How Long-Term Care Insurance Premiums Are Paid in Japan: Pension Deduction or Payment Slip

Who pays what

Long-term care insurance (kaigo hoken) has two groups of insured people, and they pay in different ways. Residents aged 40 to 64 who belong to a medical insurance scheme are Category 2. Their care premium is collected by the health insurer together with the health insurance premium, so it never arrives as a separate bill. How that works on National Health Insurance is covered in National Health Insurance after 40, and when Category 2 people can actually use care is explained in long-term care insurance under 65.

Residents aged 65 and over are Category 1. Their premium is set by the city or town where they live and collected by that city, so it changes when the person moves. This page is about that Category 1 premium: the routes it travels, the calendar it follows, and how a family can keep it paid. What happens when it is not paid has its own page, unpaid care insurance premiums, and this page only summarizes it at the end.

MHLW published its fiscal 2025 survey of all 1,573 insurers on October 2, 2026. As of April 1, 2025, it counted about 32.21 million people paying by pension deduction and about 3.77 million paying by slip or bank debit.

Pension deduction rules

The default route is special collection (tokubetsu choshu), in which the pension payer takes the premium out of the pension before paying it. Article 131 of the Long-Term Care Insurance Act makes this the rule and uses ordinary collection only where special collection does not apply. Article 135 says the city shall collect the year's premium by deduction once the pension payer has reported the person in its April round. The person does not apply for it and cannot opt out of it.

The test is the pension, not the household. Under Article 134 each pension payer reports its recipients aged 65 and over to the city, leaving out anyone whose pension for the coming year is under the amount set by Cabinet Order. Article 41 of the Enforcement Order fixes that amount at ¥180,000 a year. Kagoshima City's page adds that the test applies to the pension used for deduction: two pensions that add up to ¥180,000 do not qualify if the one used for deduction is under that line.

Which pensions count is also fixed. Article 40 of the Enforcement Order lists the old-age basic pension, disability and survivors' pensions under the National Pension and Employees' Pension Insurance acts, and older public and mutual-aid pensions. Every item on the list is paid under a Japanese pension law. A pension from another country is not on it, so it cannot carry the deduction however large it is. Where a person has several listed pensions, Article 42 of the Order sets the order, and the old-age basic pension comes first.

This matters for foreign residents and returnees. An old-age basic pension earned from only a short period of Japanese coverage can fall under ¥180,000 a year even when the person lives comfortably on a foreign pension. In that case the premium is billed by slip or debit every year.

Kagoshima City lists further cases in which no deduction is taken:

• Only pensions outside the list are received, such as onkyu
• The pension is temporarily stopped, for example because a status report was filed late
• The address held by the pension payer differs from the resident record
• The person moved in from another city or turned 65 during the fiscal year

Payment slips and debit

Everyone else pays by ordinary collection (futsu choshu). The city sends a payment notice and slips, and the insured person pays them. Article 132 makes the insured person liable and adds two people who are jointly liable: the head of the household and the spouse. A son or daughter living in a separate household is not on that list. The instalment dates are set by each city's ordinance under Article 133.

Koto Ward splits the year's premium into ten instalments from June to March, each due at the end of its month. Itabashi Ward bills monthly. Both wards accept slips at banks, convenience stores and ward counters. Both also list smartphone payment: Koto names Mobile Regi and some e-money services, and Itabashi names Mobile Regi and PayPay among others.

Bank debit (koza furikae) has to be set up separately. It does not start by itself when a slip arrives. Itabashi takes applications on a paper form, by Pay-easy at a ward counter with the bank cash card, or online. An online application starts debiting from the following month. Itabashi's payment page adds that debit covers only ordinary collection, so a pension deduction cannot be moved to a bank account. In MHLW's survey, 1,556 insurers (98.9 percent) offered debit for slip payers.

Provisional and final

Japanese public pensions are paid six times a year, in the even months, so the deduction happens six times too. The premium for the fiscal year starting in April cannot be fixed until the previous year's income is assessed for resident tax. The law therefore splits the year in two. From April to September the pension payer takes a provisional amount (kari choshu). From October to February it takes the final amount (hon choshu), which settles the balance.

Under Article 140, the April deduction equals one of the previous year's October-to-February instalments. June and August normally repeat it, but the city may set a different figure where that amount would be unsuitable. Many do. MHLW's survey counted 631 insurers (40.1 percent) that changed the provisional amount from June 2025 and 825 (52.4 percent) that changed it from August 2025. Under Article 136, the final instalment is the year's premium minus what was taken from April to September, divided by the remaining payments.

Koto Ward sends every resident aged 65 and over a premium decision notice in June, once resident tax is set. That is the letter showing the year's amount. If the premium rises later in the year, for example after an amended tax return, Koto bills the difference by slip instead of adding it to the deduction. That is one reason a parent whose premium comes out of the pension can still receive a slip.

