Japan’s Health Insurance Explained — Real Costs, Coverage & the High-Cost Benefit

Japan’s Health Insurance Explained — Real Costs, Coverage & the High-Cost Benefit — YouTube

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In Japan, almost everyone has health insurance. While a doctor's visit in the U.S. might cost over a hundred dollars, in Japan it's often less than twenty. I'll explain how this system works, its benefits, and some challenges.

Basics of Japan's Health Insurance#

In Japan, it is mandatory for everyone to be enrolled in some form of health insurance. Because of this system, patients usually pay only 30% of their medical costs, while the remaining 70% is covered by insurance. For example, if the total cost of a visit is about 5,000 yen, which is around 35 dollars, the patient pays only about 1,500 yen, or 10 dollars. Children and the elderly often pay even less.

In my case, I suffer from hay fever during certain seasons. When I visit an ear, nose, and throat doctor, the consultation fee is usually around 1,000 yen, and the medicine costs another 1,000 to 2,000 yen. So in total, I pay only about 3,000 yen, which is roughly 20 dollars. I also go to the dentist regularly for cleanings. Some of these treatments are covered by insurance, and in those cases, I pay only around 3,000 yen per visit.

Of course, since it's affordable, hospitals are usually very crowded. Waiting 30 minutes to an hour, or even longer, is quite normal in Japan. That's another typical feature of our healthcare system.

Treatments Not Covered by Insurance#

Japanese health insurance only applies to treatments approved by law as "insured medical care." Cosmetic surgery and orthodontics, for example, are not covered, and patients must pay the full amount. New drugs and some advanced medical treatments that are not yet approved by the Ministry of Health are also excluded.

I personally had orthodontic treatment, which cost me several thousand dollars out of pocket. However, at the same time, I also received treatment for cavities and had my wisdom teeth removed. Those procedures were covered by insurance, so I only paid 30%.

Even within dental care, whether insurance applies can depend on the material you choose for fillings or crowns. This is why it's important to discuss the details with your doctor before starting treatment.

Types of Health Insurance#

There are two main types of health insurance in Japan: "Social Insurance", which covers company employees and public workers, and "National Health Insurance", which covers the self-employed, freelancers, students, and unemployed people.

Social Insurance and Premiums#

Social Insurance is deducted directly from your salary. It's not just health insurance, but also includes pension and employment insurance. The higher your income, the more you pay. But the good thing is, your company pays half of it, so your personal burden is only half.

Another big feature of Social Insurance is the dependent system. If your spouse or children meet certain conditions, you can add them as dependents without paying extra premiums, and they are also covered.

National Health Insurance and Premiums#

National Health Insurance is managed by local governments. Premiums are calculated based on your previous year's income, household size, and sometimes even property taxes. This means people with higher income pay more, and the amount can also differ depending on where you live.

Unlike Social Insurance, there is no dependent system. Each family member must pay premiums individually. However, low-income households can get reductions.

Switching Between Insurances#

If you have a period of unemployment, you need to apply for National Health Insurance yourself. For example, when I changed jobs, there was a three-month gap before I started my new job. During that time, I had to go to the city hall and sign up for National Health Insurance on my own.

On top of that, I also had to handle pension and tax payments, which was honestly a hassle. So, if possible, it's easier to avoid a gap between jobs, because of those troubles.

The High-Cost Medical Expense Benefit#

One of the most important features of Japan's health insurance system is the High-Cost Medical Expense Benefit. If your out-of-pocket expenses in a single month exceed a certain limit based on your income, the extra amount will be reimbursed. Even if a surgery costs one million yen—around 7,000 dollars—your personal payment might be limited to just a few hundred dollars. This system prevents people from going bankrupt because of medical bills.

Take appendicitis, for example. With insurance, including surgery and hospitalization, the cost might be 100,000 to 200,000 yen, which is about 800 to 1400 dollars. But if your monthly limit is 80,000 yen, anything above that will be reimbursed later, so your actual burden is capped at 80,000 yen, which is about 500 dollars.

My family and friends have used this system for treatments like diabetes, cancer, and infertility. It has been a huge help to many people.

However, this benefit only applies to treatments covered by insurance. If the treatment itself is not approved, you must pay the full amount. That's why it's important to know what's covered and what isn't.

Strengths and Challenges of the System#

Japan's health insurance system has many advantages. On the other hand, there are some challenges. Japan has an aging population, and medical costs are increasing every year. As a result, the burden on the working generation is also rising. In fact, Social Insurance premiums can now take 10 to 15% of a person's salary.

The system is great, but keeping it sustainable is becoming a serious issue.

In this article, I introduced Japan's health insurance system. Thanks to this system, people in Japan can see doctors and receive treatment without worrying too much about costs. At the same time, challenges like rising expenses and an aging population remain. How we maintain this system in the future will be an important issue for Japanese society.

Closing Remarks#

Thank you for reading my article today. I hope you found the information helpful.
If you have any questions, please share comments on Twitter or YouTube.
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