Travel insurance for Japan: do you need it?

As of today, Japan does not require travel insurance to enter as a tourist: it is not an entry requirement the way a passport is. Even so, the Japanese authorities have for years strongly recommended that all visitors travel insured. In fact, the Japanese government has floated making it mandatory, partly because of the problem of medical bills that some tourists leave unpaid; there is no confirmed official date, so it is worth checking the current situation before your trip.

Official channels in many countries (embassies and foreign offices) likewise advise travellers to hold private accident and illness cover that also includes repatriation costs. This is therefore not a commercial recommendation: it is what official sources advise too.

The fact that it is not mandatory does not mean it makes no difference whether you carry it. The underlying reason is financial: if you have a medical problem in Japan without coverage, the cost is entirely out of your pocket, and healthcare there is not cheap for a foreigner. That is why, for the vast majority of travellers, taking out travel insurance is one of those decisions you almost never regret.

Japan has a high-quality healthcare system, with modern hospitals and good care. The important nuance is that this system is designed for residents with their national health insurance; a foreign tourist without coverage pays the full rate, just like any private patient.

In practice, this means two things worth knowing:

• Upfront payment. Many medical centres ask uninsured patients to pay for care in advance or on the spot, especially if there is admission. It is not like systems where emergencies are treated first and sorted out afterwards.
• Bills that escalate quickly. A simple consultation already carries a meaningful cost, and from there any test, an emergency or, above all, a hospital stay of several days can turn into very high figures. A multi-day admission or surgery are by far what drive the bill up the most.

This is not about scaring you with exact figures, but about understanding the order of magnitude. As a rough guide, just to give you an idea (the real amounts vary a great deal by centre, city and treatment):

• A medical consultation can be a few thousand yen; a fuller visit or one with a specialist goes up from there. In general we are talking about tens of euros at the exchange rate.
• A night of hospitalisation tends to be in the range of tens of thousands of yen, that is, several hundred euros per day.
• A procedure with a multi-day stay (for example appendicitis or a fracture requiring surgery) can easily reach figures on the order of a million yen or more, equivalent to several thousand euros.
• A serious emergency with transfer and surgery is the worst case and can reach much higher amounts, in the range of several thousand euros and up.

The idea is simple: what you would resolve at home with public healthcare can mean serious spending in Japan if you travel without insurance. To place this risk within the trip as a whole, you can lean on the guide to how much it costs to travel to Japan and, if it is your first time, on the guide to travelling to Japan for the first time.

This is one of the most expensive and most common mistakes. The European Health Insurance Card (EHIC) grants the right to necessary healthcare during a temporary stay, but only within a specific geographic area: the countries of the European Union, the rest of the European Economic Area (Iceland, Liechtenstein and Norway), Switzerland and the United Kingdom.

Japan falls outside that area as it belongs neither to the EU nor the EEA. In other words: your European health card gives you no coverage in Japan. Nor do the medical insurances of your provider or your bank card work on their own, unless they expressly cover international travel to Japan with a sufficient limit; it is worth reading the fine print before assuming they are valid.

Not all travel insurance is the same, and the cheapest is not always the one that suits you. More than the price, what matters is what it covers and with what limits. These are the points people tend to focus on when comparing policies for Japan:

• Medical expenses and hospitalisation. This is the core cover for Japan. What matters here is the maximum limit: the higher, the better the margin against an emergency or admission. It is the line item most worth getting right.
• Repatriation and medical evacuation. Medical transfer to your country, or between hospitals, is among the most expensive things that can happen; having it included avoids the worst case.
• Common illness and 24-hour assistance. That it covers everyday illnesses (not just accidents) and has an assistance line operating at any hour, ideally in your language.
• Baggage. Loss, theft or damage to baggage, and significant delays in its delivery.
• Cancellation and early return. If you need to cancel the trip before leaving or return early for a covered reason. Check carefully which reasons qualify.
• Civil liability. For damage to third parties you may cause during the trip.
• Sports and activities. If you plan to ski, do mountain hiking, diving or other activities, check they are included; many basic policies exclude them.

As a quick reference, many comparisons recommend a generous medical expenses limit for Japan (it is common to see policies with limits of hundreds of thousands of euros, and even no limit), precisely because the medical line item is the one that can spike the most. Adjust the rest of the cover to your type of trip. This guide does not recommend or sell any specific policy: comparison and purchase are up to you, through whichever channels you prefer.

Before travelling it is worth reviewing it alongside the rest of your preparations, such as what to pack in your suitcase, the visa or entry formalities and how to handle money in Japan.

Everything above is intended for a short or medium-length tourist trip. If your plan is different (a long stay, studying, working or residing in Japan), the situation changes and tourist travel insurance is usually not the right tool.

In those cases the Japanese national health insurance (when you register as a resident), international health insurance specific to expats, or the particular requirements of the corresponding visa usually come into play. If you fit one of these scenarios, get information through the official channels for your visa, because the rules are different from those for tourism.

Having insurance is only half of it; knowing how to use it on the day you need it is the other half. A few simple habits save you trouble:

• Always keep the 24-hour assistance number handy and the policy number, on your phone and also written down separately in case you run out of battery.
• Contact your insurer before going to the centre whenever possible (except in a serious emergency): they can point you to an in-network centre, authorise the expense or arrange direct payment.
• Keep all bills, reports and receipts. Without documentation, the later reimbursement gets complicated.
• Note the address of the centre and carry any relevant medical details (allergies, medication) translated or in English if you can.
• Review excesses and exclusions before leaving, so you are not caught out about what is and is not included.