Foreign residents in Japan may soon be required to prepay their National Health Insurance premiums when enrolling, under a new proposal put forward by the ruling Liberal Democratic Party (LDP).
The proposal, introduced on 21 May 2025, calls for a system where foreign nationals pay premiums in advance when joining the country’s public health insurance program. The plan will soon be submitted to the relevant ministries and government agencies for review.
According to Japan’s Ministry of Health, Labour and Welfare, all foreign residents staying in Japan for more than three months are required to enrol in the National Health Insurance (NHI) system.
However, a recent survey conducted by the ministry across around 150 municipalities revealed that only 63% of foreign residents were paying their insurance premiums, significantly lower than the 93% payment rate among Japanese citizens.
This was the first government-led study focused specifically on health insurance participation by foreign residents in Japan. The findings have raised concerns among lawmakers, some of whom fear that people may be entering the country to take advantage of the system, especially for costly medical treatments.
In response, the ministry conducted a deeper investigation into how many foreigners pay their premiums and the kinds of benefits they receive under the insurance program.
The LDP’s proposal suggests that a lack of awareness and understanding of Japan’s tax and social insurance systems among foreign residents may be contributing to the lower payment rate. It recommends proactively educating foreign nationals about the NHI system before they arrive in Japan to help improve compliance and understanding.
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