Moving to Japan

Japan has mandatory universal health insurance. If you hold a residence status longer than three months, you must be enrolled in one of two systems — there’s no opting out, and no “I’ll just pay cash” path for residents.

• Employees’ Health Insurance 社会保険 · shakai hoken — if you work full-time for a company, your employer enrolls you automatically and deducts premiums from your salary. You don’t need to do anything at the ward office. It also bundles in your pension.
• National Health Insurance 国民健康保険 · kokumin kenkō hoken (“NHI”) — for everyone else: freelancers, students, part-timers below the hours threshold, the unemployed, and people between jobs. You enroll yourself at the ward office (section 4).

What it costs you at the point of care: both systems cover 70% of standard medical costs — you pay a 30% co-pay, and it drops with age. So a clinic visit that “costs” ¥10,000 costs you ¥3,000 out of pocket, or less if you’re older.

Sources: MHLW; Japan Digital Agency (myna.go.jp); Tokyo Metropolitan Government.

You don’t need to memorize the full rulebook here — our Health Guide lays out the prohibited and restricted categories, the exact quantity thresholds, and the certificate process in detail. What you need to do before you move is three things:

Sources: MHLW personal-import guidance; Japan Customs; Consulate-General of Japan medication guidance.

Within 14 days of moving into your address, file a move-in notification 転入届 · tennyū todoke at the office for the municipality where you live. In Tokyo’s 23 special wards, that’s your ward office 区役所. You can’t file it before you’ve actually moved in.

Why it matters: this creates your resident record 住民票 and puts your address on your residence card. It’s the prerequisite for enrolling in health insurance, joining the pension system, opening a bank account, and getting a phone contract. Skip it or delay it and everything downstream stalls — and late registration carries fines.

After you register, your My Number notification is mailed to your new address, and you can then apply for the My Number Card — which, as noted above, doubles as your health-insurance card. Larger Tokyo wards (Shinjuku, Minato, Shibuya, among others) have foreign-resident support desks; go early in the day, and don’t hesitate to ask for English.

Sources: municipal/ward office guidance; Immigration Services Agency; Basic Resident Registration Act.

Who this is for: residents not covered by an employer. If your company enrolls you in 社会保険, skip this — you’re already covered. Everyone else — freelancers, students, part-timers, the unemployed, people between jobs — enrolls in NHI themselves.

When and where: at your ward or city office’s National Health Insurance counter 国民健康保険課, within 14 days of registering your address. It’s an in-person process, and you can usually do it in the same visit as your resident registration.

What it costs: premiums are based on your previous year’s income, so new arrivals with no Japanese income in their first year pay very little — often only a modest per-person base amount. Bills come monthly or quarterly; you can pay at convenience stores, by bank transfer, or by automatic withdrawal.

What it covers: 70% of standard costs (your 30% co-pay), doctor visits, prescriptions, and basic dental. It also includes a high-cost medical expense cap 高額療養費制度 that limits your out-of-pocket in any month if you have a large bill. It does not cover routine checkups, most vaccinations, cosmetic procedures, or normal childbirth (which is offset by a separate lump-sum payment instead).

Sources: MHLW; municipal NHI guidance. Premium formulas differ by ward — confirm yours locally.

Japan uses a “free access” model — there’s no GP gatekeeper, so you can go straight to the relevant specialist and usually be seen the same day or within a few days.

Clinic or hospital?

• Small clinics 診療所 · クリニック handle everyday illness, minor injuries, and first consultations. Start here for routine problems.
• Large hospitals 病院 are for surgery, serious conditions, and advanced testing. Turning up at a large hospital (200+ beds) without a referral letter 紹介状 triggers an extra “selective treatment fee” of at least ¥7,000 for a first visit, on top of your normal co-pay and not covered by insurance. The referral letter from a clinic costs only a few hundred yen — always get one rather than paying the surcharge.

A mindset shift: there’s usually no single family doctor coordinating your care. You assemble your own small “medical map” — a clinic for everyday illness, a dentist, and an emergency hospital you’d go to. Bring to your first visit: your insurance card or My Number Card, your residence card, and any referral letter. A first clinic visit on insurance typically costs ¥2,000–¥5,000 out of pocket.

Sources: Tokyo Metropolitan Government (Himawari); JNTO; JMIP; Japan Health Insurance Law (referral fee).

Japan separates prescribing from dispensing 医薬分業, which surprises many newcomers. Here’s the actual flow:

• At the clinic, the doctor examines you and writes a prescription 処方箋 · shohōsen — a piece of paper — but does not dispense the drug.
• You take that paper to a separate dispensing pharmacy 調剤薬局 · chōzai yakkyoku — not a general drugstore. Look for the kanji 調剤 or 薬局 on the sign. These cluster right around clinics and hospitals, so there’s almost always one next door.

If the exact drug you’re used to isn’t available in Japan — which happens — the pharmacist may offer a generic equivalent or call the doctor. This is where the English letter from your home doctor (section 2) earns its keep, helping a Japanese doctor prescribe a suitable local substitute.

Sources: MHLW; national health-insurance dispensing rules.

You do not need fluent Japanese to get good care in Tokyo.

• Multilingual medical questionnaires. The Kanagawa International Foundation publishes free, downloadable medical questionnaire sheets in around 23 languages, covering many specialties. Fill one in before your visit and hand it to reception — it conveys your symptoms and history even when staff don’t share your language.
• AMDA International Medical Information Center. A multilingual hotline (Tokyo: 03-6233-9266) offering guidance and free remote medical interpretation in English, Chinese, Korean, Spanish, Portuguese, Tagalog, Vietnamese, and Thai.
• Tokyo Himawari. Call 03-5285-8181 (daily 9:00–20:00) for help in English, Chinese, Korean, Spanish, and Thai, including finding language-capable facilities. A separate emergency medical interpretation line, 03-5285-8185, covers weekday evenings and weekend/holiday daytimes.
• Translation apps such as VoiceTra handle on-the-spot conversation; learning a few key phrases helps too.
• Your ward’s foreign-resident desk. Many Tokyo wards run consultation services and some offer medical interpreter support — check your ward’s website.

Sources: Kanagawa International Foundation; AMDA; Tokyo Metropolitan Government.

Ambulance versus going yourself: call 119 for anything life-threatening or if the person can’t move — severe breathing difficulty, serious bleeding, loss of consciousness, a severe allergic reaction, or major trauma. For milder problems, take a taxi to an emergency hospital, or call #7119 first. Note that an ambulance takes you to the nearest suitable hospital, not one you choose.

Sources: Tokyo Fire Department; Fire and Disaster Management Agency; Tokyo Metropolitan Government.