Understanding Your Health Insurance Options in Japan

Navigating Healthcare: Japan's 3 Insurance Types

There are three main types of health insurance in Japan. They are: (1) employees' insurance (被用者保険, Hiyosha hoken) such as Health Insurance Association, (2) National Health Insurance (国民健康保険, Kokumin Kenko Hoken or Kokuho), and (3) Medical Care System for Older Senior Citizens.

(1) Employees' Insurance (被用者保険, Hiyosha hoken)

If you work at a company or other organization in Japan, you'll be enrolled in employees' health insurance (被用者保険, Hiyosha hoken). This is deducted from your salary, with your employer covering 50% of the cost. Employees’ health insurance also covers your dependents.

(2) National Health Insurance (国民健康保険, Kokumin Kenko Hoken or Kokuho)

Kokuho covers those who do not belong to (1) employees' insurance or (3) the Medical Care System for Older Senior Citizens. If you work as a freelance or self-employed, Kokuho is your health insurance. Kokuho covers citizens up to under 75 years of age.

For example, if you are employed by a company and then resign and become unemployed, you will become a member of Kokuho. The same applies to retirement; in that case, you will be covered by Kokuho until you turn 75. After you turn 75, you will be automatically enrolled in the Medical Care System for Older Senior Citizens.

(3) Latter-stage Elderly Healthcare System or Medical care system for senior citizens (後期高齢者医療制度 Koki Koreisha Iryo Seido)

The system offers comprehensive healthcare for individuals aged 75 and older. This includes coverage for medical expenses, nursing care, and other health-related services. You are automatically enrolled in this system on your 75th birthday. (People with disabilities are eligible to join at age 65.)

This system requires participants to pay insurance premiums. In most cases, these premiums are deducted directly from pension income.

By the way, many considered the term 'latter-stage elderly' to be insensitive or even extremely rude. In fact, it faced strong criticism when first introduced, and some believe it contributed to the LDP's significant election loss at the time.

While the official name of the healthcare system hastily tried to switch the word to 'chouju' (長寿, meaning 'longevity' to celebrate the age), the term 'latter-stage elderly' still persists even in everyday conversation, often with a self-deprecating or ironic tone. For example, someone might jokingly say, 'Well, I guess I'm officially late-stage elderly now...'

How Health Insurance Premiums Are Calculated?

The amount you pay for health insurance (your premium) is calculated yearly based on your income and employment status.

If you work for a company with more than five employees, you are generally required to join Employees' Health Insurance. The amount you pay for health insurance (your premium) is calculated yearly based on your income. Your employer pays half of your health insurance expenses if your health insurance is the Employees'.

For Kokuho or National Health Insurance, you pay 100% of the expenditure, which can be considerably higher than employer-sponsored insurance. To be honest, in my case, I was shocked to see the bill when I became a member of Kokuho after I resigned from my first employer. I wasn't fully aware of the cost because my health insurance and pension contributions were automatically deducted from my salary.

Key Considerations for Health Insurance in Japan

It's important to note that premiums for both Kokuho and the Latter-stage Elderly Healthcare System are not uniform across Japan. While the Latter-stage Elderly Healthcare System has less regional variation than Kokuho, both programs have premiums that vary by municipality, as each local government calculates its own rates based on factors like healthcare costs in the area.

It's also crucial to be aware of your rights as an employee. If a company in Japan hires you, your employer is legally obligated to enroll you in employees' health insurance, not Kokuho. I emphasise this because a friend of mine had a previous employer in Japan who illegally enrolled her in Kokuho instead of employees' health insurance. It took her a while to discover the employer's illegal actions, as she was used to health insurance being expensive in the United States.

Disclaimer: This information is accurate as of the published date. Please note that this information is subject to change due to potential rule updates etc.

Reference:
Japan Medical Association: '日本の医療保険制度の仕組み' (in Japanese). Last accessed Oct. 16, 2024.

Mistry of Health, Labour, and Welfare, GoJ: '高齢者医療制度' (in Japanese). Last accessed Oct. 16, 2024.