Japan's Healthcare System: Kenko Hoken, Kokumin Kenko Hoken, Monthly Cap and Access to Care

The ISA guidebook for living and working in Japan sets out the principle: whatever your nationality, you must join the public health insurance, so that everyone can access care at a moderate cost by sharing the burden among all. Two schemes complement each other.

• Kenko Hoken (employees’ health insurance): mandatory for permanent employees, executives and part-time employees who work at least three quarters of the time of a full-time employee, or who meet more than 20 hours a week, more than 88,000 yen a month, an expected duration of more than two months and an employer of 51 employees or more, excluding students. The employer and employee each pay half of the contribution; dependants pay none.
• Kokumin Kenko Hoken (national insurance, NHI): for residents under 75 outside Kenko Hoken (self-employed, students, retirees, working holiday visa holders). The contribution is calculated per household according to income and the number of people, and is paid by the head of household; reductions exist depending on income through the city office.

At 75, the resident moves to the healthcare system for the elderly. A change of municipality or joining an enrolled company ends NHI enrolment. For comparison with the systems of other countries, see the guide to healthcare systems around the world.

A foreigner must enrol as soon as their length of stay exceeds three months, with a residence card and an address reported to the city office. The ISA guidebook lists the exceptions: a stay of under three months, temporary visitor status, a specified medical care activity (and companion) or tourism and leisure, diplomat, a person without valid residence status, and a person holding an official certificate of coverage under a foreign social security system when Japan has concluded an agreement with that country covering sickness. Even under three months, enrolment is open to the entertainer, technical intern and dependant statuses and to certain specified activities, on proof of a longer stay.

The My Number card can serve as a health insurance card at equipped doctors’ offices and pharmacies. Non-payment of contributions is taken into account: for a permanent residence application, the ISA examines payment of public health insurance contributions over the last two years. Employees seconded by a French company can remain in the French scheme with a certificate (see the detail on the page on healthcare reimbursement and the Japan country guide).

The ISA guidebook sets the insured person’s contribution: 20% for children under six, 30% from 6 to 69, 20% from 70 to 74 (30% for people with working income), then 10% from age 75, 20% above a certain income and 30% for working income. The rest is covered by the insurance, which relies on a uniform national tariff of procedures.

Some costs fall outside this framework. The MHLW cites among the examples not covered dental implants, vaccinations, technical aids such as glasses and hearing aids, and cosmetic care; treatment outside insurance is paid in full. Meal and bed costs during hospitalisation are also excluded from the monthly cap calculation. In a few cases (card not yet received, orthopaedic appliance, prescribed acupuncture, care outside Japan), the patient advances the full amount and then claims reimbursement of the covered share.

Employees also receive a sickness allowance paid from the fourth day of absence for 18 months at most, and a maternity leave allowance for the 42 days before delivery (98 days for twins) and the 56 days after. The childbirth lump sum reaches 500,000 yen per child at establishments covered by the obstetric compensation scheme and 488,000 yen elsewhere or before 22 weeks.

The reimbursement system for high medical costs limits each month the amount left to the insured person (excluding meals and hospital bed) according to age and income. The MHLW revised the caps starting with care from August 2026 and added an annual cap: once reached, no further payment is requested for the period. The so-called “multiple occurrences” threshold (at least four months of exceeding the cap in the year) lowers the cap further, and the ministry has kept these amounts.

Example for an insured person under 70 whose annual income is between 3.7 and 7.7 million yen: 1 million yen of costs gives an out-of-pocket cost of about 93,000 yen, i.e. 85,800 yen plus 1% of the portion of costs above 286,000 yen (the costs are those of the national tariff, before the co-payment). The ministry has planned, from August 2027, a finer breakdown of income brackets: check the scale in force on its website at the time of your care. The scheme applies to people enrolled in a public scheme.

The ISA guidebook distinguishes three levels: practices and clinics for mild symptoms, medium-sized hospitals for surgery, hospitalisation and emergencies, and large hospitals for life-threatening emergencies and advanced care. Present your insurance card, failing which all the costs are at your expense. For a first consultation at a large hospital without a doctor’s letter, the MHLW provides for an additional sum to pay, of at least 7,000 yen; the exact amount should be checked with the establishment.

To choose: the city office, municipal bulletins, the national “Medical Information Net (NAVII)” site, the Japan National Tourism Organization’s foreign-language guide (which lists hospitals accepting foreign patients) and the country’s 400 medical safety support centres. The French embassy keeps an up-to-date list of French-speaking and English-speaking doctors and hospitals, and France Diplomatie recommends consulting it before departure. International associations and non-profit organisations near you can also guide you in your language.

For a medical emergency, dial 119: the operator asks whether it is a fire or a medical emergency, then the location (a nearby landmark), the symptoms and the person’s age, your name and your number. 110 reaches the police. Prescription medicines are collected at the pharmacy; drugstores sell only non-prescription products (ISA).

France Diplomatie sets out the rules for bringing in medicines: one month of treatment with a prescription without authorisation, prior authorisation beyond that, strict regulation for narcotics (morphine, codeine, oxycodone, pethidine) and a ban on methadone. It recommends the usual vaccines of the French schedule, depending on the case vaccines against hepatitis A and B or Japanese encephalitis, and published in March 2026 an alert on a rise in measles cases.

Public insurance covers care in Japan, but not medical evacuation or repatriation: France Diplomatie reminds us that the embassy never covers healthcare costs and that insurance covering health expenses and repatriation is essential. Kenko Hoken and the NHI also leave a 30% contribution to the patient, and notably exclude implants, glasses and vaccinations.

Several solutions complement the Japanese scheme: the CFE (the French social security fund for expatriates) and its supplementary cover, expat health insurance, or repatriation assistance. Expavy helps you compare these options with the diagnostic.