Japan’s Kaigo Insurance Explained: Payments, Eligibility, and the First Application

2026年9月20日

Japan’s Kaigo Insurance Explained: Payments, Eligibility, and the First Application

Japan’s long-term care insurance system is called kaigo hoken (介護保険). Registered residents generally begin paying into it at age 40, but paying premiums does not automatically mean that every illness or care need is covered.

The central distinction is age:

At 65 or older, you may use covered services after the municipality certifies that you need support or care, regardless of the cause.
From 40 to 64, you must be enrolled in medical insurance, and the need for care must result from one of the specified age-related diseases defined by the system.
In either group, you normally need municipal certification before insurance-funded services begin.
Most approved users pay 10% of covered service costs, although some people aged 65 or older pay 20% or 30% according to income.

This guide is for foreign residents planning their own care, helping a parent or spouse in Japan, or trying to understand a new premium notice. The information is current as of August 22, 2026, but premium amounts, available providers, and some support programs differ by municipality.

TOC

Paying and using the system are two separate questions

The most important point is simple: premium liability is based mainly on age and enrollment, while access to services depends on care certification and, for people under 65, the cause of the condition.

Japan divides insured residents into two groups.

Category 1: residents aged 65 or older

This group is called dai-ichigō hihokensha (第1号被保険者), or Category 1 insured persons.

A Category 1 resident can apply when physical or mental difficulties make everyday activities harder. Examples of the activities assessed include bathing, using the toilet, eating, moving around, and managing daily life safely.

The cause does not have to be one of the specified diseases used for younger applicants. What matters is the municipality’s decision about the person’s need for ongoing support or care.

Category 2: residents aged 40 to 64

This group is called dai-nigō hihokensha (第2号被保険者), or Category 2 insured persons. It covers people aged 40 to 64 who are enrolled in a Japanese medical insurance program.

They can receive kaigo insurance benefits only when their need for care is caused by a legally specified age-related disease. The national list includes conditions such as:

early-onset dementia;
cerebrovascular disease, including certain effects of stroke;
terminal cancer that meets the applicable conditions;
Parkinson’s disease and related disorders;
rheumatoid arthritis;
amyotrophic lateral sclerosis, or ALS;
osteoporosis with fracture;
spinal canal stenosis;
chronic obstructive pulmonary disease;
advanced osteoarthritis affecting both knee or hip joints;
diabetic complications such as neuropathy, nephropathy, or retinopathy.

There are 16 specified disease categories in total. A diagnosis alone does not guarantee approval: the municipality still evaluates how much assistance the applicant needs and whether the condition satisfies the insurance rules.

Someone aged 50 who needs help after an accident, for example, may not qualify through kaigo hoken if the need is unrelated to a specified disease. Medical insurance, disability welfare, municipal assistance, or private services may be relevant instead.

ここがポイント: A resident aged 65 or older is assessed according to care needs regardless of the cause. A resident aged 40 to 64 must satisfy both the care-needs test and the specified-disease rule.

When foreign residents join kaigo hoken

Nationality is not the main test. Municipal registration, age, medical insurance enrollment, expected period of residence, and certain legal exclusions determine coverage.

Official English guidance from Shinjuku states that registered foreign residents are included under the same basic age rules. Yokohama likewise describes coverage for registered residents aged 65 or older and residents aged 40 to 64 who belong to a medical insurance scheme.

In practice, check your status with the municipality where your jūminhyō (住民票), or resident record, is registered. Short stays and special residence situations need individual confirmation. Osaka City, for example, explains that a foreign national initially admitted for three months or less may still be covered if the person’s purpose and living circumstances show an expected stay of more than three months.

This matters in several common situations:

You recently entered Japan and are unsure whether your registration has activated coverage.
Your period or status of residence has changed.
You moved from one municipality to another.
You live in a facility subject to a special insurance exception.
You are 40 to 64 but are not enrolled in Japanese medical insurance.

Do not decide from the residence-card period alone. Ask the municipal kaigo insurance counter to confirm your enrollment date and whether any exception applies.

How premiums are collected

The payment route changes at age 65. There is no single national premium amount that every resident pays.

Ages 40 to 64: usually part of medical insurance

For Category 2 insured persons, the kaigo contribution is generally collected with medical insurance premiums.

If you have employees’ health insurance, the contribution is included with your health-insurance payment. The Ministry of Health, Labour and Welfare explains that the employee and employer generally share this premium equally.
If you have National Health Insurance, the kaigo portion is calculated and collected with the household’s National Health Insurance premium.

