🏥 Health Insurance vs. Private Insurance in Japan: What Foreign Residents Should Know


Introduction

If you’re living in Japan as a foreigner, one important part of your life is health insurance. But Japan has two types of health insurance systems:

  1. Public Health Insurance (required)

  2. Private or Voluntary Insurance (optional)

In this article, we’ll explain the difference between these two, and help you understand which one you need, and why both can be useful.

✅ 1. What Is Public Health Insurance in Japan?

Japan has a universal healthcare system, and everyone living in Japan for more than 3 months must join one of the two types of public health insurance:

a) Employees’ Health Insurance (Shakai Hoken / 社会保険)

  • For full-time company workers

  • Premiums are shared between you and your employer

  • Includes pension and unemployment insurance

  • Automatically deducted from your salary

b) National Health Insurance (Kokumin Kenkō Hoken / 国民健康保険)

  • For students, freelancers, part-time workers, or unemployed

  • You pay the full premium yourself (based on income and local rates)

  • Apply at your city hall

📌 Both types cover 70% of your medical costs. You only pay 30% out of pocket.

❓ Who Needs to Join?

✅ You must join public health insurance if you:

  • Stay in Japan for more than 3 months

  • Have a residence card

  • Are not already covered by employer health insurance

⚠️ Not joining public health insurance can lead to:

  • Large medical bills

  • Penalties or back payments

  • Trouble with visa renewal

🆚 2. What Is Private or Voluntary Insurance?

Private insurance is optional and is offered by insurance companies. It is not a substitute for public insurance.

Examples:

  • Hospital cash plans (pays you daily while hospitalized)

  • Cancer insurance

  • Life insurance

  • Accident insurance

  • Overseas travel coverage (for short stays outside Japan)

Private insurance adds extra protection, especially for:

  • Serious illnesses

  • Hospital stays with private rooms

  • Income protection if you can’t work

🧾 Comparison Table

FeaturePublic Health InsurancePrivate Insurance
Required by law?✅ Yes❌ No
CostFixed % of income or city rateVaries by plan and provider
Covers hospital visits?✅ Yes (70% covered)✅ Sometimes (extra benefits)
Includes pension?✅ If Shakai Hoken❌ No
Visa requirement?✅ Important for renewal❌ Not required

💬 Which Should You Get?

SituationRecommended
Living in Japan long-term✅ Public insurance is mandatory
Want extra peace of mind👍 Add private insurance (e.g., cancer or accident)
Short stay in Japan (<3 months)🔸 Consider travel or international insurance only
Working full-time at a company💼 Covered by employer (Shakai Hoken)

🧠 Final Thoughts

For foreigners living in Japan, public health insurance is not optional — it’s part of living legally and safely in the country.
But adding a private plan can give you more security and comfort in case of serious health problems.

📝 Tip: If you’re unsure which insurance you have, check with your city hall or your employer’s HR department.

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