Healthcare in Japan: compulsory cover, 30% co-payment and no CAK route

Yes, you are well insured in Japan, but not automatically and not for free. Anyone who lives there has to be in the public system: as an employee through your employer's Employees' Health Insurance, otherwise through your municipality's National Health Insurance. The premium is a percentage of your salary, and for every treatment you pay 30% yourself. The pitfall is on the Dutch side: Japan is not a treaty country of the CAK scheme, so your basic insurance stops on the day you deregister, and nothing takes it over automatically.

Why is there no CAK route to Japan?

The CAK's foreign-residence scheme only applies in countries with which the Netherlands has agreements on medical care. NederlandWereldwijd lists them: European countries, plus Morocco, Tunisia, Turkey and Cape Verde among others. Japan is not on it. So even if you go with AOW or a pension, you do not fall under the CAK but under the Japanese system. The social security agreement between the Netherlands and Japan does cover Japanese health insurance, but only for seconded workers: whoever is sent to Japan by a Dutch employer for up to five years stays under Dutch legislation and, with a certificate of coverage, does not have to join the Japanese system. If you emigrate on a Japanese contract, that does not apply.

Which insurance do you get: employer or municipality?

The Japanese immigration agency says it plainly in its guide for newcomers: wherever you come from, you are obliged to join public insurance.

	Employees' Health Insurance	National Health Insurance
For whom	employees of an employer that is obliged to enrol them	registered residents under 75 not insured through an employer
Enrolment	by your employer	yourself, at the municipal office
Premium	percentage of your salary, the employer pays half	per household, by income and household size
Family members	covered as dependants without premium	count in the household premium
Sickness pay	from the fourth day of illness, up to 18 months	not among the NHI benefits

At Kyōkai Kenpo, the Japan Health Insurance Association, the premium rate for 2026 averages 9.9%; in Tokyo 9.85%. Since April 2026 a national contribution of 0.23% is added, and between the ages of 40 and 64 also the long-term care premium of 1.62%. You pay half, your employer the other half. If your employer has its own fund (a Health Insurance Association), that fund's rate applies.

National Health Insurance has no fixed national rate: the municipality calculates the premium per household, and the head of the household pays. If you later switch to employer insurance, or move to another municipality, you deregister with the municipality.

What do you pay yourself at the doctor?

Who	Co-payment
Children before primary-school age (under six)	20%
Schoolchildren and adults up to and including 69	30%
70 to 74	20% (30% with a working-level income)
75 and over, in the separate system for the elderly	10%, 20% or 30%, by income

That sounds heavy, but there is a brake on it: the monthly ceiling on medical costs (kōgaku ryōyōhi). If your co-payment in a month exceeds a limit that depends on your age and income, the insurance covers the rest. The ministry works an example: someone under 70 with an annual income of roughly ¥ 3.7 to 5.1 million who receives treatment costing ¥ 1 million pays about ¥ 93,000 themselves under the system from August 2026. Since August 2026 there is also an annual ceiling for people in long-term treatment. Register your My Number card as your health insurance card, or request a ceiling certificate in advance: then you do not pay more than the ceiling at the counter.

For a birth you receive a one-off allowance of, as a rule, ¥ 500,000 per child, because an ordinary birth does not count as an illness and so does not fall under the co-payment arrangement.

How do you avoid a gap around the day you travel?

Between your deregistration and your start in Japan you are not insured anywhere. Your Dutch basic insurance ends on the day you deregister, and the Japanese insurance is tied to your employment or to your registration as a resident. Arrange temporary travel insurance with medical cover for those days, and only cancel the Dutch policy with proof of deregistration in hand.

Two more things that count in the first weeks. If you need treatment before your insurance card or My Number registration is ready, you first pay the full amount yourself; you submit the bill later and get back everything above your co-payment. And the cover stops at the border: treatment abroad you pay yourself first, and you claim the reimbursement afterwards. Additional travel insurance therefore remains useful when you visit the Netherlands.

How to close the Dutch side is in cancelling your health insurance without a gap; what happens to your AOW and pension, in AOW, pension and tax in Japan.

In Vertrekklaar this is phase 3 of 5 of the journey, step 3.1: the same steps, but for your situation — in your order, tickable, and with the deadlines watched. See the whole journey to Japan or go straight to step 3.1 in the open plan.