# National Health Insurance (国民健康保険) for foreigners: cost, students and leaving

URL: https://japanhow.com/money/insurance/national-health-insurance-japan-foreigners/
Author: japanhow editors
Updated: Oct 21, 2026

## Summary

Foreign residents staying in Japan for more than 3 months must join National Health Insurance (国民健康保険) if they have no workplace health insurance. You apply at your city office within 14 days and pay 30% at the clinic. As of October 2026, Shinjuku charges a single person under 40 with no income ¥67,073 a year before reductions, and ¥338,979 on ¥3 million of income. Unpaid premiums can count against visa renewal and permanent residency.

## Key facts

- Who must join: Stay over 3 months, no workplace insurance
- Shinjuku FY2026, no income: ¥67,073 a year before reductions
- You pay at the clinic: 30% (school age to 69)
- Deadline to join: 14 days

If you live in Japan for **more than 3 months** and your job doesn't enroll you in workplace health insurance, you must join your city's National Health Insurance (国民健康保険), whatever your nationality. You apply at the city office within **14 days** and pay **30%** of most medical bills. As of October 2026, Shinjuku charges a single person under 40 with no income **¥67,073 a year** before low-income reductions.

**Shinjuku, FY2026, one person under 40, ¥0 income:** ¥67,073 a year (Before the 70% low-income cut. About ¥5,600 a month, billed in 10 installments from June (Shinjuku City))

## Do foreigners have to join National Health Insurance?

Yes, unless you are covered another way. According to Shinjuku and Meguro wards, a foreign resident with a resident record (住民票) must join if:

- your **period of stay is more than 3 months**, and
- you are **not covered by workplace health insurance** (社会保険), and you don't receive public assistance.

Holders of Entertainer, Technical Intern Training, Dependent or Designated Activities status with 3 months or less can also join if they show objective documents proving they will stay longer than 3 months.

You **can't** join on Temporary Visitor (短期滞在) or Diplomat status, after your status has expired, or on Designated Activities for medical treatment or sightseeing.

### National Health Insurance or workplace insurance?

| Your situation | Insurance |
|---|---|
| Employee or executive of a company (株式会社, 合同会社 and so on) | Workplace health insurance, through your employer |
| Part-time worker meeting the thresholds (for example 20+ hours a week and ¥88,000+ a month; students excluded) | Workplace health insurance |
| Dependent family of an employee | The employee's workplace insurance |
| Freelancer, self-employed, unemployed, student, between jobs | **National Health Insurance** |

The two systems **don't switch automatically**. When you leave a job, or get a job with workplace insurance, you must tell the city.

## How much does National Health Insurance cost?

Each city sets its own rates. We use **Shinjuku City (新宿区), Tokyo, for FY2026** (April 2026 to March 2027). The premium has four parts. Each has a flat amount per member plus a percentage of your household's assessment base:

| Part | Per member | Rate on income | Yearly cap |
|---|---|---|---|
| Medical (医療分) | ¥47,600 | 7.51% | ¥670,000 |
| Elderly support (支援金分) | ¥17,600 | 2.80% | ¥260,000 |
| Long-term care (介護分), ages 40 to 64 only | ¥17,800 | 2.43% | ¥170,000 |
| Child support (子ども・子育て支援金分), new in FY2026 | ¥1,873 | 0.27% | ¥30,000 |

The **assessment base** (算定基礎額) is your **previous year's** total income (総所得金額等) minus ¥430,000. Total income is not your gross salary or take-home pay. For a salaried worker it is the 給与所得控除後の金額 on your withholding slip (源泉徴収票).

Shinjuku's own estimates for one person, before reductions:

| Total income in 2025 | Under 40 or 65+ | Aged 40 to 64 |
|---|---|---|
| ¥0 to ¥400,000 | ¥67,073 | ¥84,873 |
| ¥1,000,000 | ¥127,379 | ¥159,030 |
| ¥2,000,000 | ¥233,179 | ¥289,130 |
| ¥3,000,000 | ¥338,979 | ¥419,230 |

**Per month:** Shinjuku bills in **10 installments, June to March**. Each one covers 1.2 months. So ¥338,979 a year is about ¥28,250 a month spread over 12 months, but each bill is about ¥33,900.

**Just arrived in Japan?:** Premiums are based on last year's income as recorded in Japanese resident tax data. Shinjuku says that if you moved in on or after 2 January 2026, your June bill shows only the per-member amounts. The income part follows once the ward has your previous city's tax data. The ward's pages don't say how income earned abroad is treated. Ask at the counter.

## How can I lower my National Health Insurance premium?

**1. Declare your income, even if it was zero.** Shinjuku cuts the per-member amounts by 70%, 50% or 20% for low-income households. But the cut applies only if the income of **every member, including the head of household,** is known. If you had no income, file a resident tax declaration (住民税の申告) at the city where you lived on 1 January.

For a one-person household in Shinjuku (FY2026, based on 2025 income):

| Total income | Cut to per-member amounts |
|---|---|
| ¥430,000 or less | 70% |
| ¥740,000 or less | 50% |
| ¥1,000,000 or less | 20% |

After a 70% cut, the per-member part is ¥1,677 a month if you are under 40.

**2. Lost your job for company reasons?** If Hello Work classes you as a specified eligible recipient (特定受給資格者) or a specified reason leaver (特定理由離職者), and you were under 65, Shinjuku counts your previous salary income at **30%**. It lasts until the end of the following fiscal year. Bring your employment insurance card from Hello Work. See [unemployment benefits for foreigners](/money/benefits/unemployment-benefits-japan-foreigners/).

