Japan Health Insurance for Expats: EHI vs NHI and the My Number Card

Moving to Japan comes with a learning curve, but healthcare does not have to be confusing. This guide explains how care works, where to go, and how Public Health Insurance keeps your costs predictable. It also covers the part most older guides miss: the shift to the My Number insurance card (マイナ保険証), which changed how your “insurance card” actually works from December 2024. You will find links to step-by-step visit scripts and booking tools where you need them.

What Is Public Health Insurance?

Japan’s public health insurance is a national system that keeps medical care affordable for everyone. Instead of paying the full bill, patients generally cover only 30% at the counter. The remaining 70% is handled directly between the medical provider and the insurance system.

There are two main programs under Public Health Insurance: Employee Health Insurance (EHI / 社会保険) for company workers, and National Health Insurance (NHI / 国民健康保険) for the self-employed, students, and others. If you plan to live in Japan for more than three months, enrollment is required by law. Once you join, you show your insurance details at clinics and hospitals and pay your share at checkout.

What Public Health Insurance covers (overview)

Public Health Insurance broadly covers doctor visits, hospital care, diagnostic tests, and most prescription medicines. Your share is usually 30% at the clinic or hospital. Reduced shares apply by age and income for children, older adults, and certain categories. If your monthly out-of-pocket total becomes very high, the High-Cost Medical Expense Benefit (高額療養費) caps what you pay and reimburses the excess after you apply.

Coverage is generous, but not absolute. Cosmetic procedures, private room surcharges, and some vaccines or elective screenings are common exclusions (full list further down). If something is not covered, the clinic bills you the full amount for that item, so it is worth asking before you agree to optional services.

Want the reception-to-payment flow with phrases you can use? See Visiting a Clinic in Japan: Step-by-Step with Scripts.

EHI vs NHI: the quick comparison

Most people are in one program or the other depending on how they work, not by choice. Here is the difference at a glance:

	Employee Health Insurance (EHI / 社会保険)	National Health Insurance (NHI / 国民健康保険)
Who joins	Full-time company employees	Self-employed, students, freelancers, retired (under 75), and anyone not in EHI
How you enroll	Automatically, through your employer’s HR	Yourself, at your city or ward office (within 14 days of registering your address)
Premium based on	Your standard monthly income	Household income, age, and household size (rates set by your city)
Who pays	Roughly 50/50 with your employer; deducted from your payslip	100% you, billed by your city
Dependents	Spouse and children often covered at no extra premium	No dependent concept—each family member enrolls and is charged
Extra benefits	Pension, sickness allowance, maternity allowance (if eligible)	Medical coverage only

The short version: if you work for a company, EHI is handled for you and tends to be cheaper for families. If you don’t, NHI is your route, and you manage it yourself. The two sections below fill in the details.

Employee Health Insurance (EHI / 社会保険)

If you are employed full-time by a company, you will usually be enrolled in Employee Health Insurance. Enrollment is handled by your employer’s HR after you submit basic documents. Premiums are calculated from your standard monthly income and are shared roughly 50/50 between you and your employer. Dependents (spouse and children) can often be added at no additional premium, which makes EHI cost-effective for families.

Beyond medical coverage, EHI typically includes pension contributions and income-replacement benefits. The two that matter most in practice:

• Sickness allowance (傷病手当金): if illness or injury keeps you off work for more than three consecutive days, you can receive roughly two-thirds of your daily wage for up to a total of 1 year and 6 months.
• Maternity allowance (出産手当金) and the lump-sum childbirth grant (出産育児一時金, currently ¥500,000 per child), the latter of which is available under NHI too.

Premiums appear as deductions on your payslip, so you do not pay the city office each month. Your coverage is registered automatically—see the My Number insurance card section below for what you actually carry to the clinic.

National Health Insurance (NHI / 国民健康保険)

If you are self-employed, a student, unemployed, retired under a certain age, or otherwise not in EHI, you will join National Health Insurance at your city or ward office. Premiums are set by local governments and depend on household income, age, and household size. Unlike EHI, there is no dependent concept for premiums: each family member enrolls and is charged separately, which can raise costs for larger households.

NHI focuses on medical coverage. It does not include the sickness or maternity income-replacement benefits that EHI does, though the ¥500,000 childbirth grant still applies. You will receive a payment slip or set up a bank transfer with your city. Keep your address and household information up to date to avoid billing problems.

