International Health Insurance in Japan for Expats

Yes. It is mandatory for all residents of Japan with a visa valid for more than three months to enroll in either the National Health Insurance (NHI) programme or the Social Health Insurance (SHI) scheme through an employer. Failure to enroll can result in difficulties renewing your visa or changing residency status. All legal residents, including Americans, are entitled to enroll regardless of nationality, and the public system covers the vast majority of medical costs.

The NHI is available to residents who are not covered by employer-based SHI – including self-employed individuals, part-time workers, students and unemployed residents. To enroll, you must register your residence at your local municipal office within 14 days of moving to Japan, then apply for NHI at the same office. The NHI covers 70% or more of medical costs, with the patient paying a co-payment of 30% or less. Premiums are income-based and generally affordable compared to US health insurance.

Once enrolled in NHI or SHI, you receive a health insurance card (now transitioning to the My Number Health Insurance Card from December 2025 onwards) which you present when accessing medical services. For most routine care, you visit a clinic or hospital, present your card and pay the co-payment. English-speaking doctors are available at international hospitals in major cities including the International Clinic in Tokyo and St. Luke’s International Hospital. International health insurance can supplement the co-payment and provide access to a wider range of English-speaking providers.

This is one of the most important considerations for Americans moving to Japan. If you are employed by a Japanese company, SHI through your employer can take time to come into effect – in some cases up to a year. If you are enrolling in NHI, there is a process involving residence registration before you can formally enroll. During this transitional period, you are responsible for the full cost of any medical treatment. International health insurance provides continuous coverage during this gap, which is why many expats choose to maintain a private plan alongside the public system.

No. US Medicare does not provide coverage outside the United States in most circumstances. Some Medicare Advantage plans offer limited emergency cover abroad and certain Medigap policies include emergency foreign travel coverage, but these are designed for short trips rather than long-term living abroad. Americans planning to live in Japan should arrange international health insurance as a separate plan to cover the gap before public coverage begins, and to supplement the 30% co-payment under the NHI system. ExpatInsure can help you find options suited to your situation in Japan.