National Health Insurance in Japan After 40: Care Premiums, the Switch at 75, and Visa Renewal

Who this guide is for

This is for foreign residents aged 40 and over who are on National Health Insurance (kokumin kenko hoken, NHI) through their city or ward: the self-employed, early retirees, people between jobs, and spouses who are not covered by an employer plan. It is also for adult children helping a parent in Japan read a premium notice that suddenly got larger.

Three age lines change the bill: 40, 65 and 75. Each one changes what is collected and who collects it, and the third one moves the person into a different insurance system entirely. Unpaid premiums now also count in residence screening, which is why the bill matters more to a foreign resident than the yen amount alone suggests.

Related questions have their own pages. Enrollment rules, co-payments by age and the high-cost cap are in healthcare for foreign retirees in Japan. A first year back with no Japanese income is covered in your first-year National Health Insurance premium. What the care side of the system pays for is in our long-term care insurance guide.

What changes at 40

From the month a resident turns 40, they become a Category 2 insured person in long-term care insurance (kaigo hoken). MHLW's leaflet for people turning 40 says the status starts automatically at 40 and switches automatically to Category 1 at 65. For someone on NHI, the care premium is not a separate bill. It is collected as part of the NHI premium.

Yokohama's NHI page describes the same thing from the bill's side. For insured people aged 40 to 64, the city calculates a care portion (kaigo-bun) inside the NHI premium, and when someone in the household turns 40 it recalculates the premium after the birthday and sends a revised notice. Nationality does not change this. A foreign resident who is registered as a resident and expected to stay more than three months is insured on the same terms.

People who work for a company and are covered by its health insurance pay the care premium through payroll instead. Paying from 40 does not mean services are available from 40. Before 65, covered care applies only when the need comes from one of 16 specified diseases, explained in long-term care insurance under 65.

What changes at 65

At 65 the care portion leaves the NHI bill. Yokohama's care insurance page says that from 65 the care premium is no longer paid as part of the health insurance premium and is instead paid to the city individually. The city sets the amount from a base figure and the previous year's income, and it is usually deducted from a public pension of ¥180,000 a year or more.

So the NHI notice gets smaller at 65 and a second notice starts arriving. Households sometimes read the smaller NHI bill as a saving and miss the new care bill, which is how arrears start. Missed care premiums lead to a higher co-payment when care is needed later, as set out in unpaid long-term care premiums.

What changes at 75

On the 75th birthday the person leaves NHI and joins the Late-Stage Elderly Medical Care System (koki koreisha iryo seido). Yokohama's FAQ says this happens automatically from the birthday, with no application. People aged 65 to 74 with certain disabilities can also join once certified.

Kanagawa Prefecture's page confirms that foreign residents legally staying more than three months, other than short-term visitors, are covered: under 75 by NHI and from 75 by the Late-Stage system. The premium is set by the prefecture's wide-area union (koiki rengo), not the city, and the city collects it. Care insurance continues alongside it, so a person over 75 still receives the separate city care bill.

How Yokohama sets the premium

Every city sets its own NHI rates. The examples here use Yokohama only because the city publishes its full FY2026 (April 2026 to March 2027) rates, fixed by public notice on May 25, 2026. Other cities use different rates, and some add a flat charge per household, so treat these numbers as an illustration and check your own city's page.

In Yokohama the premium is calculated for each insured person and added up for the household. Each portion has a flat amount per person and an income-based amount. The income-based amount is a rate applied to the person's base income for the previous year: total income after the salary or pension deduction, minus a basic deduction of ¥430,000 for incomes up to ¥24 million. The premium is billed in ten instalments from June to March. Our National Health Insurance calculator runs the same arithmetic for Yokohama, Tokyo's 23 wards and six other major cities, including the low-income reductions.

Worked examples at Yokohama FY2026 rates

These examples apply the table above to simple households. They assume no low-income reduction applies. In FY2026, Yokohama's smallest reduction (20 percent of the flat amounts) stops at a household total income of ¥430,000 plus ¥570,000 per insured person, so ¥1,000,000 for one person and ¥1,570,000 for a couple with one earner. Both examples are above that line.

