The Envelope You Did Not Expect
What This Coupon Actually Is
A postcard-sized voucher that arrives from the municipal office a few months after enrolling in National Health Insurance is a checkup ticket, not junk mail, and using it is usually free.
Foreign retirees who enroll in Japan's National Health Insurance system for the first time are often surprised when, a few months later, a postcard-sized voucher arrives from the municipal office. It is easy to assume it is an advertisement and toss it, especially if the household has not yet registered a preference for Japanese or English mail. The voucher is a checkup coupon (kenshin ken), and it is the entry point to Japan's preventive health system for residents over 40. Ignoring it is the single most common reason retirees miss a year of free screening.
The coupon is tied to two separate government programs depending on age. Residents 40 to 74 enrolled in municipal National Health Insurance receive an invitation for the specific health checkup (tokutei kenshin), a metabolic-syndrome-focused exam created under the High-Age Medical Care Confirmation Act. Residents 75 and older are automatically shifted into the Late-Stage Elderly Medical Care System, as described in our guide to healthcare enrollment for foreign retirees, and receive a separate, fully free checkup coupon under that system instead.
Neither checkup diagnoses disease on its own. Both measure blood pressure, blood tests, urine tests, and body measurements, and both exist to catch high blood sugar, high cholesterol, and kidney decline early, before they become the kind of chronic condition that drives up long-term medical and care costs. Municipal cancer screening (gan kenshin) is a third, separate program that residents can usually book alongside either checkup, at the same clinic, on the same visit.
Are You Actually Eligible?
Eligibility depends on which public insurance you carry and your age on the relevant date, not on nationality or visa type.
Eligibility for the specific health checkup requires enrollment in a municipality's National Health Insurance and being 40 to 74 years old as of the fiscal year (April to March). Foreign residents who work for a company and are covered by employees' health insurance (shakai hoken) instead receive an equivalent checkup through their employer, not the municipality, so the municipal coupon is specifically a National Health Insurance benefit.
Residents turning 75 during the fiscal year are moved into the Late-Stage Elderly Medical Care System from the month after their birthday, and a new checkup coupon for that system follows automatically, generally sent from mid-April with a window running through the end of March the next year. There is no separate application: the municipality tracks age from residence registration.
Visa category, nationality, and length of residence do not affect eligibility once a person is properly enrolled in National Health Insurance or the Late-Stage system. What does affect it is whether the household kept its address registration current, since the coupon is mailed to the registered residence. Families who moved recently should confirm the new address was updated at the ward or city office; our pre-move checklist covers this registration step in the context of arrival.
Comparing the Three Programs
Specific Health Checkup, Ages 40 to 74
The specific health checkup is free in most municipalities and, where it is not, the self-pay portion is small and capped.
The specific health checkup targets metabolic syndrome: it measures waist circumference, BMI, blood pressure, blood sugar (HbA1c or fasting glucose), lipids, and liver function through a blood draw and urine test. In Kawasaki City, for example, the checkup itself is free for National Health Insurance members aged 40 to 74, with the checkup ticket mailed in mid-June and valid through the end of March the following year. The one common add-on charge is a PSA prostate test for male members 50 and older, which carries a small separate fee (around ¥400 in Kawasaki) because it sits outside the core metabolic panel.
Municipalities vary in how they price the base checkup, and some charge a modest flat fee rather than offering it free, so households should read the coupon itself or call the number printed on it rather than assume a nationwide figure applies. What is consistent nationwide is the age band (40 to 74), the annual frequency, and the metabolic focus of the test panel.
Anyone who scores above the threshold on the checkup is offered specific health guidance (tokutei hoken shido), a follow-up counseling program aimed at lifestyle change rather than treatment. It is optional, and skipping it does not affect eligibility for next year's checkup.
Late-Stage Elderly Checkup, Ages 75 and Older
Once a resident moves into the Late-Stage Elderly Medical Care System at 75, the equivalent checkup is fully free, with the same core test panel as the working-age version.
The late-stage elderly checkup mirrors the specific health checkup's core panel (blood pressure, blood sugar, lipids, liver and kidney markers, urine test) but is administered through the Late-Stage Elderly Medical Care System rather than National Health Insurance. In Kawasaki City it costs nothing for the recipient; the same is generally true across municipalities because the late-stage system centralizes cost differently than working-age National Health Insurance.
