You’ve just visited a doctor in Japan and handed over your health insurance card at reception. When the bill arrives, you notice something surprising: the total was ¥10,000, but you only paid ¥3,000. Welcome to Japan’s copayment system, where the government covers the majority of your medical expenses, and you pay the rest out of pocket.
Understanding copayment rates is essential for budgeting your healthcare costs in Japan. Whether you’re covered by National Health Insurance or Employee Health Insurance, the rates work the same way. This guide explains exactly how much you’ll pay based on your age, what happens when bills get expensive, and how to avoid surprise charges.
The 30% Rule: Your Basic Copayment Rate
Most working-age adults in Japan pay 30% of their medical costs. When you visit a doctor, get a prescription, or undergo treatment, your health insurance covers 70% while you pay the remaining 30% at the time of service. This applies whether you’re seeing a general practitioner for a cold or visiting a specialist for more serious care.
The system is straightforward in practice. Your doctor charges a standard price for the consultation or treatment, and when you present your insurance card, you automatically receive the 70% discount. There’s no filing claims or waiting for reimbursements—you simply pay your 30% share before leaving the clinic.
This copayment structure applies equally to Japanese citizens and foreign residents enrolled in the health insurance system. Your nationality doesn’t affect the rate you pay. As long as you have valid health insurance coverage in Japan, you pay the same percentage as everyone else your age.
How Copayment Rates Change with Age
While 30% is the standard rate for most adults, Japan adjusts copayments based on age to reduce healthcare costs for children and seniors. The system recognizes that young children and elderly residents often need more frequent medical care, so it reduces their financial burden accordingly.
Young Children (Under Age 6) pay just 20% of medical costs. This lower rate applies to all preschool-age children, making routine checkups, vaccinations, and childhood illnesses more affordable for families. Many municipalities go even further by offering subsidies that reduce or eliminate this 20% copayment entirely, which we’ll discuss in the regional variations section.
Children and Adults (Ages 6 to 69) pay the standard 30% copayment rate. This covers the majority of people living and working in Japan, from elementary school students through retirement age. Whether you’re 15 or 55, you pay the same rate.
Young Seniors (Ages 70 to 74) typically pay 20% of medical costs, a reduction from the standard 30%. However, if you have high income during these years, you continue paying 30%. The government defines “high income” as earning ¥1.6 million or more annually in taxable income, or having a household income above certain thresholds.
Older Seniors (Age 75 and Above) pay just 10% of their medical expenses under the Late-Stage Medical Care System. This represents the lowest copayment rate in the Japanese healthcare system. Like the 70-74 age group, high-income seniors continue paying 30%, but most elderly residents benefit from the reduced 10% rate.
These age-based reductions mean that healthcare becomes progressively more affordable as you get older in Japan. A medication that costs a working adult ¥3,000 out of pocket would cost a 75-year-old senior just ¥1,000.
What Your Copayment Covers (and What It Doesn’t)
Your copayment applies to a comprehensive range of medical services. Hospital care, both inpatient and outpatient, is covered at your age-appropriate rate. Clinic visits for any medical reason fall under the same coverage, whether you’re treating a minor illness or managing a chronic condition. Mental health care, prescription medications, and home health services all receive the same 70% coverage with your 30% copayment.
Dental care surprises many expats who assume it requires separate insurance. Basic dental treatments are covered by standard health insurance, including cavity fillings, gum disease treatment, root canals, and even wisdom tooth extractions. You pay the same 30% copayment for these services as you would for any other medical care.
The insurance system specifically excludes certain services and costs. Cosmetic procedures don’t receive coverage—this includes teeth whitening, orthodontics for appearance rather than medical necessity, and dental implants. Normal pregnancy and childbirth aren’t considered medical treatment under Japanese health insurance, so routine prenatal checkups and standard vaginal delivery aren’t covered by the copayment system.
However, pregnancy complications change this equation entirely. If you need a cesarean section, experience premature delivery, or require treatment for severe morning sickness, these become covered medical procedures with standard copayment rates. The government does provide a Childbirth and Childcare Lump-Sum Grant of ¥500,000 to help offset the average cost of normal delivery, which partially compensates for the lack of direct insurance coverage.
When you’re hospitalized, remember that your copayment covers medical treatment only. You’ll pay separately for meals during your stay, typically ¥460-500 per meal. If you want a private room instead of the standard shared ward, expect to pay ¥5,000-20,000 per day as an additional out-of-pocket expense. These costs don’t count toward your copayment percentage or monthly spending caps.
The Safety Net: High-Cost Medical Expense Benefits
The most important protection in Japan’s healthcare system is something many expats don’t discover until they need it. The High-Cost Medical Expense Benefit System, called kogaku iryohi in Japanese, caps your monthly out-of-pocket medical expenses. This system prevents a serious illness or major surgery from creating financial catastrophe.
