I more or less broke even on a recent hospital stay
Anyone living in Japan is required to join the national health insurance (健康保険). This covers your medical expenses at clinics and hospitals. Most people are required to pay 30% of the costs themselves (some people pay 20% or even 10%), but there is a monthly cap on large medical expenses.
Because of these systems, private medical insurance (医療保険) is not really necessary in Japan, although some people choose to have it for peace of mind or to smooth out medical spending.
I have a medical insurance policy through Fukoku Seimei, mainly because my wife’s friend works for them and we wanted to do her a favour.
(this is not a good reason to take out insurance, by the way)
Last month I had to go into hospital for surgery on my knee (meniscus repair). The operation went well and after I got out of hospital I sent in a claim to my insurance company. They paid out as follows:
My policy pays 5,000 per day in hospital, so this time I received 20,000 yen for four days in hospital, 100,000 yen for the surgery itself (20x daily rate), and 50,000 yen for being hospitalised (10x daily rate).
Unfortunately I had to get a doctor’s report from the hospital to claim this, which cost me 11,000 yen.
However, I also have sports insurance through my jiu-jitsu club, provided by Tokyo Marine. I was able to claim for this insurance too, and they only required an online application form and a photo of the hospital bill. I received the following from them:
9,000 yen for hospital visits before the hospitalization (1,500 per visit), 16,000 yen for being in hospital for four days (4,000 yen per day), and 40,000 yen for the surgery (10x the daily rate).
So in total I received 235,000 yen from insurance for the operation and hospital stay/visits.
The total hospital bill was 126,990 yen, including a private room for the duration.
So in a way I made just over 100,000 yen’s worth of profit from having insurance. However, my Fukoku Seimei insurance costs 6,715 yen a month, and the sports insurance is about 3,000 yen a year.
I estimate I would have more money if I didn’t have insurance and instead invested that money and paid my medical bills myself. But there is not much in it.
I am fairly neutral on medical insurance. If you would feel better having it please shop around and find the cheapest option for your situation (don’t just buy it from your wife’s friend).
You can check kakaku.com to see what rates are like, or visit a hoken madoguchi shop.
If you don’t think you need medical insurance, you probably don’t. Just make sure you have an emergency fund so you can pay your own way without getting into trouble.
How about you? What’s your experience of medical insurance and hospital stays?
Hello, Ben. Thank you for your post. I have been looking into life insurance, so I will follow up once I am finished. Anyways, regarding medical insurance, I pay about 4,000 yen monthly to Alfac. I am enrolled in national health insurance, but I wanted medical insurance in case I needed to go to the hospital for a long period of time. When I had my surgery for my knee, I had to pay out of pocket but was reimbursed for the cost of my stay. Also, I got 10,000 per day for staying in the hospital. I also did not want to pay out of pocket so that is why I signed up for this insurance. Thanks for the post.
I recently did a 1 month stint in the hospital (pre and post a 6 hour operation). In addition to the National health insurance, we have our prefecture insurance. There are two or maybe three options. In my case, it pays out 10,000 per day for hospitalization and a small amount for death (that’s the balance we chose). My private room was 8,800/day so we came out even there. Fortunately the whole stay was within one month so I will need to pay the 80,000 deductible for just one month. Like you said, we have lost money on the prefecture insurance. We pay 48,000/year and this is our second time to claim benefits (first time was 10 day stay 18 years ago). We like the prefecture though because they return all of the unused money yearly to those who pay in. In our case, usually close to 10,000 every year is refunded.
It is often said that everyone in Japan has to join the national health system, but that isn’t really the case. When I came to Japan 20 odd years ago, working for AEON eikaiwa, they got us private insurance. I never used it, didn’t think much about it. After a couple of years away, I returned to Japan and signed up with Interglobal private insurers. A few years later I was married and the wife was pregnant. She insisted that I had to join the Japanese health system so that she could get benefits under my name. I had no choice, but wasn’t keen as it meant immediately owing 2 years (I think) back payments, even though I had my own insurance during that time. A million yen! Anyway, I never paid that as we moved cities and they apparently don’t track, so I rejoined Interglobal that has lower premiums. They have changed corporate insurers a few times, with AETNA recently stopping business in Japan altogether. They made a deal with Allianz to pick up their business at the same rates. At that time I toyed with rejoining the Japanese system, as it would be simpler in many ways. However, I was put off by the fact it would take a much bigger chunk of my income, and I would owe a small fortune immediately in back pay. Anyway, the moral of the story is that you are breaking no laws by not being in the Japanese system.
Employers have an obligation to enroll employees in shakai hoken, but this has not been enforced properly. It’s getting better though.
If you are self-employed and don’t own a company you might be able to get away with not enrolling, but it’s probably better to do so if you are planning to live here long-term.
I teach at several universities, and most of my fellow part-time teachers seem to be in a similar position. You are a finance guy; what makes more financial sense?
I currently pay under ¥300,000 a year for private health insurance from Allianz. It has more comprehensive coverage than Japan’s National Health System, though I have a deductible that means it wouldn’t be worth using unless I had medical bills over ¥200,000. To leave this system I would immediately owe over ¥1,500,000 in arrears and have to pay well over ¥500,000 annually (not sure on exact dues).
Should I join Japan’s system? If they don’t enforce the “law”, it can’t be that serious. To be honest, I’d rather be in Japan’s system. It’s simpler, but can’t accept the huge financial hit. Cheers.
This is a really interesting question, and I think it would make an interesting video, so look out for it on our YouTube channel.
For now, here are my thoughts:
1) I would look into the actual cost of NHI for your situation, rather than guessing
2) the maximum you have to backpay is 2 years, so I don’t see how your annual payment would be 500,000 but the arrears are 3x that
3) NHI premiums are completely tax deductible, unlike foreign health insurance (this alone might bring the premiums closer to what you pay now)
4) there is no deductible for NHI, but rather a cap on monthly spend for high cost treatments
5) does your private insurance actually cover you for serious illnesses, etc.? Will you be able to continue using it for the long-term?
6) are you paying into nenkin? That is legally mandated, and would give you access to iDeCo (or kokumin nenkin kikin if you are American). Not paying into a pension is something that most people regret very much when they are older
Hope that helps!
Thanks for your reply.
1) I did look into the actual figures a while back, but can’t remember the exact figures.
2) Maybe it was a million yen
3) I’m probably maxed out on tax deductibles at the minute, having built a house a few years ago. My wife is good at sorting that out.
4) With NHI you have to pay 30% of the costs, up to a point. Similar to a deductible in that you don’t get 100% returned.
5) Private insurance has high coverage, including serious illness, and not just in Japan (America excluded for obvious reason). Yes, you can continue for long term, though of course premiums will increase as you get older. There is a point as you get into your sixties that you would definitely be better off in NHI. I know some colleagues who have switched at that point. One craftily after lowering his schedule, thus income, for a couple of years, so as to reduce the costs.
6) Yes, I pay the max into nenkin (¥67,000 a month?)…. on your advice… haha! If the system crumbles, I’m blaming you.
Cheers!
>6) Yes, I pay the max into nenkin (¥67,000 a month?)
I think you are confused with your numbers.
If you are not paying nenkin through your employer (shakai hoken) then you are paying 16,520yen a month for kokumin nenkin.
https://www.nenkin.go.jp/service/pamphlet/kaigai/kokunenseido.files/2English.pdf
The 67,000 you mention may be the maximum iDeCo payment perhaps?
It is actually 68,000yen if you are Category 1.
https://www.ideco-koushiki.jp/english/