Japan has formally ended the use of traditional health insurance cards, completing a shift to the My Number identification system as the main means of verifying eligibility for public medical services. The change represents a shift in how patients present coverage at hospitals, clinics, and pharmacies, with implications for health system administration, data use, and insurance operations in Japan.
A report by The Mainichi revealed that as of Dec. 2, the function of health insurance cards has been integrated into My Number ID cards, according to the Ministry of Health, Labor, and Welfare. Existing employer-based and National Health Insurance cards officially expired on Dec. 1, following a phased wind-down that began last year. The government has established a transition period under which expired cards can still be presented at medical institutions until the end of March next year. During this period, policyholders will continue to pay the usual share of treatment costs, typically between 10% and 30% of medical expenses at the point of service.
Residents who do not have a My Number card remain eligible for insured medical treatment. They can present a separate certificate confirming enrolment in a public health insurance scheme, which allows access to services for those who have not shifted to using the digital ID. The ministry said using My Number as a health insurance identifier is intended to make it easier for medical institutions to refer to a patient’s health records and prescription history, potentially reducing administrative burdens and improving data consistency across providers.
The My Number system was launched in 2016 as a unified national identification framework. Since then, incidents involving personal information leaks and registration mistakes have been reported, contributing to public scepticism and slowing widespread use. Employer-based health insurance cards, covering around 78 million people, stopped being issued in December last year, with a one-year grace period before expiry. Under the National Health Insurance program, which generally covers the self-employed and unemployed, about 70% of cards expired at the end of July this year, with the remainder expiring on Dec. 1, effectively ending almost all physical card usage.
As of the end of October, 87.3 million people had registered their My Number card for use as a health insurance card, representing 88% of all My Number holders, ministry figures show. However, only 37.1% of cardholders had actually used their My Number card in a health insurance context, indicating that practical adoption lags behind registration. For insurers, intermediaries, and health providers, these usage patterns will be relevant in assessing the impact on claims processes, eligibility checks, and the integration of medical data within the My Number framework.
Alongside the transition to My Number for health identification, Japan is preparing a separate regulatory shift aimed at foreign residents who participate in the public health and pension systems but fall behind on payments. Government sources have indicated that the Ministry of Health, Labor, and Welfare and the Immigration Services Agency plan to factor individuals’ public health insurance and pension payment histories into decisions on renewing or changing residency status. According to reporting by NHK World Japan, implementation is targeted for June 2027.
Foreign nationals staying in Japan for three months or longer are required to enrol in the country’s national pension and public health insurance schemes. Recent data show contribution gaps. For the fiscal year ending March 2025, foreign residents paid 49.7% of the pension amounts due. A survey of 150 municipal governments found that foreign residents had paid an average of 63% of their assessed health insurance premiums by the end of the previous year. Authorities have also identified cases of foreign nationals leaving Japan with unpaid health insurance premiums after using public healthcare services. Under the planned changes, residency procedures would be linked more closely to contribution records, tightening enforcement of social insurance obligations and targeting unpaid premiums.
