Health Insurance for Expats in Japan

Overview

Japan has one of the world's best healthcare systems—ranked highly for quality, access, and outcomes. However, the system operates primarily in Japanese, and navigating it as an expat requires understanding the mandatory insurance requirements and finding English-speaking care.

All residents of Japan, including expats on long-term visas, must enroll in either National Health Insurance (NHI) or employer-based health insurance. Many expats supplement this with international insurance for English-language support and global coverage.

Healthcare System

Japan's healthcare system is universal, efficient, and affordable—but designed primarily for Japanese speakers. Understanding how it works is crucial for expats.

National Health Insurance (NHI)

NHI (国民健康保険, Kokumin Kenkō Hoken) is mandatory for residents not covered by employer insurance:

• Covers 70% of medical costs (you pay 30%)
• Premiums based on income and municipality (typically ¥20,000-50,000/month)
• Must enroll within 14 days of receiving residence card
• Covers most treatments at any Japanese medical facility
• No pre-existing condition exclusions

NHI is genuinely good insurance—comprehensive coverage at reasonable cost. The main limitation for expats is the language barrier.

Employer Health Insurance (Shakai Hoken)

Employees of companies with 5+ staff are enrolled in Shakai Hoken:

• Same 70/30 coverage split as NHI
• Premiums split between employer and employee
• Often slightly better benefits than NHI
• Includes pension contributions

Healthcare Quality

Japanese healthcare is excellent by any standard:

• St. Luke's International Hospital (Tokyo): Premier expat-friendly facility with English support
• Tokyo Medical and Surgical Clinic: English-speaking primary care
• University hospitals: Advanced care, but primarily Japanese
• Kameda Medical Center: JCI-accredited, some English services

Visa and Insurance Requirements

Japan requires most long-term residents to enroll in the national insurance system:

Work Visa

Employees must be enrolled in either NHI or employer health insurance (Shakai Hoken). This is mandatory, not optional.

Spouse/Dependent Visa

Must enroll in NHI if not covered as a dependent under a spouse's employer insurance.

Student Visa

Students staying over 3 months must enroll in NHI. Reduced premiums often available.

Designated Activities Visa (Digital Nomad)

Japan's digital nomad visa (launched 2024) allows 6-month stays:

• Requires private health insurance covering Japan
• NHI enrollment not required for this visa category
• International insurance meets the requirement

Short-term Stay (90 days)

Tourist visa holders are not required to enroll in NHI. International travel insurance recommended.

Recommended Plans

For expats in Japan, international health insurance serves a different purpose than in most countries. Since NHI is mandatory and comprehensive, international insurance provides:

• Access to English-speaking providers and hospitals
• Care coordination and translation services
• Coverage when traveling outside Japan
• Coverage at international clinics (some don't accept NHI)
• Medical evacuation if specialized care is needed

Note: Prices shown for age 40. Japan's high healthcare costs result in higher international insurance premiums than many Asian countries.

For Long-term Expats

Cigna Global and BUPA Global have strong networks in Japan with relationships at international hospitals. They provide care coordination that helps navigate the Japanese system.

For US Expats

GeoBlue works well for Americans who may return to the US for care or want BCBS network access when visiting home.

For Digital Nomads

SafetyWing meets the digital nomad visa requirement at minimal cost. However, for longer stays, more comprehensive coverage is advisable given Japan's high medical costs.

For Corporate Expats

Many companies provide international insurance as part of expat packages. Cigna, BUPA, and Allianz are common corporate choices.

Expected Costs

Japanese healthcare is affordable with NHI coverage. Without insurance, costs are higher than many Asian countries but lower than the US.

NHI Premium Costs

NHI premiums vary by municipality and income:

• Low income: ¥15,000-25,000/month (~$100-170)
• Middle income: ¥30,000-50,000/month (~$200-330)
• High income: ¥50,000-80,000/month (~$330-530)

International Insurance Premiums

For a healthy 40-year-old in Japan:

• Budget (SafetyWing): $45-80/month
• Mid-range (IMG, Allianz): $180-340/month
• Premium (Cigna, BUPA): $250-420/month

Japan's high healthcare costs (by Asian standards) mean international insurance premiums are higher than Southeast Asian destinations.

Dual Coverage Strategy

Most long-term expats in Japan carry both NHI and international insurance:

• Use NHI for routine Japanese-language care (70% covered)
• Use international insurance for English-speaking providers
• International insurance covers the 30% copay at some facilities
• International insurance provides global coverage for travel

Frequently Asked Questions

Do I really have to enroll in NHI even with international insurance?

Yes, for most long-term visa categories. NHI enrollment is a legal requirement in Japan, not optional. International insurance supplements but doesn't replace NHI. The exception is the digital nomad visa, which accepts private insurance.

Is Japanese healthcare really as good as people say?

Yes. Japan consistently ranks among the top healthcare systems globally for outcomes, access, and efficiency. The challenge for expats is the language barrier, not the quality of care.

Can I find English-speaking doctors in Japan?

In Tokyo and Osaka, yes—but options are limited and often more expensive. St. Luke's International Hospital, Tokyo Medical and Surgical Clinic, and similar facilities cater to expats. Outside major cities, English-speaking care is rare.

What if I need specialized care not available in Japan?

Japan has excellent specialists for most conditions. For rare cases, international insurance with evacuation coverage provides the option to seek care elsewhere, though this is rarely necessary.

Why are Japan insurance premiums higher than other Asian countries?

Japan's medical costs are higher than Southeast Asia (though lower than the US). International insurers price premiums based on local healthcare costs, so Japan falls between Thailand/Vietnam and Western countries.

Should I get international insurance if I already have NHI?

It depends on your needs. If you're comfortable navigating Japanese healthcare in Japanese, NHI alone may suffice. If you want English-speaking care, help navigating the system, or coverage when traveling, international insurance adds significant value.