When deduction starts

Deduction does not start on the 65th birthday or on the day a parent registers at a new address. The city learns of a new pensioner only through the payer's reports, and Article 134 fixes six report rounds a year. Each one looks at status on the first day of an even month, from April 1 through to February 1.

Article 135 then sets what the city may do. For people reported in the June and August rounds, it may collect part of the current year's premium by deduction. For people reported later, deduction is set to begin in the next fiscal year, within the April-to-September provisional stretch. Kagoshima's page shows both patterns in its arithmetic, with a first-time deduction starting in April or in June.

In practice the slip period lasts months. Koto Ward says that after turning 65 or moving in, deduction does not start for six months to a year, until the Japan Pension Service is ready. Itabashi Ward says the same people pay by slip for a while. Koto adds that it sends a notice when deduction begins. Until that notice arrives, each slip in the envelope needs paying.

Back to slips

Deduction can also stop. Under Article 139, a person may stop receiving the pension used for deduction. The city then collects the rest by slip at the next instalment dates, or at once if none are left. The same article requires the city to refund any excess the pension payer sent in. Where the person still owes premiums, it allows the city to put that refund toward them.

So a parent can move between the two routes several times. Check the route on each year's notices from the city.

Paying from abroad

A family abroad has three realistic routes. Debit from the parent's Japanese bank account is the steadiest, since nobody has to see the slip. Itabashi's online application can be completed for an account at more than 60 institutions, though it still needs the parent's bank account details. A relative or helper in Japan can also take the slips to a convenience store or bank before each due date.

The third route is smartphone payment where the city offers it. Koto and Itabashi both list it. Itabashi says it works from anywhere at any time, but neither ward mentions use from outside Japan. Test one instalment early instead of on the last day. If none of the routes fits, ask the city's care insurance section how it accepts payment for a resident whose family is abroad.

Keep the receipts with the decision notice as the record of paid months.

Mail and address

Slips go to the address the city holds. Under Article 131, the payment notice may also be sent to the household head or the spouse. A parent who has moved into a facility, gone into hospital or left the house empty may never see the envelope.

Some cities let the mailing address be changed. Koto and Nerima both describe a procedure for sending care insurance notices to another address. Ask the parent's city whether it has one and who may apply. Planning who checks the post is covered in managing a parent's finances from overseas.

Tax deduction for payers

Care insurance premiums count for the social insurance premium deduction on a Japanese tax return. The National Tax Agency's guidance says a resident taxpayer can deduct premiums they paid for themselves or for a spouse or relative who shares their living expenses (seikei o itsu ni suru).

Who paid decides who deducts. In the agency's Q&A, a premium taken from a wife's pension was paid by the wife, so her husband cannot deduct it even though he supports her. For a premium paid by bank debit, the agency's answer on the late-stage medical premium gives the deduction to the account holder, provided that person is the insured person or a relative sharing living expenses.

So a child in Japan who shares living expenses with the parent and pays the slips from their own money may be able to deduct them, while a pension-deducted premium belongs to the parent's return. The deduction is written for resident taxpayers. A child who lives abroad and is not taxed in Japan as a resident should ask a tax accountant before counting on it.

Moving or leaving Japan

Under Article 11, status with a city ends on the day after the person stops having an address there. When the person moves straight into another Japanese city, it ends that same day. Nerima Ward's guidance says the premium is then recalculated by month and owed up to the month before the one containing the end date. Anything overpaid is refunded.

The new city starts its own premium, usually by slip, and the deduction gap described above applies again. Leaving Japan works the same way: status ends with the address and the old city recalculates. A parent leaving Japan for good should also read leaving Japan with long-term care insurance. One returning after years abroad re-enters the system at registration, as set out in re-enrolling in health and care insurance.

After a death

A death ends status the same way, and Nerima Ward recalculates the premium by month. Any overpayment goes to the heirs, after overdue premiums are offset against it.

Nerima accepts a refund claim from close relatives such as a spouse or child, and anyone else must prove the relationship. A person who renounced the inheritance cannot claim. The right to the refund ends two years after the refund notice is sent.

Late payment

A missed slip starts a timetable set in the Act. After a year overdue, the city can switch care to full payment up front with a refund later. After eighteen months, refunds can be withheld. The right to collect a premium lapses after two years under Article 200, but a demand letter renews that period, and a lapsed premium later raises the co-payment for a set number of months. The details and the fixes are in unpaid care insurance premiums.

Residence status is a separate concern. The Immigration Services Agency adopted a guideline on revoking permanent residence on October 1, 2026. It applies from April 1, 2027. It treats willfully not paying public levies as a ground and defines them broadly as compulsory charges collected for public purposes. Its examples are health insurance and pension premiums, and it does not name the care premium. Inability to pay for reasons outside the person's control does not count. What unpaid health insurance premiums already mean for visa renewals is covered in National Health Insurance after 40. For the wider system, see the long-term care insurance guide.