How much does NHI cost?

Because rates are set city by city, there is no single national figure—but two things are worth knowing. First, if you arrive partway through the year with little or no Japan-side income, your first-year premium is often low. Second, premiums are capped: for fiscal 2025 the annual ceiling for the medical portion is ¥920,000 (¥1,090,000 once the long-term-care portion for ages 40–64 is added). To put the gap with EHI in perspective, a single self-employed person earning about ¥10,000,000 a year can pay close to that cap, whereas a company employee on the same income pays roughly ¥390,000 as their share of EHI (the employer covers the rest). These are rough estimates; ask your ward office for a figure tied to your actual income.

The My Number insurance card (マイナ保険証): what changed

This is the part that trips up newcomers, because most older guides still say “your plastic insurance card will arrive in the mail.” That is no longer how it works. From December 2, 2024, Japan stopped issuing new conventional health insurance cards. The system now runs primarily on the My Number insurance card (マイナ保険証)—your My Number Card with your health insurance registered to it.

In plain terms, you have one of two situations:

• You have a My Number Card. Register your insurance to it (at a clinic card reader, at konbini, or via the Mynaportal app), then tap it at the clinic reader on arrival. That card is now your insurance card.
• You don’t have one yet—common if you’ve just arrived. You’ll be issued a Certificate of Eligibility (資格確認書 / shikaku-kakunin-sho) automatically and free of charge. You hand it over at reception exactly like the old paper card, and you receive insured care with no difference in coverage.

Old-style cards are being phased out: existing ones expired by December 1, 2025, with transitional and special measures running into 2026. So whenever this guide says “show your card,” read it as “tap your My Number insurance card, or present your Certificate of Eligibility.” As a brand-new resident, the Certificate of Eligibility is the realistic default until your My Number Card and registration are sorted out.

Who can enroll (and who must)

Public Health Insurance is mandatory for residents with a stay of more than three months and a residence card. This applies to employees, students, freelancers, and dependents. The principle behind it is simple: no resident should be denied necessary care because of cost.

Tourists and short-term visitors are not eligible and must pay the full cost of care. Hospital bills can be steep without insurance, so travel insurance is strongly recommended for visitors. For finding English-speaking providers during a trip, see How to Book English-Speaking Doctors and Pharmacies in Japan.

If you qualify but fail to register, you can still be billed retroactively for the unpaid premiums—sometimes months of them at once. It is better to enroll early than to face a lump-sum back bill later.

How to enroll

If you are a company employee (Employee Health Insurance)

Your employer’s HR will guide you. Submit the required documents after you start work. Premiums are deducted from your salary, and your coverage is registered soon after. You do not need to visit the city office for health insurance enrollment.

If you are self-employed, a student, or unemployed (National Health Insurance)

Apply at your city or ward office, usually at the National Health Insurance counter (国民健康保険課). The deadline is 14 days from the day you register your residence. If you miss it, coverage can still be applied retroactively once you pay the missed premiums—which means past medical bills can be adjusted down to the insured rate.

Bring:

• Residence card and passport
• My Number card or notification letter
• Proof of income if available (for premium calculation)
• Any documents related to recent job changes, moves, or household changes

Once enrolled, you’ll either register your insurance to your My Number Card or receive a Certificate of Eligibility—your ticket to insured care anywhere in Japan.

Changing jobs, leaving work, or leaving Japan

Your coverage is tied to your work status, so it doesn’t move automatically. The key thing is that you should never have a gap—enrollment is mandatory the whole time you’re a resident.

• Changing employers: your new company’s HR enrolls you in EHI again. A short gap between jobs may need bridging via NHI or voluntary continuation.
• Quitting without a new job lined up: within 14 days, either enroll in NHI at your city office, or apply to voluntarily continue your EHI (任意継続) for up to two years—usually within 20 days of leaving. Compare the two premiums before deciding.
• Leaving Japan for good: file your move-out notice at the city office and submit the NHI withdrawal so billing stops on the right date.

At the clinic: using your card and paying your share

When you arrive, present your insurance at reception—tap your My Number insurance card at the reader, or hand over your Certificate of Eligibility. The visit is processed under Public Health Insurance, and you pay your share (usually 30%) at checkout. Keep your receipts and any itemized statements in case you need them for private insurance claims or a high-cost reimbursement.

