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Guide

How the premiums work, and what arrears cost you

Everyone pays from the age of 40. At 65 it stops coming out with the health premium and becomes a separate bill from the city, which is where arrears begin. One year and you pay up front and claim back; eighteen months and refunds stop; two years and your own share rises to 30 or 40 percent, with no way to settle the debt.

Everyone pays from the age of 40. And falling behind raises your own share to 30% or 40% when you eventually need care. After two years the debt passes the limitation period and can no longer be paid at all.

How you pay depends on your age

Aged 40–64Aged 65 and over
Paid toTogether with your health insuranceThe city, individually
AmountSet by your health insurerBanded by your and your household's tax and income
MethodWith the health premiumDeducted from the pension, or by slip or direct debit

At 65 it stops coming out with the health premium and becomes a separate bill from the city. This is where arrears start without anyone noticing.

Whether it comes out of your pension is not your choice

If you receive 180,000 yen a year or more in public pension, it is deducted at source as a rule. Otherwise you pay by slip or direct debit.

The method is set by law; you cannot pick. Deduction also does not begin the moment you turn 65 — until it does, you pay by slip. That gap is the most common way people fall behind.

What happens if you fall behind

How far behindWhat happens
1 yearYou pay in full and claim back. The whole cost up front, refunded on application. Room and meals in a facility are charged in full too
18 monthsThe refund is suspended, and may be set against the unpaid premiums
2 yearsYour share rises to 30% or 40%. Room and meals are charged in full, and the high-cost refund is not paid

Premiums more than two years overdue can no longer be paid. You cannot settle them even if you want to, and the heavier share stays for a set period. There is no way back.

Care is usually needed years after the premiums start. By then nobody remembers a gap from years ago. You find out at the counter, when you try to use the service.

If you cannot pay, say so

Reductions and deferrals exist for disaster, job loss and similar. Whether they apply is decided by the city. What matters is not staying silent — instalments can sometimes be arranged. Leaving it until the limitation period is the most expensive option.

Bands and amounts are reviewed every three years. Check the current figures at the source. The restrictions above are national, under the Long-Term Care Insurance Act.

Find your support centre Official page (Japanese)

Source: Kawasaki City · Last verified 2026-09-13. Rules change. Check the source page before you act on this. This is a plain-English summary of public information, not an official translation.

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