Health insurance in Tokyo: shakai hoken, NHI and the 30% you pay

Japan's public health insurance is good, compulsory and not free. You'll pay 30% of most bills, but a monthly cap stops a hospital stay from wrecking your savings.

The short version

• Australia has no reciprocal health care agreement with Japan. Your Medicare card does nothing in a Tokyo clinic [1].
• Every registered resident must join public health insurance: employer insurance (shakai hoken) if your job offers it, otherwise your ward's National Health Insurance (NHI). Private or travel cover doesn't replace it [2][3].
• Sign up within 14 days. Join late and the ward backdates premiums to the month you became eligible [3].
• From school age to 69 you pay 30% of the bill. Under-school-age children pay 20% [4].
• The high-cost medical expense benefit caps what you pay each month. For a middle-income household it's around ¥80,100 plus 1% of costs above ¥267,000 [5].

Two schemes, one requirement

Back home, Medicare covers you because you're an Australian resident, and premiums come through the Medicare levy at tax time. In Japan you must enrol in a scheme, and you pay a premium directly. Which scheme depends on your job.

Who can't join NHI

Minato City lists the exclusions: people staying less than three months, those on Temporary Visitor status, diplomats, and people already on employer insurance. Holders of a certificate of coverage from a country with a social security agreement with Japan are also exempt [3]. Australians seconded to Tokyo by an Australian employer under the Australia–Japan agreement should ask about this.

Signing up with your ward

If your employer enrols you in shakai hoken, HR does the work. If not, you join NHI at the ward office, usually on the same visit as your address registration.

1. Register your address first. NHI follows resident registration. See our guide to your residence card and ward registration.
2. Go to the NHI counter within 14 days of becoming eligible, whether that's arriving, losing employer cover or moving wards [3].
3. Bring your documents. Minato City asks for your residence card, your My Number card or notification card, and a signature or seal. Bring your passport if you're on Designated Activities status, and a certificate of loss of coverage if you've just left an employer scheme [3].
4. Apply for a reduction if your income was low. Shinjuku City, for example, offers a 70% premium reduction if your Japanese employment income last calendar year was ¥980,000 or less. New arrivals should apply [2].
5. Set up payment. Wards send bills in June for the year, as monthly slips from June to March or one annual slip. You can pay at banks, convenience stores or the ward office, or by automatic bank transfer [6].
6. Link your My Number card. Japan stopped issuing traditional paper insurance cards from 2 December 2024. You now use your My Number card as your insurance card, or a certificate of eligibility if you don't have one [2].

Don't fall behind

Skipped NHI payments come back to bite. After a reminder, a year without paying means your card is swapped for an eligibility certificate that makes you pay the full bill upfront. Long-term arrears can lead to seizure of assets [6]. Pay everything you owe before you move out of the ward or leave Japan [2].

What 30% looks like at the counter

The co-payment rates are the same under both schemes. Minato City lists them as 20% for pre-school children, 30% from school age to 69, and 20% or 30% from 70 depending on income [4].

Japanese healthcare prices are set nationally, so a GP visit costs much the same in Roppongi as it does in Nerima. A routine visit with a prescription often comes to a few thousand yen at the 30% rate. Private international clinics that bill outside the insurance system can cost much more, so check whether a clinic is "insurance accepted" before you book.

A few things that surprise Australians:

• There's no GP gatekeeper. You can walk into a specialist clinic, such as dermatology, ENT or orthopaedics, without a referral. Large hospitals charge an extra fee if you arrive without a referral letter.
• Pharmacies are separate. You take your prescription to a pharmacy (yakkyoku) next door and pay 30% there too.
• Dental is covered for standard treatment, unlike Medicare.
• Childbirth isn't covered as an illness, but insurance pays a childbirth lump-sum allowance of ¥500,000 per baby, usually paid straight to the hospital [4].

The monthly cap that saves you

The high-cost medical expense benefit (kogaku ryoyohi) is Japan's safety net. If your co-payments in a calendar month go over a limit set by your income, the excess is refunded, or you pay only the limit at the hospital if you show a limit certificate or your My Number card [4][5].

The Ministry of Health, Labour and Welfare's December 2025 paper sets out the monthly limits for people under 70 [5]:

The income bands are approximate; NHI uses last year's taxable income and employer schemes use your standard monthly salary. The government has been reviewing these limits, so check your ward's or insurer's current figures [5].

In plain terms: a middle-income earner with a ¥1 million hospital bill pays around ¥87,430 that month, not ¥300,000. Apply for a limit certificate before a planned operation or birth, so you don't have to pay upfront and wait three or four months for the refund [4].

Where private cover still fits

Public insurance doesn't cover private hospital rooms, many international clinic fees, or medical evacuation to Australia. Some Australians keep a private international policy on top. If you're thinking of keeping your Australian private health cover, read private health insurance when you move overseas first.

Finding an English-speaking doctor

Smartraveller notes that English-speaking staff are available at many facilities in major cities, Tokyo included, and that some hospitals use translation apps [1].

• Himawari: the Tokyo Metropolitan Government's medical information service on 03-5285-8181, open every day from 9 am to 8 pm. It helps in English and other languages to find clinics with foreign-language support and explains how Japanese healthcare works [7].
• Your ward: many wards publish English lists of local clinics and night-time and holiday clinics.
• The Australian Embassy: at 2-1-14 Mita, Minato-ku, phone +81 3 5232 4111. It can't pay medical bills but can help in a serious emergency [1].
• Emergencies: call 119 for an ambulance [1].

For real-world names of English-speaking GPs, dentists and obstetricians in your area, ask Cooee Japan, our Facebook group for Australians in Japan.

Medicare, medication and the Australian side

• Medicare generally stops covering you once you leave Australia for good, and it never covered treatment in Japan. Visitors from Australia need travel insurance; residents need Japanese insurance. See Medicare when you live abroad.
• Medication is the trap. Japan bans some common Australian medicines and limits others. Codeine, morphine and oxycodone need a narcotics certificate [1]. Read our guide to bringing medication into Japan before you pack.
• The social security agreement with Japan covers pensions, not health. There's no agreement between Australia and Japan for free healthcare [1].

Sources

1. Japan travel advice – Smartraveller
2. National Health Insurance Guide (digest version) for foreign residents – Shinjuku City
3. National Health Insurance System – Minato City
4. National Health Insurance benefits – Minato City
5. High-cost medical expense system: reference material, December 2025 – Ministry of Health, Labour and Welfare (Japanese)
6. National Health Insurance premiums – Minato City
7. Medical information service for foreign patients (Himawari) – Tokyo Metropolitan Government

Keep reading

• Bringing medication into Japan: ADHD meds, Sudafed and the Yunyu Kakunin-sho
• Japan's nenkin pension: the lump-sum refund and the Australia deal
• Moving to Tokyo from Australia: the complete guide
• Medicare when you live abroad