Here’s how it works in practice. Let’s say you need surgery that costs ¥1,000,000. Normally, your 30% copayment would be ¥300,000—a substantial amount. However, the high-cost medical expense system sets a monthly ceiling on what you actually pay based on your income level. For middle-income earners, that ceiling is approximately ¥80,100 per month. You’d pay ¥80,100, and your insurance would reimburse you the remaining ¥219,900 of your copayment.
The system uses five income brackets to determine your monthly ceiling. These brackets are based on your standard monthly remuneration, a standardized calculation of your salary. High-income earners with monthly remuneration of ¥830,000 or more face higher ceilings. Middle-income earners, with monthly remuneration between ¥280,000 and ¥500,000 (roughly equivalent to ¥3.7-7.7 million annual income), use a formula: ¥80,100 plus 1% of medical costs exceeding ¥267,000. Lower-income residents below ¥280,000 monthly pay a maximum of ¥57,600 per month. Those exempt from resident taxes due to low income have the lowest ceiling at ¥35,400 monthly.
The ceiling applies automatically to all insurance-covered treatments and medications. If you need multiple procedures or ongoing treatment in a single month, all those costs combine toward your ceiling. When you exceed it, everything above that amount gets reimbursed.
The system includes an important provision for chronic conditions requiring ongoing expensive care. If you trigger the high-cost medical expense benefit three or more times within twelve months, your ceiling automatically lowers starting from the fourth month. This reduction recognizes that people with serious ongoing health issues need additional financial protection.
Family members covered under the same insurance can combine their medical expenses toward the household ceiling. If your spouse needs treatment and you also require care in the same month, both sets of bills count together toward reaching the ceiling, providing faster access to reimbursement.
Getting Your High-Cost Medical Benefit: Two Approaches
You can access the high-cost medical expense benefit either prospectively or retroactively, and the method you choose affects your cash flow significantly.
The prospective approach requires obtaining an “Eligibility Certificate for Ceiling-Amount Application,” known in Japanese as gentei gakusei shoumei. You request this certificate from your insurance provider before receiving expensive treatment. When you present this certificate at the hospital along with your regular insurance card, the hospital only bills you up to your ceiling amount. You never need to pay the full copayment upfront, which means you don’t need to have large amounts of cash available.
The retroactive approach works if you didn’t know about the system beforehand or couldn’t obtain the certificate in time. You pay your full copayment amount at the hospital, then apply to your insurance provider for reimbursement afterward. The insurance company reviews your case and typically issues your refund within two to three months. This method requires more upfront cash but still provides the same ultimate protection.
Recent modernization makes this even easier. If you’ve registered your My Number Card as your health insurance card, the system automatically applies your ceiling amount without requiring any paperwork or certificates. The hospital’s computer system recognizes your ceiling based on your income data, and you’re billed the correct capped amount immediately.
What You’ll Actually Pay: Real-World Costs
Understanding percentages and ceilings helps, but knowing actual costs makes budgeting concrete. A typical doctor’s office visit for something minor like a cold or minor injury costs ¥1,000-3,000 as your 30% copayment. The full bill might be ¥5,000-10,000, but you only pay your share.
Be prepared for the “initial consultation fee” when visiting a new clinic or hospital for the first time. This one-time surcharge ranges from ¥3,000 to ¥10,000 depending on the facility. University hospitals and large medical centers tend to charge higher initial fees, especially if you arrive without a referral from another doctor. Once you pay this fee at a facility, you don’t pay it again on future visits to that same place.
Prescription costs also follow the 30% copayment rule. After seeing your doctor, you take your prescription to a pharmacy where you pay 30% of the medication cost. Common medications typically cost ¥500-2,000 out of pocket. More specialized or newer medications cost more, but the same copayment percentage applies. Your pharmacy costs count toward your monthly medical expenses for high-cost benefit purposes, so keep those receipts along with your hospital bills.
Specialist visits work the same way as general practitioner visits regarding copayment rates. Unlike some countries’ healthcare systems, Japan doesn’t require referrals to see specialists. You can book directly with a cardiologist, dermatologist, or any other specialist, and you’ll pay the same 30% copayment. However, large hospitals may charge you that initial consultation fee if you show up without a referral, so getting a referral letter from your regular doctor can save you ¥5,000-10,000.
Regional Variations: Children’s Medical Subsidies
While national copayment rates remain consistent across Japan, municipal governments offer significant variations in children’s healthcare subsidies. These local programs can reduce or completely eliminate copayments for children, making healthcare essentially free for young families.
Tokyo’s 23 wards implemented the most generous program starting in April 2024. Children through high school age receive completely free medical care with no income restrictions. This means families living in central Tokyo pay nothing for their children’s healthcare, regardless of household income. The municipal subsidy covers the standard 20% copayment for young children and the 30% copayment for school-age children through age 18.
Other cities offer varying levels of support with different age cutoffs and income restrictions. Some municipalities provide free care only through elementary school age, while others extend it through junior high school. Certain cities impose income limits where higher-earning families receive reduced subsidies or no subsidy at all. The benefit amounts also vary—some cities eliminate copayments entirely, while others reduce them to ¥200-500 per visit.