**3. Other cuts.** Pre-school children's per-member amount is halved automatically. Under-18s pay no per-member child-support amount. There is a reduction around childbirth, and a general reduction (一般減免) if you can't pay after dismissal, illness or disaster. Apply for the general reduction before the due date.

## Do international students have to pay National Health Insurance?

Yes. Shinjuku lists foreign students among the residents who join, and students are excluded from the part-time thresholds for workplace insurance. Because most students had little or no Japanese income the year before, the **low-income reduction** usually matters most. File the income declaration every year so it applies.

## How do I join?

Late is expensive: if you join late, you **still owe premiums back to the date you became eligible**.

## What happens if I don't pay National Health Insurance?

Three things, as of October 2026:

- **Collection.** Shinjuku says it may investigate your bank savings and seize assets without notice if you don't pay without a special reason. If you can't pay, ask for a payment consultation (納付相談) first.
- **Visa renewal and change.** The Immigration Services Agency (出入国在留管理庁) guideline says serious cases (悪質なもの) of large or long-term unpaid NHI premiums are treated like unpaid tax: a negative factor. Since its June 2026 revision, it also says immigration may decide using payment information it receives from other agencies. You show your health insurance at the counter when you apply.
- **Permanent residency.** The PR guideline (revised February 2026) requires taxes, pension and health insurance premiums paid properly. Premiums paid late, even if settled before applying, are in principle judged negatively.

**Some cities already send non-payer data to immigration:** According to a Cabinet Secretariat paper, 68 municipalities shared NHI arrears data with immigration as of June 2025. Shinjuku's plan, for 1 June 2026 to 31 March 2027 and later years, is to give the Tokyo Regional Immigration Services Bureau the name, residence card number and status of foreign residents who stay in arrears after collection efforts. Immigration then asks them for an NHI payment certificate when they renew or change status.

A national rule is **planned, not law**. The government says it is building a system so immigration receives unpaid-premium data from cities. Jiji Press reported in November 2025 that the health ministry plans to refuse renewals in principle for people who refuse to pay, starting **June 2027**. As of October 2026 we found no official ministry or immigration page confirming that date or the rules. We will update this page when they are published.

## What do I do with National Health Insurance when I leave Japan?

1. **File your moving-out notification (転出届)** at the city office.
2. **Then file the loss of eligibility (資格喪失)** at the insurance counter. Bring ID (passport, residence card or My Number Card) and your 資格確認書 if you have one.
3. **Settle the premium.** In Yokohama, if every NHI member in the household leaves, the premium is settled at the counter.

As long as your resident record stays in Japan, you stay enrolled and keep owing premiums. For the full list of things to close, see the [leaving Japan checklist](/visa/leaving/leaving-japan-checklist/).

This page is general information. For your own case, ask your city's NHI counter, or a licensed immigration specialist (行政書士) about visa questions.

## More guides

- [The Japanese pension for foreigners](/money/pension/japan-pension-foreigners/): the other premium you pay with NHI.
- [Resident tax for foreigners](/money/tax/resident-tax-japan-foreigners/): the tax data your premium is based on.
- [Child allowance and childbirth payments](/money/benefits/child-allowance-japan-foreigners/): includes the ¥500,000 childbirth lump sum.
- [Visa renewal in Japan](/visa/visas/visa-renewal-japan/)
- [Permanent residency requirements](/visa/residency/permanent-residency-japan-requirements/)

## Questions people ask

### How much is National Health Insurance per month in Japan?

It depends on your city and last year's income. In Shinjuku for FY2026, a single person under 40 with ¥0 to ¥400,000 of income pays ¥67,073 a year before reductions, about ¥5,600 a month, billed in 10 installments.

### Do foreign students have to join National Health Insurance in Japan?

Yes, if you stay more than 3 months and have no other public insurance. File a resident tax declaration even with no income, so the city can apply the 70%, 50% or 20% low-income reduction.

### Can I skip National Health Insurance if I have private or travel insurance?

No. The cities' rules make enrollment compulsory for residents staying over 3 months without workplace insurance. If you join late, you pay the premiums back to the date you became eligible.

### Do unpaid National Health Insurance premiums affect my visa?

They can. The immigration guideline says serious cases of large or long-term unpaid premiums are treated like unpaid tax in renewals, and the permanent residency guideline requires premiums paid on time. Some cities, including Shinjuku from June 2026, share data on long-term non-payers with immigration.

### How do I stop National Health Insurance when I leave Japan?

File your moving-out notification (転出届) first, then the loss of eligibility at the city's insurance counter. If everyone in the household leaves, the premiums are settled on the spot.

## Sources

- [国民健康保険の加入資格](https://www.city.shinjuku.lg.jp/hoken/index02_01.html), Shinjuku City (新宿区) (accessed Oct 21, 2026)
- [外国籍のかたの国民健康保険の加入](https://www.city.meguro.tokyo.jp/kurashi/kokuho/kanyu_dattai/kanyu-gaikoku.html), Meguro City (目黒区) (accessed Oct 21, 2026)
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- [国民健康保険料に係る東京出入国在留管理局への滞納者情報の外部提供について](https://www.city.shinjuku.lg.jp/content/000453574.pdf), Shinjuku City (新宿区) (accessed Oct 21, 2026)
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