Student Health Insurance in Japan: What You Pay, What You Get
Japan’s National Health Insurance (NHI) covers 70% of all medical costs and charges a student with no income about ¥20,000/year (~€124) after the 70% low-income reduction (Shinjuku, Tokyo, FY2026). You pay a flat 30% co-pay at every clinic and hospital. Enrollment is mandatory within 14 days of moving in, and your cover and premiums run from your moving-in date. Japan had 408,069 international students as of 1 May 2025 (JASSO), and every single one must join NHI — there are no opt-outs.
This guide covers the full picture: how NHI works, what it costs, how to register at your local ward office, what is and is not covered, the high-cost medical expense cap, supplementary insurance options, and practical tips for navigating Japanese healthcare. For an overview of studying in Japan, see our Japan country guide.
How Japan’s Healthcare System Works
Japan runs a universal healthcare system. Every resident — citizen or foreign national — must be enrolled in a public health insurance plan. There is no separate “student plan” or “expat plan.” You join the same system as everyone else.
The Two Main Insurance Systems
Employees’ Health Insurance (Shakai Hoken / 社会保険): For full-time company employees. Premiums are split between employer and employee. Not relevant for most students.
National Health Insurance (Kokuho / 国民健康保険): For everyone not covered by employer insurance — self-employed, retirees, and students. This is your insurance. It is managed by your city, town, or ward (市区町村), not by the national government.
The 70/30 Split
NHI covers 70% of every medical expense. You pay 30%. This applies to everything: GP visits, specialist consultations, hospital stays, surgery, prescriptions, mental health treatment, and basic dental care. There are no referrals needed — you can walk into any clinic or hospital in Japan and present your My Number card or insurance eligibility certificate (資格確認書).
A typical clinic visit costs ¥3,000–10,000 total. Your share: ¥900–3,000 (~€6–19). A prescription might add ¥500–2,000 (~€3–12) on top.
NHI Costs for Students in 2026
NHI premiums are income-based. Since most international students arrive in Japan with no prior Japanese income, you start at the lowest tier.
What You Actually Pay
| Cost Item | Amount | Notes |
|---|---|---|
| Annual NHI premium (no income) | ≈ ¥20,000/year (~€124) | Shinjuku, Tokyo, FY2026, after the 70% reduction; varies by municipality |
| Monthly equivalent | ≈ ¥1,700/month (~€10) | Only if you file the yearly income declaration, even with zero income |
| Typical doctor visit (30% co-pay) | ¥900–3,000 (~€6–19) | Walk-in clinic or GP |
| Prescription (30% co-pay) | ¥500–2,000 (~€3–12) | Filled at a pharmacy, not the clinic |
| Hospital stay per day (30%) | ¥5,000–15,000 (~€31–93) | Shared ward, meals included |
| High-cost cap (monthly) | ¥36,900 (~€229) | Maximum out-of-pocket per month for households exempt from resident tax since August 2026 (¥35,400 until July 2026); new annual cap: ¥290,000 |
Example — Shinjuku, Tokyo: A single student with no Japanese income pays about ¥20,000/year (~€124) in NHI premiums (FY2026, after the 70% reduction). A GP visit at a neighborhood clinic costs ¥1,500 out of pocket. A month of allergy medication runs ¥800. Total annual healthcare spending for a healthy student: roughly ¥25,000–35,000 (~€155–220) including premiums and co-pays.
Why Premiums Vary by Municipality
Each city and ward sets its own NHI rates. Tokyo’s Shinjuku ward charges different premiums than Sapporo or Fukuoka. The base rate consists of:
- Income portion (所得割): A percentage of your previous year’s income in Japan. For new arrivals: ¥0.
- Per-capita portion (均等割): A flat amount charged to every enrollee. This is the main cost for students.
- Household portion (平等割): A flat amount per household (not all municipalities charge this).
Many municipalities apply reductions (7割・5割・2割軽減) for low-income residents. Students with no income typically qualify for the maximum 70% reduction on the per-capita portion — but only if they file the yearly income declaration, even with zero income.
How to Enroll in NHI: Step by Step
Step 1: Arrive and Get Your Residence Card (Zairyu Card)
At major airports (Narita, Haneda, Kansai, Chubu, New Chitose, Hiroshima, Fukuoka), immigration issues your Zairyu Card (在留カード) on arrival — your residence card. This is your ID in Japan. It shows your visa status (“Student”), name, address, and period of stay.
If you arrive at another airport, your passport is stamped and the Zairyu Card is sent to you by post after you register your address.