This is why a worker may never receive a separate kaigo payment slip even though kaigo premiums are being paid. Look at your salary statement or medical-insurance notice, and ask payroll or the insurer if the breakdown is unclear.

Age 65 and over: the municipality calculates the premium

From age 65, the municipality calculates an individual Category 1 premium. The amount reflects local service costs and the resident’s income category, so it varies between cities and wards.

Payment may be:

withheld from an eligible public pension;
made with municipal payment slips;
collected by bank transfer.

A person who has just turned 65 or recently moved may initially receive payment slips even if pension withholding will apply later. Read notices carrying terms such as kaigo hokenryō (介護保険料), meaning long-term care insurance premium, and nōnyū tsūchisho (納入通知書), meaning payment notice.

Municipal premium schedules are generally set for three-year planning periods. The current ninth long-term care insurance planning period runs from fiscal 2024 through fiscal 2026, but the actual brackets and annual amounts remain local. A Shinjuku amount should not be used to estimate a bill in Yokohama, Osaka, or another municipality.

What you pay when services begin

Premiums are the cost of participating in the insurance system. A copayment is the separate amount charged when an approved person actually uses a covered service.

The standard user share is:

10% for Category 2 users aged 40 to 64;
10% for most Category 1 users aged 65 or older;
20% or 30% for Category 1 users above the applicable income thresholds.

The applicable percentage appears on the kaigo hoken futan wariai shō (介護保険負担割合証), or long-term care insurance copayment-rate certificate. Show it with the kaigo insurance certificate when required.

Not every charge is included in the percentage

The 10%, 20%, or 30% share applies to covered service fees within the approved plan and benefit limit. It does not mean that every care-related expense is reduced to that percentage.

Depending on the service, the user may separately pay for:

meals;
accommodation or room charges;
everyday personal supplies;
services beyond the monthly insurance limit;
optional services not covered by kaigo hoken.

Facility care can therefore cost much more than a quick calculation based only on the copayment rate suggests. Before signing, ask the provider for a written estimate separating the insured service fee from meals, accommodation, optional charges, and non-covered expenses.

Income- and asset-based assistance may reduce certain meal, accommodation, or copayment costs. The names and application forms can be difficult to identify, so ask whether the household qualifies for a futan genmen (負担減免), meaning a reduction or exemption, or a certificate limiting eligible facility costs.

How to apply for care services

The application starts with the municipality, not with a private nursing home. The standard national process has four main stages.

1. Contact the municipal counter or support center

Ask for yō-kaigo nintei (要介護認定) or yō-shien nintei (要支援認定)—certification of a need for care or support.

Applications are commonly accepted by:

the city or ward office’s elderly-care or kaigo insurance section;
a chiiki hōkatsu shien sentā (地域包括支援センター), or Community General Support Center;
an authorized in-home care support provider acting on the applicant’s behalf.

Community General Support Centers offer free consultations and may have a different English name locally. They are often the best first contact when a family knows that help is needed but does not yet know which service to request.

2. Prepare the application information

Exact requirements vary, but applicants commonly need:

the municipal application form;
the long-term care insurance certificate for a Category 1 applicant;
medical-insurance eligibility information for a Category 2 applicant;
the name and contact details of the regular medical institution and doctor;
identity or authorization documents if someone applies on the resident’s behalf.

Health-insurance cards have been replaced in many administrative situations by My Number Card-based confirmation or a shikaku kakuninsho (資格確認書), or eligibility confirmation document. Follow the current document list issued by your municipality rather than relying on an old checklist.

If the applicant has no regular doctor, tell the counter immediately. The doctor’s written opinion is a central part of certification.

3. Complete the home assessment and medical review

A municipal assessor interviews the applicant, usually at home or in the place where the person is staying. The questions cover physical movement, memory and understanding, behavior, medical care, and assistance with daily activities.

The municipality also requests a written opinion from the named doctor. A certification committee then reviews the assessment and medical information.

The result will normally be one of the following:

yō-shien 1 or 2 (要支援1・2): Support Level 1 or 2;
yō-kaigo 1 to 5 (要介護1～5): Care Level 1 to 5;
not certified under the insurance criteria.

The Ministry states that a decision should, in principle, be notified within 30 days. Delays can occur when medical information is missing or the assessment cannot be completed promptly.