Coupons for this checkup are typically mailed from mid-April, with a receipt window running to the end of the following March. Residents who turn 75, or who move into Kawasaki as an existing 75-plus enrollee, receive their coupon roughly two months after the system registers the change, rather than at the same mid-April point as continuing enrollees.
Because clinic capacity is limited during the peak months, municipalities generally recommend booking early rather than waiting for the final weeks of the fiscal year. A late booking risk is not financial (the checkup stays free within the valid window) but scheduling: popular clinics fill their preferred appointment slots months ahead.
Municipal Cancer Screening Alongside Either Checkup
Cancer screening is priced per test, not bundled with the metabolic checkup, and typical self-pay amounts run from a few hundred to a few thousand yen per screening.
Municipal cancer screening follows the age bands and intervals set out in the health ministry's cancer screening guideline: cervical cancer screening from age 20 every two years, lung, colorectal, and breast cancer screening from age 40 (lung and colorectal annually, breast every two years), and gastric cancer screening from age 50 every two years for the standard endoscopy option. The barium X-ray option is also available from age 50 every two years, but a transitional measure in the guideline still lets many municipalities offer it annually to residents 40 and older; endoscopy does not have that annual option.
Self-pay amounts are set by each municipality rather than nationally, so the figures below are illustrative of a typical mid-size city rather than universal. In Kawasaki City, published self-pay amounts include roughly ¥900 for a lung X-ray, ¥700 for a colorectal fecal test, ¥2,500 for a gastric X-ray or ¥3,000 for gastric endoscopy, ¥1,000 for a mammogram, and ¥1,000 to ¥1,800 for cervical screening depending on scope. Residents 70 and older are commonly exempt from the self-pay charge entirely in the same municipality, and many cities also mail free vouchers for breast and cervical screening to residents in specific age brackets.
Because the copay structure differs by municipality and by test, retirees should treat any number seen online, including the Kawasaki figures above, as a reference point rather than a fixed nationwide price, and confirm the actual self-pay amount printed on their own coupon or through their city's cancer screening call center before booking.
| Checkup or screening | Age band | Frequency | Typical self-pay |
|---|---|---|---|
| Specific health checkup (tokutei kenshin) | 40 to 74, National Health Insurance | Annual | Free in many cities; small fee in some |
| Late-stage elderly checkup | 75 and older | Annual | Free |
| Gastric cancer screening | 50 and older (X-ray or endoscopy) | Every 1 to 2 years | Approx. ¥2,500 to ¥3,000 |
| Lung cancer screening | 40 and older | Annual | Approx. ¥900 to ¥1,100 |
| Colorectal cancer screening | 40 and older | Annual | Approx. ¥700 |
| Breast cancer screening | 40 and older | Every 2 years | Approx. ¥1,000; free coupon at set ages |
| Cervical cancer screening | 20 and older | Every 2 years | Approx. ¥1,000 to ¥1,800; free coupon at set ages |
Deciding What to Book This Year
Do You Actually Need to Book Cancer Screening Too?
Book cancer screening in the same visit whenever the age band matches, since the marginal cost is small and the metabolic checkup does not itself detect cancer.
The specific health checkup and late-stage elderly checkup are built to catch metabolic and kidney problems; they do not include imaging or tests aimed at detecting cancer. A retiree who only completes the metabolic checkup and skips cancer screening has covered one risk category and left the other unaddressed, even though both are available through the same municipal system and, in many clinics, the same appointment.
The decision point for most households is not whether to screen at all but which tests match the household's age band and family history. A person over 50 who has never had a gastric screening, for instance, faces a materially different risk profile from someone who had a clear endoscopy two years ago, and clinics generally let patients discuss history before choosing between the X-ray and endoscopy options for gastric screening.
Retirees who are also managing a parent's care, rather than only their own health, should note that the checkup coupon system applies to the retiree as an individual resident, not as a household. Each eligible family member enrolled in National Health Insurance or the Late-Stage system receives an individual coupon, so a spouse or parent living in the same household needs to check their own mail rather than assume one coupon covers everyone.
When the Checkup Finds Something
An abnormal result routes into ordinary medical care, and a result suggesting reduced independence can also route into the long-term care insurance system, which is a separate application.
