Foreigners may have to pay lump sum for health insurance in some parts of Japan

TOKYO – Foreign residents may soon have to pay their national health insurance premiums up front in some areas, according to a plan by the Health, Labor and Welfare Ministry. The move is meant to keep foreign residents from dodging medical fees.

National health insurance, part of the social safety net, is managed by prefectural and municipal governments. The program enrolls people who are self-employed, jobless or under nonregular contracts. Foreigners must enroll if they live in Japan for more than three months and are not covered by any other insurance, such as what they might receive from their place of work.

In fiscal 2023, national health insurance covered 970,000 foreigners, who accounted for 4% of the total.

As of the end of 2024, foreigners were only paying their insurance premiums 63% of the time, well below the 93% figure for all residents of Japan, both Japanese and foreign nationals, according to a survey by the ministry of 150 municipalities.

Under the national health insurance program, those who are enrolled receive payment slips by mail and use them to pay their premiums. But many foreigners fail to make these payments. The ministry believes this is because they lack such systems at home and do not understand why they must pay into the program.

Members of the ruling parties and the opposition have called for insurance premiums to be paid in advance, claiming that some foreigners who do not join the national health insurance program also shirk their medical bills.

The ministry aims to notify municipalities this fiscal year of what ordinances they need to amend so that they can require advance payment of premiums beginning as early as next April. However, it will be up to each local government to decide whether they change the way they bill premiums.

The ministry plans to have foreigners, when they move to Japan and register with a local government, pay a lump sum for national health insurance, such as the cost for a year’s worth of coverage.

For the national pension, premiums are the same nationwide and there is already a system that allows people to pay their premiums in advance.

However, premiums for national health insurance differ by municipality. If foreign residents move to other municipalities after paying a lump sum, the municipality will have to partially refund the payment, which could place new burdens on municipalities. Because of this, the ministry will let each municipality decide whether to require lump sum payments for national health insurance.

The health ministry will also begin improving its understanding of foreign residents’ payment history.

Currently, most local governments do not know whether foreign residents are paying their insurance premiums because they do not know the nationality or residence status of those enrolled in insurance.

Improvements will be made in fiscal 2026, and the Immigration Services Agency will use records of premium payments to screen residents as early as June 2027.

In the future, the government hopes to make it possible to also share information about whether foreigners are paying their pension premiums and medical fees. If foreigners are found to have not made the necessary payments, the government could refuse to renew their residence status.