Insurance in Japan: Your 4-Part Survival GuidePart 1: Health Insurance—Do You Really Need a Private Plan?

Japan’s healthcare system is world-class, but if you’re new here, navigating it can feel like a maze. You’re legally required to join the national insurance system—but is that enough? Or should you also get a private plan?

Let’s break it down—with real talk and practical advice.

🔹 The Basics: Mandatory Health Insurance in Japan

Health insurance isn’t optional. If you’re staying in Japan for more than three months, you must enroll in one of two systems:

• National Health Insurance (NHI):

For self-employed people, freelancers, students, retirees, or those not covered by a company. Premiums vary by income and city. It covers 70% of medical costs; you pay the remaining 30%.

• Social Health Insurance (Shakai Hoken):

For employees. Premiums are split 50/50 with your employer. It also covers 70% of medical costs—but includes maternity leave support and 傷病手当金 (sick/injury allowance), which NHI doesn’t.

✅ Both systems cap your out-of-pocket costs via the 高額療養費制度 (High-Cost Medical Expense Benefit). For example, if your monthly hospital bill hits ¥500,000, you may only need to pay about ¥80,100 (for average income earners). The cap depends on age and income.

📌 Tip: Sign up for NHI within 14 days of arriving or losing a job—late fees can add up fast.
📌 Tip: Treatments like ceramic implants, cosmetic surgery, or advanced cancer therapies (e.g. proton beam, heavy particle therapy) are not covered by either system. These can cost around ¥3 million out-of-pocket. Also, you’ll pay separately for hospital meals and bed upgrades.

🔹 Mandatory vs. Commercial Insurance

Feature NHI Shakai Hoken Commercial Insurance

Coverage 70% of medical costs 70% of medical costs Lump-sum payouts or hospital subsidy

Eligibility Self-employed, students Employees Anyone (optional)

High-cost cap Yes Yes/Sick Leave Support No (but can supplement income)

🔹 Commercial Insurance: Worth It?

Private insurers like Aflac or Tokio Marine offer:

• Lump-sum payouts upon diagnosis (e.g. cancer)

• Daily hospitalization subsidies

• Coverage for uncovered therapies (e.g. Maruyama Vaccine)

Still, Japan’s public system already covers a lot—and caps costs. So is private insurance worth it?

🧾 According to the 2022 “Survey on Security in Life”, 65.7% of Japanese people have life insurance with hospitalization benefits—despite the strength of public healthcare.
💰 The average out-of-pocket cost per day during hospitalization is ¥20,700. Even with public coverage, it can add up quickly.

Source: Life Insurance Culture Center – 2022 Survey on Security in Life

👩‍💼 Aki’s HR & Personal Take:

• HR Perspective: It depends on your income, savings, and risk tolerance.

• Personal Choice: I bought a private plan in my 30s but canceled it when I moved to the U.S. at age 42, since the policy didn’t cover treatment overseas. After returning to Japan, I crunched the numbers and realized that, with the High-Cost Medical Expense Benefit, the total premiums could end up exceeding the actual medical costs. Still, it all comes down to your personal risk tolerance.

💡 Who Might Benefit from Private Health Insurance?

✔️ Low savings
✔️ Family history of illness or high medical risk
✔️ Self-employed (no paid sick leave)

❌ Who May Not Need It?

✔️ Sufficient savings (6–12 months of living expenses)
✔️ Strong employee benefits (paid leave during treatment)

For example, if your monthly expenses are ¥200,000, aim for ¥1.2–2.4 million in savings as a buffer.

🔹 Real Stories

✅ Kevin’s Ski Accident:
Broke his leg in Hokkaido. His ¥300,000 bill was 70% covered by Shakai Hoken. He paid less than ¥80,000. No private plan, no problem.

✅ Sohyoung’s Cancer Journey:
Survivor. Her private plan paid ¥1 million lump sum—helped cover private chemo and eased her stress.

🔍 Myth vs. Fact

• Myth: “Mandatory insurance covers everything.”
  Fact: Cosmetic and some advanced treatments aren’t covered. You still pay 30%, unless the high-cost cap kicks in.

• Myth: “You must have private insurance in Japan.”
  Fact: Most people are fine with just public insurance. Private plans are a nice-to-have, not a must.

✅ What You Should Do Now

✔️ Know your insurance type: NHI (freelancers/students) or Shakai Hoken (employees)
✔️ Ask: “Would I pay ¥2,000/month for peace of mind and a potential ¥1 million payout?”
✔️ If yes, shop around. If not, you’re probably fine.

💬 Share Your Experience

What’s your take on Japan’s health insurance? Have a story to share or a tip that helped you? Drop a comment!

🗂 Up next: Part 2—Life Insurance in Japan (coming soon!)
And don’t forget to check the Freebie Shelf on NavigatorJapan.com for practical tools and downloads.