For the single 45-year-old, the medical portion is 8.33 percent of ¥3,000,000, which is ¥249,900, plus the ¥40,870 flat amount. The care portion is 2.84 percent of the same base, ¥85,200, plus ¥16,200. Turning 40 adds ¥101,400 a year to this person's bill, about ¥10,140 on each of the ten instalments. For the couple, both spouses pay the flat amounts even though one has no income, and the care portion is charged on both because both are between 40 and 64.

At 65, the ¥394,720 row applies to the NHI bill, and the city's separate care premium is added on top. That amount depends on the city's own bracket table and is not shown here.

The Late-Stage premium in Kanagawa

For residents of Yokohama and the rest of Kanagawa, the wide-area union's rates for FY2026 and FY2027 are a flat ¥52,531 per person plus 10.30 percent of base income for the medical portion. The child-support portion for FY2026 is ¥1,330 plus 0.25 percent. The annual caps are ¥850,000 for the medical portion and ¥21,000 for the child-support portion.

Take a 76-year-old living alone in Yokohama with a base income of ¥1,500,000. The medical portion is ¥154,500 plus ¥52,531, which is ¥207,031. The child-support portion is ¥3,750 plus ¥1,330, which is ¥5,080. The union drops amounts under ¥10, so the year's premium is about ¥212,110. A lower income can qualify for a reduction of the flat amounts. Kanagawa's FY2026 reduction lines start at ¥430,000 and are listed on the city page cited below.

What unpaid premiums mean now

Unpaid NHI premiums already count in residence screening. The Immigration Services Agency's guideline for changing status and extending the period of stay was last revised in June 2026. It says that where large or long-running arrears of NHI premiums come to light, serious cases are treated the same way as unpaid tax, which counts against the application. A note added to the guideline says the agency may decide using payment information it receives from other agencies.

Yokohama's NHI page states the point plainly: if premiums are unpaid, an extension of the period of stay may not be granted. The same page lists what the city itself does about arrears. It sends reminders, adds late charges once the deadline in the reminder has passed, and can seize savings, wages or insurance policies without further warning.

For permanent residence the test is stricter. ISA's permanent residence guideline asks that public pension and public medical insurance premiums have been paid properly. It adds that a premium paid late is in principle viewed negatively even if it has been settled by the time of the application.

What is planned from 2027

The government's package of measures for foreign nationals, decided by the Cabinet on January 23, 2026, sets out a data link. Cities are to upgrade their systems during FY2026 so they can see foreign residents' NHI collection status. For all residence statuses, ISA is to be able to check NHI payment information electronically from June 2027 through a My Number data link. The agency is considering how to use it in residence screening and to prompt payment where premiums are unpaid.

The same package says that from March 2027 ISA is to receive NHI and national pension payment information from the agencies that hold it. MHLW's explanatory material for municipalities describes cities sending about five years of each foreign insured person's payment records every month, a detail it says is still being coordinated. In its flow chart the examiner views any arrears with the applicant's consent. An applicant who does not consent is asked for a payment certificate, and without one the extension is in principle not granted. The same chart shows that paying, or agreeing an instalment plan, leads to a certificate or a document showing a relief measure. These are plans with dates, not rules in force today, and the details may change before they start. Check ISA's own pages before any application.

If a premium is hard to pay

The workable move is to contact the ward office before the deadline passes, not after. Yokohama allows a deferral of up to six months when a disaster, closing a business or a serious loss makes a premium impossible to pay at once, applied for before the due date with supporting documents. It also has reductions for disaster and for unemployment, and a separate relief for people who lost their job involuntarily.

If you are handling this for a parent from overseas, or the notices are in Japanese and the deadlines are close, contact us with the city and the notice you received. We can explain the bill and what to ask for at the ward office. Visa questions belong to an immigration lawyer or a gyoseishoshi, and we will tell you when to bring one in.

• Ask the ward office's insurance and pension section about deferral or reduction before the due date
• Keep receipts, or request a payment certificate (nofu shomeisho) from the city, before a residence application
• File the city's income declaration even in a year with no income, since a household without income records cannot get the low-income reductions
• Watch for the second notice at 65 and the move to a new system at 75, since both change who bills you