Step 2: Register Your Address at City/Ward Hall
Within 14 days of moving into your apartment or dormitory, go to your local city hall (市役所/shiyakusho) or ward office (区役所/kuyakusho). Bring:
- Your passport
- Your Zairyu Card
- Your housing contract or dormitory assignment letter
You submit a Moving-In Notification (転入届/tennyu-todoke). The clerk updates your Zairyu Card with your address and simultaneously starts your NHI enrollment.
Step 3: Enroll in NHI (Same Visit)
At the same office, visit the NHI counter (国民健康保険窓口). In many offices, the clerk directs you there automatically after address registration. Bring:
- Zairyu Card (now with your address)
- Passport
- Student ID or enrollment certificate from your university (if available)
The process takes 15–30 minutes. You fill out an enrollment form — staff will help you if you do not read Japanese.
Step 4: Get Your Proof of Coverage
Japan no longer issues paper insurance cards (保険証/hokensho) — not since December 2024. Register your My Number card as your health insurance card, or use the free certificate of insurance eligibility (資格確認書/shikaku kakuninsho) that your city/ward office sends you. The certificate shows your name, insurance number, and the name of your municipality.
Keep your card or certificate with you at all times. Present it at every medical visit. Without it, you pay 100% upfront and must file for reimbursement later.
Step 5: Pay Your Premiums
Premium payment notices (納付書/nofusho) arrive by mail. You can pay at:
- Convenience stores (7-Eleven, Lawson, FamilyMart) — cash only
- Banks — at the counter or ATM
- Automatic bank debit (口座振替/koza furikae) — set up at the ward office
- Credit card or PayPay — available in some municipalities
Payments are typically due monthly or in installments spread across 10 months. Since FY2026 (from April 2026), however, municipalities may require residents arriving from abroad to pay a full year of premiums in advance. Missing payments can eventually lead to restrictions on your NHI benefits.
What NHI Covers
NHI coverage is broad. The 30% co-pay applies to all of the following:
Full Coverage (70% NHI, 30% You)
| Category | What’s Covered | Typical Co-pay |
|---|---|---|
| GP / Clinic visits | Consultations, examinations, blood tests | ¥900–3,000 |
| Specialist visits | Cardiology, dermatology, orthopedics — no referral needed | ¥1,500–5,000 |
| Hospital stays | Shared ward, surgery, meals, nursing care | ¥5,000–15,000/day |
| Emergency care | Ambulance (free in Japan), A&E treatment | ¥3,000–10,000 |
| Prescriptions | All prescribed medication | ¥500–2,000 |
| Mental health | Psychiatry, counseling, medication | ¥1,500–3,000/session |
| Dental (basic) | Check-ups, fillings, extractions, root canals | ¥1,000–5,000 |
| Maternity care | Prenatal check-ups, delivery | ¥100,000–150,000 total (after lump-sum benefit) |
| Rehabilitation | Physical therapy, occupational therapy | ¥1,000–3,000/session |
| MRI / CT scans | Diagnostic imaging | ¥2,000–8,000 |
The Ambulance Difference
In Japan, ambulance service is free. No co-pay, no charge, no insurance claim. Dial 119 for an ambulance, 110 for police. This is one of the few healthcare services in the world that is completely free at point of use.
Prescriptions Work Differently
Japanese clinics and hospitals follow a separation of prescribing and dispensing (医薬分業). Your doctor writes a prescription, and you take it to a nearby pharmacy (薬局/yakkyoku) to pick up the medication. The pharmacy is usually right next to the clinic. Both the clinic visit and the pharmacy charge are covered at 70% by NHI.
The High-Cost Medical Expense System (高額療養費)
This is one of NHI’s strongest features and a reason Japan consistently ranks among the top healthcare systems globally.
How It Works
If your total medical co-pays in a single month exceed a threshold, NHI reimburses the excess. For students and other low-income residents in households exempt from resident tax (住民税非課税), the monthly cap is ¥36,900 (~€229) since August 2026 (¥35,400 until July 2026). In addition, a new annual cap of ¥290,000 (~€1,800) limits your total co-pays over the year.
Example: You break your leg skiing in Nagano. Hospital treatment costs ¥500,000 total. Your 30% share would be ¥150,000 (~€930). But the high-cost cap limits your payment to ¥36,900. NHI covers the remaining ¥113,100.
Applying for Reimbursement
Two methods:
- Retroactive claim (後から申請): Pay the full 30% at the hospital, then file for reimbursement at your ward office. You get the excess back within 2–3 months.
- Gengaku Certificate (限度額適用認定証): Apply for this certificate at your ward office before or during treatment. Present it at the hospital, and they charge only up to the cap. This is the better option for planned procedures or extended stays.