Forgot to bring it? Don’t panic. You can pay the full amount on the day, then bring your card or certificate plus the receipt back to the clinic and have the difference refunded. One heads-up: many clinics still prefer cash, though more now accept cards or QR payments.

When bills get big: the High-Cost Medical Expense Benefit

The 30% share sounds manageable until you face surgery or a hospital stay. This is where the High-Cost Medical Expense Benefit (高額療養費) matters: it caps your out-of-pocket cost per calendar month based on your age and income. For a typical working-age earner on an average income, the monthly ceiling for covered care lands somewhere around ¥80,000–90,000 plus a small percentage of the amount above a threshold—far less than the raw 30% on a large bill.

You can either claim the excess back afterward, or—better—get a Limit Application Certificate (限度額適用認定証) in advance (or use your registered My Number card, which can apply the cap automatically) so you only pay up to the ceiling at the counter. If you know a big procedure is coming, sort this out before admission.

What isn’t covered by Public Health Insurance

Public Health Insurance is generous, but some services are excluded or only covered in limited circumstances. Common examples:

• Cosmetic treatments such as plastic surgery or laser eye surgery (unless medically necessary)
• Private hospital rooms and other amenity fees
• Routine checkups for work or school that aren’t ordered by a physician
• Certain vaccinations (travel vaccines, for example)
• Elective screenings like full-body scans without a medical referral
• Dental or orthodontic services beyond basic covered treatment
• Over-the-counter drugs bought directly at pharmacies

One that surprises people: normal pregnancy and childbirth aren’t treated as “illness,” so routine delivery isn’t covered—but the ¥500,000 childbirth lump-sum grant offsets most of the cost. Coverage rules shift by procedure and indication, so if a service matters to you, ask the clinic in advance whether it’s covered and what your out-of-pocket cost will be.

System Basics in Japan (and Common Surprises)

Japan’s system is free-access. You don’t register with a family doctor. You pick a department and go directly.

• No GP gatekeeper. Choose the department that fits your symptoms and book directly. When unsure, internal medicine (内科) is a safe first stop and can refer you onward. (Need search tools? See How to Book English-Speaking Doctors and Pharmacies in Japan.)
• Clinics first for non-urgent care. Large hospitals focus on advanced treatment and may charge an extra fee if you arrive without a referral letter. Starting at a clinic saves time and money.
• Copays even with insurance. Most working-age patients pay 30% at the counter, with caps for very high monthly costs and reduced shares by age and income.
• Separate pharmacies, short validity. Doctors issue a paper prescription; you fill it at an outside pharmacy (薬局). Most prescriptions are valid for 4 days including the issue date, so go promptly. (Rules, refills, and tips: How Prescriptions Work in Japan.)
• After-hours and emergencies. Unsure if it’s urgent? Many regions offer nurse triage (e.g., #7119). For emergencies call 119 (ambulance/fire) or 110 (police).

For booking tools, 24/7 options, and city hotlines, see How to Book English-Speaking Doctors and Pharmacies in Japan. For prescription rules, refills, and pharmacy tips, see How Prescriptions Work in Japan.

Quick tips for expats

• Apply within 14 days. Company employees join through HR; others enroll at the city or ward office.
• Sort out your card. Register your insurance to your My Number Card, or use the Certificate of Eligibility until you do.
• Carry it. Without it you pay in full first and claim a refund later.
• Bring some cash. Many clinics still prefer cash at checkout.
• Keep receipts. You may need them for private insurance or high-cost reimbursements.
• Older adults (75+). A separate program (後期高齢者医療制度) applies, with reduced patient shares.

Need a step-by-step look at the clinic experience—what forms to fill out and what conversations to expect? See Visiting a Clinic in Japan: Step-by-Step with Scripts.

Conclusion

Japan’s healthcare is rules-based but friendly once you know the steps. Public Health Insurance anchors the system so that most residents pay only a fraction of the bill. Enroll on time, get your My Number insurance card or Certificate of Eligibility sorted, keep it with you, and know what is and isn’t covered—do that, and you can walk into any clinic or hospital with confidence. When you need more help, our booking guide and step-by-step scripts make the process smoother still.

---

FAQ