This variation matters significantly when choosing where to live in Japan, especially for families with children. A family in central Tokyo with two children could save thousands of yen annually compared to the same family in a city with limited subsidies. Always check your specific municipality’s children’s medical expense subsidy program, typically called kodomo iryohi joseisei in Japanese, when you register your residence.
Practical Tips for Expats
Always carry your health insurance card. Forgetting it means paying 100% of costs upfront and filing for reimbursement later, which creates unnecessary paperwork and delays. Make checking for your insurance card part of your routine before leaving home, just like checking for your wallet and phone.
Keep all medical receipts, called ryoshusho in Japanese. You’ll need these documents if you trigger the high-cost medical expense benefit, claim dependent care expenses on your taxes, or need to track your medical spending. The receipts clearly show the breakdown of costs even if you can’t read all the Japanese, with numbers and percentages usually easy to identify.
Language barriers challenge many expats at medical facilities, but the insurance system itself helps bridge some gaps. Insurance cards are standardized, so the administrative process at reception works the same everywhere. The staff process your card, calculate your copayment, and present you with a bill showing the amount due. This happens whether or not anyone speaks English.
Many hospitals in major cities now employ English-speaking staff or offer interpretation services. Tokyo, Osaka, and other large cities have international clinics specifically catering to foreign residents, though these sometimes charge higher initial consultation fees. Some expats find that smaller neighborhood clinics offer more personal care with lower fees, even if they need to use translation apps for communication.
Consider whether supplemental private insurance makes sense for your situation. Some expats purchase additional coverage that reimburses the 30% copayment, covers private hospital rooms, provides access to English-speaking doctors, or includes medical evacuation coverage. These policies add cost but can provide peace of mind, especially for families with children or people with chronic conditions.
Common Questions About Copayments
Do I pay 30% at both the doctor’s office and the pharmacy? Yes, you pay your copayment percentage at each place separately. The doctor’s office bills you for the consultation, examination, and any procedures performed there. The pharmacy bills you separately for medications. Both amounts count toward your monthly medical expenses for high-cost benefit purposes, so keep receipts from both locations.
What happens to the copayment system when I turn 70? Your copayment automatically reduces from 30% to 20% when you reach age 70, unless you qualify as high-income. You don’t need to apply for this reduction—your insurance provider updates your status based on your birthdate. When you turn 75, you transition to the Late-Stage Medical Care System with a 10% copayment rate (or 30% if high-income).
Can I choose any hospital or do I need to stay within a network? Japan’s system allows completely free choice of healthcare providers. You can visit any doctor, clinic, or hospital in Japan, and your insurance card works at all of them. There’s no concept of “in-network” or “out-of-network” providers. However, large university hospitals may charge higher initial consultation fees if you visit without a referral from another doctor.
Do National Health Insurance and Employee Health Insurance have different copayment rates? No, copayment rates are identical across both systems. Whether you’re enrolled in National Health Insurance as a freelancer or covered by Employee Health Insurance through your company, you pay the same age-based copayment percentages. The systems differ in how they calculate premiums and who pays them, but medical care costs the same out of pocket.
How long does it take to get reimbursed if I exceed the monthly ceiling? If you apply retroactively after paying your full copayment, reimbursement typically takes two to three months from your application date. However, using the prospective certificate approach means you never pay the excess amount in the first place—the hospital only bills you up to your ceiling. This makes the prospective method strongly preferable when you know treatment will be expensive.
What if I can’t afford my copayment even with the monthly ceiling? Several additional support systems exist for people facing genuine financial hardship. Your municipal social welfare office can explain programs for low-income residents, including payment plans, temporary financial assistance, or additional subsidies. Don’t avoid necessary medical care due to cost concerns—ask the hospital’s social worker or your municipal office about available support options.
Key Takeaways
Japan’s copayment system provides affordable healthcare access while protecting against financial catastrophe from serious illness. Working-age adults pay 30% of medical costs, with reduced rates for children and seniors. The high-cost medical expense benefit system caps your monthly spending based on income level, ensuring that even expensive treatments remain manageable.
The system treats foreign residents and Japanese citizens identically—your nationality doesn’t affect what you pay. Coverage includes hospital care, clinic visits, prescriptions, basic dental work, and mental health services. Normal childbirth isn’t covered, but pregnancy complications are.
Municipal subsidies can significantly reduce or eliminate copayments for children, with benefits varying substantially by location. Tokyo’s 23 wards currently offer the most generous coverage with free medical care through age 18. Always check your local municipality’s programs when you register your residence.
Remember to carry your insurance card, keep your medical receipts, and apply for the high-cost medical expense benefit certificate before expensive treatment. These simple habits ensure you receive all the financial protections the system offers while avoiding unnecessary paperwork and cash flow problems.
Understanding your copayment rates and monthly ceiling helps you budget confidently for healthcare costs in Japan. The system is designed to make necessary medical care accessible and affordable, removing financial barriers to getting treatment when you need it.