What Japan's Health Insurance Won't Cover (The Costly List)

Information current as of March 2026 based on MHLW approved treatment lists, Kyokai Kenpo guidelines, and municipal health program information. As the founder of LO-PAL and a former Medical Coordinator for Foreign Patients at a hospital in Osaka, I helped patients navigate surprise bills caused by these coverage gaps — the "I thought insurance covered this" moment is more common than you'd think.

Quick reference: covered vs. not covered

Category	Covered (30% copay)	NOT covered (100% your cost)
Dental	Basic fillings, extractions, metal crowns, root canals, periodontal treatment	Implants (¥300,000–500,000/tooth), ceramic crowns, whitening, orthodontics
Vision	Eye disease treatment (glaucoma, cataracts, infections)	Glasses, contact lenses, LASIK, vision correction
Mental health	Psychiatrist consultations, prescription medication, inpatient psychiatric care	Counseling with clinical psychologists (¥6,000–15,000/session)
Childbirth	C-sections, complications, medically indicated procedures	Normal (uncomplicated) delivery — ¥400,000–650,000
Vaccinations	N/A (not billed through insurance)	Flu shots (~¥3,000–5,000), most voluntary vaccines
Checkups	Diagnostic tests when symptoms exist	General health checkups (人間ドック: ¥30,000–100,000+)
Hospital extras	Standard shared room, treatment, standard meals	Private room surcharge (差額ベッド代: ¥5,000–30,000+/night)
Cosmetic	Reconstructive surgery after injury/disease	Cosmetic procedures, botox, hair transplant
Fertility	IVF, ICSI, and many treatments (covered since April 2022)	Some advanced/experimental fertility procedures

Dental: the biggest surprise

Japanese health insurance covers basic dental care well — fillings, extractions, root canals, and metal crowns are all covered at the standard 30% copay. A typical covered filling costs ¥2,000–3,000 out of pocket.

But anything beyond basic care is fully out of pocket:

• Implants: ¥300,000–500,000 per tooth. Some clinics charge more.
• Ceramic or white crowns: ¥50,000–150,000 per tooth (metal crowns are covered, ceramic is not)
• Orthodontics (braces): ¥600,000–1,200,000 for full treatment
• Teeth whitening: ¥10,000–50,000 per session

Tip: If you need extensive dental work not covered by insurance, some people fly to their home country or to nearby countries where costs are lower. If you choose to have it done in Japan, many dental clinics offer payment plans (分割払い).

Vision: glasses and contacts are 100% your cost

Insurance covers treatment for eye diseases (glaucoma, cataracts, conjunctivitis) but not vision correction:

• Glasses: ¥5,000–50,000+ depending on frames and lenses
• Contact lenses: ¥3,000–10,000/month for disposables
• LASIK: ¥200,000–500,000 for both eyes

Exception for children: Corrective glasses prescribed by a doctor for children aged 8 and under are partially reimbursed by insurance (up to approximately ¥38,900 for glasses).

Tip: Budget eyewear chains like JINS, Zoff, and Owndays offer glasses from ¥5,000–¥10,000 including lenses. No prescription is needed — they do an eye test in-store.

Mental health: psychiatry is covered, counseling usually isn't

This distinction catches many people off guard:

Covered (30% copay)	NOT covered
Psychiatrist (精神科医) consultations	Counseling with clinical psychologists in private practice (¥6,000–15,000/session)
Prescription medications (antidepressants, anti-anxiety, sleep aids)	Coaching, couples therapy, life coaching
Psychosomatic medicine (心療内科) visits	Online therapy platforms (typically ¥5,000–15,000/session)
Inpatient psychiatric care

Cost saver — Jiritsu Shien Iryo (自立支援医療): If you have an ongoing psychiatric condition (depression, anxiety disorder, bipolar disorder, schizophrenia, epilepsy, etc.), you can apply for this program at city hall with a psychiatrist's certificate. It reduces your copay from 30% to 10% for all related outpatient psychiatric treatment and medication. This can save tens of thousands of yen per year.

How to apply:

1. Ask your psychiatrist for a diagnostic certificate (診断書)
2. Bring it to your city hall's disability welfare counter (障害福祉課)
3. Say: 「自立支援医療の申請をしたいです」(jiritsu shien iryō no shinsei o shitai desu)
4. Processing takes 1–2 months; the benefit is retroactive to your application date

Childbirth: normal delivery isn't covered (but you get ¥500,000)

Japanese health insurance treats normal (uncomplicated) childbirth as a non-medical event — not a "disease" — so it's not covered by the 70/30 insurance split.

