National Health Insurance in Tokyo: Cost and How to Join
If you are registered as a Tokyo resident and no employer covers you, National Health Insurance is generally not optional.
You join at your ward office within 14 days, and you pay from the date you should have joined, not the date you got around to it.
The part that catches freelancers off guard comes later. The premium is calculated from last year’s income, and the notice arrives in June.
Kokuho is less like a subscription and more like a bill for last year.
Who has to join
National Health Insurance, usually shortened to kokuho, is run by your ward. It is the default for registered residents who are not on a workplace plan.
Shinjuku City’s guide for foreign residents lists the main exceptions:
- People enrolled through an employer’s health insurance
- People who can be a dependent on someone else’s employer plan
- People whose status is for three months or less, with some exceptions
- People receiving public assistance
- People aged 75 and over, who move to a separate system
Minato City also excludes people holding a certificate of coverage under a social security agreement with their home country.
Digital nomad status is its own case. The Immigration Services Agency says holders cannot enroll in public medical insurance, which is why that status requires private cover. Our Japan digital nomad visa guide explains the trade-offs.
How to join
The sign-up normally happens right after you register your address, in the same building. If you have not done that yet, start with our resident registration guide.
The deadline is 14 days from the event that makes you eligible. That means moving in, leaving an employer plan, or having a child.
Shinjuku’s guide states it plainly: coverage does not begin on the day you file. Filing late means premiums can still reach back to the date you became eligible. Minato’s FAQ says up to two years, and that you bear all medical costs until you file.
So a freelancer who finishes a company contract in March and files in July has not saved four months. They have just postponed them.
Required documents vary by ward. Your residence card is the obvious one. If you are leaving an employer plan, ask your ward what proof of the end date it wants before you go.
Once enrolled, you show your My Number Card registered as a health insurance card, or the certificate of eligibility, at the clinic reception. Most adults then pay 30 percent of the bill. Our healthcare and pharmacies guide covers what to do from there.
How the premium is calculated
Your premium has four parts: medical care, support for the late-stage elderly system, a new child and childcare support portion, and nursing care if you are 40 to 64.
Each part combines an income-based rate with a flat amount per person. The bill is calculated per household, and the head of household pays it.
Minato and Setagaya publish the same fiscal 2026 figures. Other wards may differ, so check yours.
| Part (FY2026) | Income rate | Flat amount | Annual cap |
|---|---|---|---|
| Medical | 7.51% | ¥47,600 | ¥670,000 |
| Late-stage elderly support | 2.80% | ¥17,600 | ¥260,000 |
| Child and childcare support | 0.27% | ¥1,873 | ¥30,000 |
| Nursing care (ages 40 to 64) | 2.43% | ¥17,800 | ¥170,000 |
The income rates apply to your prior-year income minus a basic deduction of ¥430,000. Setagaya notes that dependent, social insurance and medical expense deductions do not count here, which surprises people used to income tax.
A rough budget
For a single person under 40, those figures add up to 10.58 percent of the income base, plus ¥67,073 in flat amounts.
| Prior-year income after expenses | Approx. annual premium |
|---|---|
| ¥3,000,000 | ¥340,000 |
| ¥5,000,000 | ¥550,000 |
These are editorial estimates from the published rates, for a full year in one of those wards. Your own notice is the real number.
The rule that shapes a first year is the prior-year basis. Setagaya says people with no prior-year income still owe the flat portions, so a newcomer’s early bill can look small, unless your municipality asks for prepayment (more on that below).
Then a full year of Japanese income lands on the next notice. Setting aside money from month one is the cheap way to avoid a nasty June.
The June notice
Premiums run on an April to March year. Wards mail the notice around mid-June, and Shinjuku splits the year into ten installments, June through March.
You can pay by direct debit, at banks and post offices, at designated convenience stores, or through payment apps, depending on your ward.
If you join mid-year, Minato prorates the premium by month.
One small habit matters here: file an income declaration, even with little or no income. Minato says undeclared households cannot be assessed for reductions, and the flat amounts can be cut by 70, 50 or 20 percent for low-income households. Edogawa adds that people with no income still need to file.
The ward pages we checked do not explain how overseas income is treated, so ask your ward directly if your clients or last year’s earnings were abroad.
Budget for the pension too
The same life change usually triggers the National Pension. The Japan Pension Service says residents aged 20 to 59 outside the employee pension generally enroll at their municipal office, regardless of nationality.
The fiscal 2026 premium is ¥17,920 a month. If paying is hard, you can apply for an exemption, so an application beats silence.
Non-Japanese members who leave can claim a lump-sum withdrawal if they meet the conditions, including at least six months of contributions and a claim within two years of ending their Japanese address.
Why unpaid premiums matter more now
Overdue premiums are generally due in one lump sum, Shinjuku says, and its collection section offers payment consultation.
The stakes are also rising. Reporting from November 2025 said the Health Minister announced that residence changes or renewals would in principle be refused for people who do not pay National Health Insurance or pension premiums, with payment records used in screening from a planned June 2027 start.
A Health Ministry notice from October 2025 also reportedly lets municipalities, by ordinance, require up to a year of premiums in advance from households newly arrived from abroad. Ask whether your ward does.
A Liberal Democratic Party proposal also called for strict screening of people with unpaid premiums.
Details may change, so ask your ward what applies now. The practical advice does not change: pay on time, or talk to the ward before you fall behind.
If you cannot pay, the ward counter is a better place to be than the mailbox.
FAQ
How do I stop kokuho when I leave Japan or join a company? Withdraw within 14 days of moving out of the ward, leaving Japan or joining an employer plan. Our leaving Tokyo checklist covers the rest.
Does moving wards reset anything? Yes, you withdraw from the old ward and join the new one. Minato notes that if you moved in January or later, the June notice may start with flat amounts only, then be revised once income is confirmed.
Can I use travel insurance instead? If you are a registered resident who falls under kokuho, private cover generally does not replace it. Private insurance can sit on top, but it does not remove the obligation.
Rates and procedures change, and this guide is general information rather than legal or tax advice. Your ward office and the Japan Pension Service have the final word.