The My Number Health Insurance Card (Maina Hokensho) for Foreign Seniors in Japan

Why the old paper insurance card stopped working

Japan's health insurance ministry stopped issuing new paper insurance cards on December 2, 2024, so anyone who arrives in Japan now cannot simply be handed one at city hall.

If you are researching this because you or a parent just moved to Japan, the timing matters. From December 2, 2024, insurers in Japan stopped issuing and reissuing the familiar paper or plastic health insurance card. Anyone who already held one could keep using it until it expired, but new enrollees, including a foreign senior who just registered residency, never receive a paper card at all. For the full sequence of what to set up in the weeks after landing, the hub guide on moving to Japan with elderly parents covers registration, insurance, and housing together; this article stays on one piece of that sequence, the hospital-window document itself.

This is a different question from whether Japan's health insurance system covers a foreign resident's care at all. That broader enrollment and cost picture, including what age brackets pay and how coverage shifts into late-stage elderly care, is handled in healthcare for foreign retirees in Japan. Here, the focus is narrower and more immediate: once you are enrolled, what physical or digital proof do you actually carry to the clinic desk, now that the old card is gone.

The government did not leave a gap. Two replacements exist side by side: the My Number card registered for insurance use, commonly called a maina hokensho, and a paper-free certificate called a shikaku kakuninsho for anyone who has not linked a My Number card. A foreign senior who has not yet gone through Japan's residency paperwork will usually meet both terms in the same conversation at the municipal office, and confusing them is a common mistake new arrivals make.

The grace period is shorter than most guides say

Even an already-expired paper card is not accepted forever; the temporary measure allowing it ends on July 31, 2026.

Cards that were still valid when the December 2024 cutoff hit were allowed to keep working until their own expiry date, generally about one year later. After that, Japan's health ministry has run a temporary tolerance measure letting clinics still accept an expired paper card or a "notification of qualification information" mailer without turning a patient away. That measure was first set to end in March 2026, then extended once. As of the ministry's March 19, 2026 briefing, the cutoff for that tolerance is now July 31, 2026, and the health minister said at the time that no further extension is expected past that date.

The practical takeaway for a foreign senior reading this in mid-2026: do not plan around "the old card still works." By August 2026, a clinic in Japan is expected to ask for either a My Number card set up as a maina hokensho or a shikaku kakuninsho, full stop. If you are still holding only an expired paper card past that date, budget time to sort out one of the two replacements before you need urgent care, not after.

Maina hokensho, shikaku kakuninsho, or the old card: what actually differs

The three documents differ mainly in whether you need a My Number card, how long they last, and what happens if you lose them.

The shikaku kakuninsho is the option most relevant to a foreign senior who has not yet, or does not want to, register a My Number card for medical use. Insurers were required to mail one automatically to anyone enrolled in national health insurance who had not linked a My Number card by around November 2025, and new enrollees receive one as a matter of course when they register. It costs nothing, and losing it is a minor inconvenience rather than a real problem: you call or visit your insurer's counter and a replacement is issued.

The maina hokensho route depends entirely on having a My Number card first, which for a foreign resident is a separate application tied to your residence registration, not automatic. If you have not looked into whether you need one before setting up other paperwork such as a bank account or continuing an existing prescription, the sequencing questions overlap with banking and money for foreign retirees in Japan and continuing your medication after moving to Japan, both of which also ask for identity verification early in the same first weeks.

One frequent point of confusion: a maina hokensho is not a separate physical card. It is your existing My Number card, read at a facial-recognition card reader in the clinic or pharmacy lobby, with your insurance data linked behind it in the system. There is nothing extra to carry beyond the one card, and no PIN is required at the reader itself for the health insurance function, though a PIN may still be asked for at first-time registration.

How your residence status changes the picture

A foreign resident's My Number card expires on the same date as their residence card, not on a fixed multi-year cycle.

For Japanese nationals, the My Number card runs on a standard multi-year validity cycle. For a foreign resident, the card's expiry is instead pegged to the residence period shown on your residence card or special permanent resident certificate. This means a senior who moves to Japan under, say, a one-year visa status and later extends it needs to renew the My Number card at the same time as the residence card renewal, not separately. Anyone weighing which visa route to enter under in the first place, since the choice affects how often this renewal cycle repeats, can compare the options in Japan retirement visa options for seniors.

If the residence period lapses before the renewal is done, both the My Number card and, more importantly, national health insurance eligibility can lapse with it. A maina hokensho or shikaku kakuninsho cannot substitute for a missing insurance enrollment; the document only proves eligibility that has to exist underneath it. Practically, this means the renewal reminder for your residence card should trigger a parallel check on your My Number card and your insurance status, not be treated as three unrelated errands.

This sequencing question is different again from the situation covered in re-enrolling in health insurance and long-term care insurance after years abroad, which is written for a returning Japanese national or long-time former resident re-activating a lapsed enrollment. A first-time foreign arrival is not re-enrolling; the enrollment, the My Number card, and the residence status are all being set up together for the first time, and the order matters more the first time through.

Should a newly arrived senior register for a maina hokensho right away?

Registering the My Number card for insurance use as soon as it arrives avoids a second trip to the municipal office later, but it is not strictly mandatory since the shikaku kakuninsho exists as a no-cost fallback.

If you already plan to get a My Number card for other reasons, such as tax filings, banking, or simply because it doubles as photo identification, registering it for insurance use at the same time costs nothing extra and saves a separate errand. Registration can be done at the municipal counter when the card is issued, through the My Number portal app, or at a facial-recognition card reader the first time you visit a participating clinic or pharmacy.

If you would rather not manage a My Number card at all, whether from unfamiliarity or a simple preference to keep fewer documents, the shikaku kakuninsho is a genuinely equal substitute for medical purposes. It confirms the same insurance eligibility, it is free, and clinics are required to accept it exactly as they accept the maina hokensho. The only real cost of skipping the My Number route is losing the convenience of automatic eligibility checks at the electronic reader; with a shikaku kakuninsho, staff manually confirm your details, which takes a little longer but changes nothing about your coverage.

The one scenario where getting a My Number card sooner rather than later clearly helps a foreign senior is a household where an adult child abroad is coordinating care remotely and needs the parent's paperwork to be as few separate documents as possible. Consolidating identity, insurance, and eventually pension and tax matters onto one card reduces what has to be tracked from overseas, a concern also raised throughout the moving to Japan with elderly parents checklist.

What to actually bring to your first hospital visit

Bring whichever of the two current documents you already hold, plus your residence card, since staff will cross-check both.

In practice, a first hospital or clinic visit as a newly arrived foreign senior should include your residence card, your insurance document, whether that is the maina hokensho on your My Number card or a shikaku kakuninsho, and, if you have one, the notification postcard your insurer mailed when you enrolled. If you are past July 31, 2026 and still hold neither replacement document, contact your municipal insurance counter before the appointment rather than at the reception desk; they can usually issue a shikaku kakuninsho same-day or confirm your eligibility by phone to the clinic directly.

None of this is legal or medical advice, and the exact mechanics of registration, timelines for automatic mailing, and acceptable substitute documents vary somewhat by municipality and by insurer. If anything above does not match what your city office tells you, follow the local instruction; this article describes the national framework, not every local variation.