4. Build a care plan before using services

A person certified at Care Level 1 to 5 normally contracts with an in-home care support provider for home-based care. A kea manējā (ケアマネジャー), or care manager, discusses the person’s needs and prepares a kea puran (ケアプラン).

For Support Level 1 or 2, the Community General Support Center or an assigned provider generally coordinates a preventive-care plan. A person seeking admission to a facility usually applies to the facility itself after certification.

The care plan matters because insurance benefits are not an unrestricted cash allowance. It links the certified level to specific services, schedules, providers, and monthly benefit limits.

Services that may be available

Approved services are intended to support daily life, maintain abilities, and reduce unsafe or unsustainable care arrangements.

Common examples include:

home visits for bathing, toileting, meals, cleaning, or other covered assistance;
home-visit nursing under medical direction;
day care and rehabilitation;
short stays that can also give family caregivers a break;
rental or purchase support for specified welfare equipment;
eligible home modifications;
dementia group homes and other residential services;
intensive care homes, rehabilitation facilities, and long-term care medical facilities.

Availability is not uniform. Community-based services are operated for residents of a defined municipality, and vacancies, provider capacity, transportation areas, and local programs can differ sharply. Yokohama, for example, states that its community-based services are generally limited to people insured by Yokohama City.

Certification also does not guarantee immediate admission to a preferred facility. Ask about waiting lists, admission criteria, language support, medical capability, and total monthly charges before choosing a provider.

Common mistakes that delay help or increase costs

A few misunderstandings repeatedly cause practical problems.

Waiting for a crisis before asking

A Community General Support Center can discuss declining mobility, memory problems, caregiver strain, and prevention programs before a hospital discharge or household crisis. Some municipal prevention and daily-life assistance programs are available without full care certification.

Assuming a medical diagnosis is enough

Kaigo certification measures the help required in daily life. Give the assessor specific, accurate information: whether the person can stand safely, remember medication, prepare meals, use the toilet at night, or remain alone without danger.

Do not minimize difficulties out of embarrassment. Do not exaggerate them either. Explain what happens on both good and bad days and what assistance another person actually provides.

Confusing medical insurance with kaigo insurance

Medical insurance mainly covers diagnosis and treatment. Kaigo insurance covers approved support and care services. Home nursing, rehabilitation, and equipment can sit near the boundary, so the responsible insurance depends on the person’s condition and the service ordered.

Ask the doctor and care manager which system applies before arranging a service privately.

Ignoring premium notices after moving or turning 65

Collection can change from payroll or National Health Insurance to a municipal bill. Late payment may lead to stricter payment arrangements, a higher user burden, or collection action.

If unemployment, disaster, or another serious event makes payment difficult, contact the municipality before arrears grow. Reductions or exemptions may be available under local rules.

Expecting English support from every provider

Some municipalities publish multilingual guides or offer interpretation through a call center, but individual care providers may operate mainly in Japanese. Ask early about:

interpretation during assessment and care-plan meetings;
translated contracts and fee schedules;
emergency contact procedures;
dietary, religious, and communication needs;
whether a family member may join meetings remotely.

Bring a trusted interpreter when necessary, but confirm privacy and authorization requirements before sharing medical or financial records.

Current status in 2026

The basic age groups, certification route, and 10% to 30% service copayments remain the practical starting points as of August 22, 2026.

The Ministry of Health, Labour and Welfare has also published materials on a 2026 amendment to the Long-Term Care Insurance Act. An enacted amendment does not mean that every provision changes a resident’s bill or application immediately; commencement dates, implementing rules, and local notices control what happens in practice.

For a decision now, use documents issued by your municipality for fiscal 2026 and confirm:

your current premium category and payment method;
the percentage on your copayment-rate certificate;
the current application form and accepted insurance documents;
local reductions for premiums, facility charges, or high monthly copayments;
provider availability and any municipality-only service restrictions.

Practical next steps

If you or a family member may soon need support, do not begin by searching randomly for a nursing facility. Start with the system that decides eligibility.

Find the kaigo insurance section of the city or ward where the person is registered.
Ask for the nearest Community General Support Center.
Confirm whether the person is Category 1 or Category 2 and, if under 65, whether the condition may be a specified disease.
Collect the insurance documents and regular doctor’s details.
Request a written estimate separating covered service copayments from meals, accommodation, and optional costs.

The key document to watch is the municipality’s certification result. Until it arrives, you do not yet know the approved level, benefit limit, or insured care plan—and those three points determine which kaigo services can actually be used.

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