Medical Costs and the 30% Copayment

How the copayment system works

Japan’s national health insurance system covers services according to a standardized fee schedule (診療報酬, shinryō hōshū) set and updated biannually by the Ministry of Health, Labour and Welfare. When you visit a clinic or hospital, the insured share is paid directly to the medical institution by the insurance fund; you pay the patient’s share — the copayment (自己負担, jiko futankin) — at the front desk when checking out.

For most working-age adults (aged 18 to 69), the copayment is 30% of the applicable schedule fee. This rate is uniform across all insurance schemes — NHI and shakai hoken alike — so the insurance carrier does not change what you pay at the counter.

The fee schedule covers outpatient consultations, in-clinic procedures, diagnostic imaging and blood tests, inpatient care, and medications prescribed and dispensed under the national formulary. Dental services listed in the schedule are covered; others are not.

Age-based copayment variations

The copayment rate varies by age. Children benefit from additional local subsidies that vary significantly by municipality; in many areas children under 18 effectively pay nothing out-of-pocket because the local government’s subsidy program covers the standard 30% on their behalf. Residents aged 70 to 74 pay a reduced copayment of 20%, except for those with higher incomes, who remain at 30%. Residents aged 75 and over transfer to the Latter-Stage Elderly Medical Insurance scheme (後期高齢者医療), where the copayment is 10% for most participants, rising to 20% or 30% for higher-income individuals.

What you pay at different facility types

The amount you pay at checkout depends on the type of care you received and the type of facility. For a routine outpatient consultation at a small clinic, a typical visit (consultation fee plus a basic examination) might cost ¥1,000–¥3,000 out of pocket at 30%. The same visit at a large designated hospital can be higher because of the additional surcharge imposed for patients without a referral letter.

Inpatient care generates both the standard 30% copayment on medical services and separate fees for meals (a fixed daily fee set at roughly ¥460–¥490 per meal under the 2024 schedule) and, at some facilities, room amenity fees for private or semi-private rooms. Amenity fees are not covered by insurance and are listed separately on your bill.

Prescriptions are billed at a separate stage: after receiving your prescription slip (処方箋, shohōsen) from the clinic, you take it to a pharmacy, which charges a dispensing fee in addition to the drug cost. Both are subject to the 30% copayment.

Reading your receipt

Request an itemized receipt (明細書, meisaisho) at checkout. This document lists each diagnostic code, treatment code, and pharmaceutical code, with the total fee and your 30% share for each. Keep these receipts for the fiscal year; medical expenses above ¥100,000 (or 5% of your total income, whichever is lower) qualify for an income tax medical expense deduction (医療費控除, iryōhi kōjo) when you file a tax return.

Non-covered services and mixed billing

Services outside the national fee schedule are classified as non-covered (保険適用外, hoken tekiyō gai) and billed at 100%. The clinic sets its own price for non-covered services. Japan’s mixed billing rule generally prohibits combining covered and non-covered services in a single consultation — if a non-covered treatment is added, the entire visit may become self-pay at the clinic’s private rates. Certain explicitly listed exceptions allow mixed billing, but these are specific to particular treatments. If you are uncertain whether a proposed treatment is covered, ask the clinic before it is performed.

Last reviewed: September 2026