Japan requires every resident, including foreign nationals staying more than three months, to have public health insurance. Employees get it through their employer's health insurance. Everyone else under 75 joins the National Health Insurance of the municipality where they live, as do people who have left a job until they join a new employer.
Premiums are charged per household and calculated by the municipality, mainly on the previous year's income plus a per-person charge, so rates vary by city. There is no employer to share the cost. The total is made up of separate portions, each with its own legal maximum: for fiscal 2026, 670,000 yen for medical care, 260,000 yen for the support of the over-75 system, 170,000 yen for long-term care for members aged 40 to 64, and a new 30,000 yen portion for the child and childrearing support levy, 1.13 million yen in all. Benefits are broadly the same as employer insurance, with 30% co-payment, but there is no sickness allowance.
Someone leaving a job has an alternative. If they were insured for at least two months, they can apply within 20 days to continue their former employer's health insurance for up to two years, paying both halves of the premium.
What it means for a foreign employer
- A high earner between jobs can face the maximum. Because premiums follow last year's income, a senior candidate with a gap of a few months may pay a full-rate charge. Continuing the old employer's insurance is often cheaper; it is worth raising with candidates planning a break.
- Start dates matter. Joining on the first day of a month rather than late in the previous month affects which insurer charges for that month.
- Contractors carry the full cost. Engaging a senior person as an individual contractor means they pay the National Health Insurance premium entirely themselves, which they will price into the fee.
- Arrivals start on it if not employed. A family member joining an assignee who is exempt from Japanese health insurance may still need cover.
Sources
- National Health Insurance Act, Articles 5, 6 and 76; Health Insurance Act, Article 37 (continued coverage).
- Order for Enforcement of the National Health Insurance Act, fiscal 2026 premium maximums.