The My Number card (マイナンバーカード) is increasingly accepted in place of the Gengaku Certificate at hospitals. If you have one, the cap is applied automatically.
What NHI Does NOT Cover
Understanding the gaps prevents surprise bills.
| Category | Details | Estimated Cost |
|---|---|---|
| Dental prosthetics | Crowns, bridges, implants, porcelain | ¥30,000–500,000+ |
| Orthodontics | Braces, aligners (cosmetic) | ¥300,000–1,000,000 |
| Cosmetic procedures | Elective surgery, laser treatments | Varies |
| Private hospital rooms | Single rooms (差額ベッド代) | ¥5,000–30,000/night extra |
| Advanced dental materials | Gold, ceramic fillings | ¥10,000–50,000 per tooth |
| Non-prescribed treatments | Over-the-counter supplements, some traditional medicine | Varies |
| Preventive vaccinations | Flu shots, HPV (some subsidized separately) | ¥3,000–15,000 |
| Vision correction | Glasses, contact lenses, LASIK | ¥5,000–300,000 |
| Health check-ups | Annual physicals (some employer plans cover these; student plans vary) | ¥5,000–15,000 |
The Private Room Charge
Japanese hospitals have shared wards (大部屋) covered by NHI and private rooms (個室) that cost extra. The surcharge (差額ベッド代) ranges from ¥5,000 to ¥30,000/night and is completely out of pocket. If you are admitted through emergency and no shared ward bed is available, you should not be charged the private room surcharge — but some hospitals try. Know your rights.
Supplementary Insurance Options
NHI is strong, but some students add extra coverage. Here are the main options:
Gakkensai (学研災) — run by JEES
Japan Educational Exchanges and Services (JEES) — not JASSO — runs the Personal Accident Insurance for Students (学研災/Gakkensai), which you take out through your university. More than 1,000 schools in Japan use it.
| Feature | Details |
|---|---|
| Cost | ¥650/year (~€4); ¥1,000 (~€6) with the commuting rider (Type A, AY2026) |
| Coverage | Accidents during classes and campus activities; commuting with the rider |
| Payout | Lump-sum benefits depending on the injury |
| Not covered | Illness, pre-existing conditions, non-academic activities |
Most universities strongly recommend Gakkensai enrollment during orientation. Some bundle it with the Futai Baishō (付帯賠償) liability extension (~¥340/year) that covers damage to third-party property.
University Co-op Insurance (Seikyō Kyōsai / 生協共済)
University co-ops (生協/Seikyō) offer their own insurance:
| Feature | Details |
|---|---|
| Cost | ¥6,000–14,400/year (~€37–89; plans G500–G1200, 2026) |
| Coverage | Fixed cash benefits for illness and injury (24/7, not just academic activities), paid on top of NHI |
| Extras | Some plans include liability and personal property coverage |
The co-op plan is broader than Gakkensai because it also covers illness and accidents outside of university activities — sports, travel, daily life.
Private International Insurance
| Feature | Details |
|---|---|
| Cost | Price by quote — varies by insurer and age |
| Coverage | English-speaking support, global coverage, dental, vision, repatriation |
| Best for | Students who want English-language medical coordination |
| Important | Not a substitute for NHI — you still must enroll in NHI |
Private plans from providers like Tokio Marine, Sompo, or international insurers offer English helplines and cashless treatment at partner clinics. Useful in areas with few English-speaking doctors. See our reviewed private student health insurance plans for Japan — including JEES Inbound, the most popular option for international students at Japanese universities.
For more on choosing the right insurance plan, see our dedicated guide.
MEXT Scholarship Students
If you receive a MEXT (Monbukagakusho) scholarship — the Japanese government scholarship for international students — your situation is slightly different:
- NHI enrollment is still mandatory. The scholarship does not exempt you.
- MEXT does not pay or subsidise your NHI premiums. Scholarship holders must join NHI and pay the premiums themselves out of the monthly stipend (¥143,000–¥145,000 for research students in 2026).
- Gakkensai (run by JEES) is usually covered or strongly encouraged by your university.
- Your university’s international office handles much of the paperwork. They may organize group NHI enrollment.
Even with MEXT, you pay NHI premiums out of your stipend. The amount is minimal for students with no other income (about ¥1,700/month in Shinjuku, Tokyo, FY2026), so the impact on your budget is small.
Practical Tips for Using Healthcare in Japan
Finding a Doctor
- University health centers (保健管理センター): Free or very cheap basic care — colds, minor injuries, mental health counseling. Visit here first for non-urgent issues.
- Neighborhood clinics (クリニック/診療所): Small outpatient clinics are everywhere. Search on Google Maps for “内科” (internal medicine) near your address.
