-speaking healthcare is available, but generally only through fully-private healthcare providers. However, these can be more expensive. Therefore, additional private health insurance is important to avoid high costs.   
* **Do you travel outside Japan frequently?** In this case, international health insurance is the best way to secure coverage around the world.   
* **Do you want coverage for the 30% co-payment?** If so, you’ll need supplementary private insurance, including international health insurance.   
* **Are you planning to stay in Japan long-term or might you relocate?** International health insurance can help provide coverage outside of Japan. 

## Feather: Straightforward international health insurance in Japan

While Japan’s healthcare system is high-quality, public insurance doesn’t cover the whole cost of treatment. This is particularly true for expats who require English-speaking support. These hospitals often come with higher costs. 

Therefore, supplementary insurance is a vital way to reduce out-of-pocket expenses. And if you regularly travel outside of Japan, international health insurance is a sensible choice. This is because it also provides coverage around the world. 

At Feather, our goal is to make international health insurance as simple as possible for expats around the world. This includes: 

* English-speaking support  
* Healthcare policies issued in as little as a few hours  
* Coverage applies around the world  
* No age limits

Want to find out more? [Explore our international health insurance](https://feather-insurance.com/en-ww/health-insurance/international) or [get in touch](https://feather-insurance.com/en-ww/support) with our friendly team today. We’ll be happy to chat through your health insurance needs. 