Instead, all enrolled mothers receive the 出産育児一時金 (shussan ikuji ichijikin) — a lump-sum payment of ¥500,000 (increased from ¥420,000 in April 2023). In most cases, this is paid directly to the hospital so you only pay the difference.

Scenario	Coverage
Normal vaginal delivery	NOT covered — ¥500,000 lump sum offsets cost
C-section	Surgical portion covered at 30% copay + lump sum
Complications during delivery	Medical treatment covered at 30% copay + lump sum
Prenatal checkups	14 free vouchers from city hall (worth ¥80,000–120,000 total)
Private room during delivery	NOT covered (surcharge varies by hospital)

Future change: The government has announced plans to bring normal childbirth under health insurance coverage, but the implementation date has been pushed to FY2028. Until then, the ¥500,000 lump sum system remains.

For the full breakdown, see our guide to childbirth costs in Japan.

Vaccinations: it depends on the type

Vaccinations in Japan are not billed through health insurance at all — but that doesn't mean you always pay full price.

Routine vaccinations (定期接種) — publicly funded

These are provided free or at minimal cost through your local government's voucher system, not through health insurance:

• For children: Hib, Pneumococcal, Hepatitis B, Rotavirus, DPT/IPV, BCG, MR (Measles/Rubella), Chicken Pox, Japanese Encephalitis, HPV
• For elderly (65+): Influenza, Pneumococcal

Check your city hall's health department (保健センター) for the schedule and vouchers.

Voluntary vaccinations (任意接種) — self-pay

These are 100% out of pocket:

• Influenza (general population): ~¥3,000–5,000 per shot
• Mumps: ~¥5,000–8,000
• Hepatitis A: ~¥7,000–10,000 per dose
• Meningococcal: ~¥20,000–25,000

Other notable exclusions

• Health checkups (人間ドック / ningen dock): Comprehensive screenings cost ¥30,000–100,000+. However, many employers offer annual checkups (健康診断) for free, and NHI members can get basic municipal health checks (特定健康診査) for free or at low cost.
• Private hospital rooms (差額ベッド代): If you request (or are assigned) a private room, the surcharge is not covered. Costs: ¥5,000–30,000+/night. You cannot be forced to pay this if no shared rooms were available — it only applies when you request it.
• Advanced medical treatments (先進医療): Cutting-edge treatments not yet approved under standard insurance are fully out of pocket. This is a major reason some people buy private insurance (民間保険) in Japan.
• Injuries from certain causes: Self-inflicted injuries, injuries from fights, criminal activity, or severe drunkenness may not be covered.
• Treatment abroad: Limited reimbursement is possible (海外療養費) but only at Japanese rates, which are typically far lower than costs in the US or Europe.

How to manage the gaps

Gap	Strategy
Dental implants/orthodontics	Medical expense tax deduction (医療費控除) if you spend over ¥100,000/year on medical expenses
Mental health counseling	Apply for Jiritsu Shien Iryo (10% copay for psychiatry); look for hospital-affiliated counselors who bill through psychiatry
Childbirth	¥500,000 lump sum + high-cost medical cap for complications
Large hospital bills	High-cost medical care system caps monthly out-of-pocket (~¥80,000–90,000 for most incomes)
Advanced treatments	Private health insurance (民間保険) — Aflac, MetLife, etc. offer supplemental plans
General out-of-pocket	Medical expense tax deduction (確定申告 at tax office) for total medical spending over ¥100,000/year

Useful Japanese at the hospital

English	Japanese	Romaji
Is this treatment covered by insurance?	この治療は保険適用ですか？	Kono chiryō wa hoken tekiyō desu ka?
How much will I pay out of pocket?	自己負担はいくらですか？	Jiko futan wa ikura desu ka?
I want the insurance-covered option	保険適用のものでお願いします	Hoken tekiyō no mono de onegai shimasu
I'd like to apply for Jiritsu Shien Iryo	自立支援医療を申請したいです	Jiritsu shien iryō o shinsei shitai desu
Can I get a cost estimate before treatment?	治療前に費用の見積もりをもらえますか？	Chiryō mae ni hiyō no mitsumori o moraemasu ka?
I don't need a private room	個室は不要です	Koshitsu wa fuyō desu

Related articles

• Health Insurance in Japan: 5 Mistakes That Cost Foreigners
• How to Cap a Huge Hospital Bill in Japan
• Japan's 2026 Free Childbirth Plan
• Myna Hokensho in 2026: Your Paper Card Is Gone

Not sure if your treatment is covered? Post your question on LO-PAL for free — a local Japanese helper can call the hospital or clinic in advance and confirm coverage, costs, and alternative options before your appointment.