If a specific health checkup or late-stage elderly checkup returns an abnormal value, the clinic generally recommends a follow-up appointment for further testing or referral to a specialist, billed through ordinary National Health Insurance or Late-Stage Elderly Medical Care cost-sharing rather than through the free checkup budget. This is medical care, not long-term care, and it does not require any separate application.
Cancer screening results that come back positive for further investigation (yosei, meaning the screening flagged a marker requiring more precise testing) similarly route into a follow-up diagnostic appointment, generally at reduced or standard insurance cost-sharing rather than free. A yosei result is not a diagnosis; it means the screening test could not rule out a concern and a more detailed test is needed.
Checkup results that point toward declining physical or cognitive function, rather than a specific disease, are the trigger many families use to start a long-term care insurance application, since needing help with daily activities is the threshold the certification process actually measures. Our guides to long-term care insurance eligibility and to what that insurance does not cover walk through what happens after a checkup raises that kind of concern, including the certification process and the costs that remain the household's responsibility. For costs the checkup itself does not touch, such as dental work or hearing aids, our breakdown of what National Health Insurance does not cover covers the budgeting side in more detail.
Frequently asked questions
Does the free specific health checkup cover a full-body scan or only the metabolic tests?
The specific health checkup covers a defined metabolic panel only: waist measurement, BMI, blood pressure, blood sugar, lipids, and liver function through blood and urine tests. It does not include imaging tests for cancer or a general full-body scan; those require the separate municipal cancer screening program or a private comprehensive checkup (ningen dock) paid out of pocket.
If I turn 75 partway through the fiscal year, when do I get the late-stage elderly checkup coupon instead of the working-age one?
The Late-Stage Elderly Medical Care System registers residents from the month after their 75th birthday, and the checkup coupon for that system is generally sent about two months after the registration change, rather than at the same mid-April point as continuing enrollees.
Is the PSA prostate test included automatically in the specific health checkup for men over 50?
No. In municipalities such as Kawasaki, the PSA test is an optional add-on for male members 50 and older, billed separately from the free core checkup, at a small additional fee (around ¥400 in Kawasaki).
How much does gastric cancer screening cost if I choose endoscopy instead of the X-ray?
In a mid-size municipality such as Kawasaki, the endoscopy option for gastric cancer screening runs slightly higher than the X-ray option, at roughly ¥3,000 versus roughly ¥2,500, though the exact figures are set by each municipality and should be confirmed against the resident's own coupon.
Does using National Health Insurance for the specific health checkup affect eligibility for employees' health insurance checkups later if I go back to work?
No. The checkup channel simply follows whichever public insurance currently covers the resident. Someone who later takes paid work and moves to employees' health insurance receives an equivalent employer-arranged checkup instead of the municipal coupon, with no penalty or gap tied to the earlier National Health Insurance checkup.
Do foreign residents need a Japanese guarantor or referral letter to use the checkup coupon at a clinic?
No guarantor or referral letter is required. The coupon itself, together with a health insurance card or the equivalent qualification confirmation document, is what the clinic listed in the coupon's enclosed facility directory asks for at check-in.
How Japan Care Concierge can help
We prepare the care and medical side of a move to Japan: continuity of treatment, insurance steps, and the support structure waiting on arrival.
Primary and official references
We prioritize primary and official information when checking this article. Rules, costs, and local procedures can change, so verify the linked official sources before making a final decision. Last source check: 2026-07-05.
- MHLW: Specific Health Checkups and Specific Health Guidance
- MHLW: Cancer Screening policy page
- MHLW: Guideline for Cancer Prevention Health Education and Cancer Screening Implementation (PDF, Japanese)
- Kawasaki City: Specific Health Checkup (National Health Insurance) guide (Japanese)
- Kawasaki City: Late-Stage Elderly Medical Care health checkup guide (Japanese)
- Kawasaki City: Cancer screening cost FAQ (Japanese)
About this article
This article is general orientation, not medical, legal, or individual care advice. Rules, costs, and service availability vary by municipality and by situation, so confirm specifics with the institutions involved or with licensed professionals. Publication and update dates above are actual dates. How we research, source, and correct articles is described in our editorial policy.