Long-Term Care Insurance in Japan: How It Works [2026]

Long-term care insurance lets you receive care services with a small co-payment when you need care. You join at age 40 and pay premiums. Foreign residents are covered too if registered. This guide covers how it works, premiums, certification and services.

① Who is insured

• Category 1: everyone aged 65+
• Category 2: ages 40–64 enrolled in public health insurance

Foreign residents who are registered and aged 40+ also join and pay premiums (no procedure needed).

② How premiums are paid

• Category 1 (65+): in principle deducted from pension; income-tiered premiums set by your municipality
• Category 2 (40–64): added to your health-insurance premium (deducted from salary and split with the employer for employees; added to NHI for others)

③ When you can use services

• Category 1: can use services if certified as needing care/support, regardless of cause
• Category 2: only when care is needed due to one of 16 "specified diseases" (e.g. terminal cancer, early-onset dementia, rheumatoid arthritis)

④ The care-certification process

1. Apply at your municipal office (by yourself, family or a community support center)
2. Home assessment + a doctor's opinion
3. Review → certified as Support Level 1–2 / Care Level 1–5
4. A care manager makes a care plan and services begin

⑤ Services and co-payment

• Home care (home help, day service), facilities (special nursing homes), community-based services, etc.
• The co-payment is 10% in principle; 20% or 30% for higher incomes
• If costs are high, high-cost care benefit refunds the amount over a ceiling

FAQ

Do foreign residents join long-term care insurance?Yes — if registered and aged 40+, you join and pay premiums. 65+ is Category 1, 40–64 is Category 2.

Can people aged 40–64 use care services?Only when care is needed due to one of 16 'specified diseases' such as terminal cancer or early-onset dementia.

How much is the co-payment?10% in principle, or 20%/30% depending on income. A high-cost care benefit refunds amounts over a ceiling.

Where do I apply?At your municipality's long-term care section or your local community comprehensive support center.