- Hospitals (病院): For serious or specialized treatment. Some charge an extra fee (¥3,000–5,000) if you visit without a referral from a clinic.
- AMDA International Medical Information Center: Multilingual medical helpline (03-5285-8088). They help you find English-speaking doctors.
Language at the Doctor
Most clinic staff in Japan speak limited English. In Tokyo and Osaka, larger hospitals have international departments. For smaller cities:
- Bring your My Number card (or eligibility certificate) and Zairyu Card to every visit
- Use a translation app (Google Translate’s camera mode works well for reading forms)
- Ask your university’s international office for a list of English-friendly clinics
- JNTO and AMDA maintain lists of multilingual medical facilities
My Number Card (マイナンバーカード)
Japan has replaced paper NHI cards with the My Number card system: no new paper cards have been issued anywhere in Japan since December 2024. Your My Number card functions as your health insurance card when linked to your NHI; until you link it, you use the free eligibility certificate (資格確認書).
To set this up:
- Apply for a My Number card at your ward office (free, 3–4 weeks processing)
- Link it to your NHI at a hospital terminal or online via the mynaportal.digital.go.jp website
- Present it at the card reader at any clinic or hospital
The My Number card also automatically applies the high-cost medical expense cap — no need to carry a separate Gengaku Certificate.
Pharmacy Tips
- Japanese pharmacies (薬局) are not like Western drugstores. Prescription pharmacies are small, clinical, and often next to a specific clinic.
- Drugstores (ドラッグストア) like Matsumoto Kiyoshi sell over-the-counter medications. These are not covered by NHI.
- Pharmacists in Japan are highly trained and can advise on OTC medications — even with a language barrier, pointing at symptoms on a translation app works.
What Happens If You Do Not Enroll in NHI
Skipping NHI enrollment is a bad idea for several reasons:
- You pay 100% of all medical costs. A doctor visit that would cost ¥1,500 with NHI costs ¥5,000 without it. A hospital stay for appendicitis: ¥500,000+ out of pocket instead of ¥36,900 (capped).
- Back-premiums. When you eventually enroll (and you must), the municipality charges premiums retroactively from your moving-in date — up to 2 years back. You owe all the unpaid premiums for that period.
- Visa renewal problems. Immigration authorities check your residency records. Non-enrollment in NHI can flag you as non-compliant, potentially complicating visa extensions. From June 2027, unpaid NHI premiums can lead to your visa (status of residence) renewal being refused.
- It is legally mandatory. Under Japan’s National Health Insurance Act, all residents staying 3+ months must enroll. There is no legal exemption for students.
NHI vs. Other Countries: How Japan Compares
Japan’s system stands out for affordability and simplicity. Here is how it compares to other popular student destinations:
| Country | System | Student Cost | Coverage | Co-pay |
|---|---|---|---|---|
| Japan | NHI (mandatory) | ≈ ¥20,000/year with no income (~€124) | 70% of everything | 30% flat |
| Germany | GKV (mandatory) | ~€146/month (~€1,752/year) | ~100% | Minimal |
| Australia | OSHC (mandatory) | AUD 665–726/year (~€410–445) | Varies by provider | Varies |
| UK | NHS via IHS | £776/year (~€920) | ~100% | Free prescriptions in Scotland/Wales |
| USA | University plan | $1,500–3,500/year (~€1,400–3,250) | Varies widely | Deductibles + co-pays |
| France | Sécurité Sociale | Free (+ mutuelle €10–50/month) | 70% base | 30% (complementary covers rest) |
Japan is among the cheapest options globally. The 30% co-pay sounds high, but the high-cost cap at ¥36,900/month means your maximum financial exposure is limited. And the premiums are a fraction of what you pay in Germany or the USA.
For a broader comparison, check our guide on health insurance requirements in top study destinations.
Budgeting for Healthcare in Japan
Scenario 1: Healthy Student, Minimal Care
| Item | Annual Cost |
|---|---|
| NHI premium | ¥20,000 (~€124) |
| 3 clinic visits | ¥4,500 (~€28) |
| 3 prescriptions | ¥2,400 (~€15) |
| Gakkensai (JEES) | ¥650 (~€4) |
| Total | ~¥27,550 (~€171) |
Scenario 2: Moderate Care (Allergies, Minor Injury)
| Item | Annual Cost |
|---|---|
| NHI premium | ¥20,000 (~€124) |
| 8 clinic visits | ¥12,000 (~€75) |
| Monthly allergy medication (12 months) | ¥9,600 (~€60) |
| 1 X-ray | ¥3,000 (~€19) |
| Gakkensai (JEES) | ¥650 (~€4) |
| Total | ~¥45,250 (~€281) |
Scenario 3: Serious Event (Broken Bone, Surgery)
| Item | Annual Cost |
|---|---|
| NHI premium | ¥20,000 (~€124) |
| Surgery + 5-day hospital stay | ¥36,900 (capped) (~€229) |
| Routine care (rest of year) | ¥10,000 (~€62) |
| Gakkensai (JEES) | ¥650 (~€4) |
| Total | ~¥67,550 (~€419) |
Even in this case, the high-cost cap keeps your total costs at about ¥67,550 (~€419) for the year — and if the accident happened during classes or campus activities, Gakkensai also pays a lump-sum benefit. This is why Japan is one of the most affordable countries for student healthcare.
Compare insurance options for all destinations on our insurance finder.
Frequently Asked Questions
How much does NHI cost for international students in Japan?
NHI premiums are income-based and set by each municipality. A single student with no income pays about ¥20,000/year (~€124) — roughly ¥1,700 (~€10) a month — in Shinjuku, Tokyo (FY2026), after the 70% low-income reduction. Amounts differ by municipality, and you only get the reduction if you file the yearly income declaration, even with zero income.
What does NHI cover?
NHI covers 70% of virtually all medically necessary treatment: GP visits, specialist consultations, hospital stays, surgery, prescriptions, mental health care (psychiatry and counseling), maternity care, rehabilitation, MRI/CT scans, and basic dental (fillings, extractions, root canals). You pay 30% of the total cost at every visit. Ambulance service is free.
Is NHI mandatory for international students?
Yes. All residents of Japan staying 3+ months must enroll in NHI. There is no student exemption and no opt-out for people who already have private insurance from their home country. You enroll at your local city/ward office within 14 days of moving in. Failure to enroll means paying 100% of medical costs — and when you do enroll, premiums are charged back to your moving-in date (up to 2 years).
What is the high-cost medical expense cap?
Japan’s Kougaku Ryouyouhi (高額療養費) system caps monthly out-of-pocket medical costs. For low-income residents in households exempt from resident tax, including most students, the cap is ¥36,900/month (~€229) since August 2026 (¥35,400 until July 2026), and a new annual cap of ¥290,000 applies. If your co-pays exceed this amount in a single month, NHI reimburses the difference. This protects you from catastrophic medical bills.
Do I need additional insurance beyond NHI?
NHI provides excellent core coverage. Most students add Gakkensai (run by JEES; ¥650/year, ¥1,000 with the commuting rider) for accident coverage — it is cheap and covers injuries during classes and campus activities, and on the way to university with the rider. Private international insurance (price by quote) makes sense if you want English-language medical support, dental coverage beyond basics, or repatriation insurance. But NHI alone is sufficient for most medical situations.
What documents do I need to enroll in NHI?
You need three items: (1) your Zairyu Card (在留カード) with your registered address, (2) your passport, and (3) your student enrollment certificate or university acceptance letter. Visit the NHI counter (国民健康保険窓口) at your local city hall or ward office. The process takes 15–30 minutes.
Can I use NHI at any hospital in Japan?
Yes. NHI is accepted at every clinic, hospital, and pharmacy in Japan. There is no network restriction. You can visit any doctor in any city without a referral. Some large hospitals charge an additional ¥3,000–5,000 fee if you visit without a referral from a smaller clinic, but NHI coverage still applies.
What happens if I cannot afford the 30% co-pay?
Japan’s social safety net includes the Free/Low-Cost Medical Care Program (無料低額診療事業) for people who genuinely cannot afford medical co-pays. Certain designated hospitals and clinics provide free or reduced-cost treatment. Ask your university’s international office or local ward office social services (福祉課) for information. The high-cost cap also ensures monthly expenses do not exceed ¥36,900.
How does the My Number card work with NHI?
The My Number card (マイナンバーカード) has replaced paper NHI cards, which have not been issued since December 2024. Once you apply for a My Number card (free, 3–4 weeks) and link it to your NHI at a hospital terminal or online, it functions as your insurance card. It also automatically applies the high-cost medical expense cap, eliminating the need for a separate Gengaku Certificate. Until you link it, use the free eligibility certificate (資格確認書) from your city office.
Is dental care covered by NHI?
Basic dental care is covered at the standard 70/30 split: check-ups, fillings (metal amalgam), extractions, root canal treatment, basic dentures, and periodontal treatment. NHI does not cover cosmetic dental work, porcelain/ceramic crowns, dental implants, orthodontics (braces), or teeth whitening. For comprehensive dental coverage, consider a private dental supplement.
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