A Child’s Medical Costs: the Age Covered and What You Pay Depend on Your Municipality

When a child sees a doctor in Japan, if they are enrolled in health insurance, you pay 20% or 30% of the medical cost at the counter. In practice, though, what you actually pay at the counter is often reduced to zero, or to just a few hundred yen per visit. That is because the municipality where you live subsidizes the cost of a child’s medical care.

As of April 2025, every municipality in the country provides this subsidy. However, the age up to which it is provided, whether it is limited by a parent’s income, and whether you pay a small amount at the counter, all differ by municipality. The following is based on the health insurance laws (via the e-Gov law search), a survey by the Children and Families Agency, and guidance from the City of Yokohama and the Tokyo Metropolitan Government, confirmed in September 2026. This article does not judge what applies in your own municipality.

National health insurance: 20% before starting elementary school, 30% after

The share you pay at the counter (the copayment) when you see a doctor under health insurance is set by law. For children, it is as follows.

Which health insurance you are enrolled in is covered in the article on Japan’s health insurance and pension — there is no social security agreement with Ukraine, and preparing to see a doctor is covered in the article on before you visit a hospital in Japan. The child medical expense subsidy is a system in which the municipality further covers this 20% or 30% share of health insurance.

Every municipality subsidizes it, but the details vary widely

According to the Children and Families Agency, each municipality provides the child medical expense subsidy, and each prefecture supports it based on its own guidelines. In the agency’s survey (as of April 1, 2025), all 47 prefectures and 1,741 municipalities were providing a subsidy. The breakdown by municipality is as follows.

In the same survey, 1,692 municipalities set no income cap for the outpatient subsidy, while 49 did. For outpatient care, 1,319 municipalities charge no copayment at the counter, while 422 do.

The age that prefectures use as the baseline for their own support is often lower than what municipalities actually provide. For outpatient care, “up to before starting elementary school” was the most common prefectural baseline, used by 17 prefectures. Most municipalities subsidize a wider range than their prefecture’s baseline.

Differences also exist within the same prefecture. Here are examples from three cities in Hokkaido (as of April 1, 2025).

Yokohama’s example: full coverage through the end of the fiscal year the child turns 18

Yokohama’s “Pediatric Medical Expense Subsidy” (小児医療費助成) fully covers the health-insurance copayment for a child who has an address in the city and is enrolled in health insurance. From June 1, 2026, coverage was expanded to run from age 0 through the end of the fiscal year in which the child turns 18 (the first March 31 after the 18th birthday). At the time of the Children and Families Agency’s survey (April 2025), it ran only through the end of the fiscal year the child turned 15.

• How to apply: through Yokohama’s childcare-support site “Pamatoko,” by mail, or at a ward office counter. Submitting the application form and something confirming your health insurance coverage (as the city’s guidance puts it, an eligibility confirmation certificate, a notice of eligibility information, or similar) gets you the medical certificate.
• How to use it: show the medical certificate along with your My Number health insurance card or similar at a medical institution within Kanagawa Prefecture.
• When the medical certificate cannot be used: at a medical institution outside Kanagawa Prefecture, you pay the copayment yourself first and then apply to the ward office for reimbursement. Reimbursement takes around three months, and you can no longer apply after five years from the first day of the month following the visit.
• Not covered: things not covered by insurance, such as the charge for a private hospital room, document fees, and health checkups. Also excluded if you are receiving another medical subsidy (such as for single-parent households) or public assistance.
• Injuries at school: for an injury that happens under the school’s supervision, you do not use the medical certificate; instead you go through the disaster mutual-aid benefit procedure of the Japan Sport Council.

A child who has turned 18 is legally an adult under the Civil Code, so in Yokohama they apply in their own name.

Tokyo’s example: three medical certificates by age

Wards, cities, and towns within Tokyo issue three medical certificates by age, based on the metropolitan government’s system.

The metropolitan government notes that the extent of the subsidy differs by ward, city, or town, and that some charge no copayment at the counter. The residency requirement, too, differs by ward, city, or town. If you see a doctor outside Tokyo, you pay first and then apply at the ward, city, or town where you live. A child not enrolled in health insurance, a child receiving public assistance, or a child placed in a facility under a welfare measure is not covered under any of these systems.

What you need before receiving the subsidy

The conditions common to both the Yokohama and Tokyo examples are having an address in that municipality and being enrolled in health insurance. Neither municipality’s guidance mentions a nationality requirement. For a family that has just come to Japan, the order is as follows.

• Register as a resident with the municipality (report your move-in). The vocabulary of this procedure is covered in the article on words that come up in Japan’s resident registration — within 14 days of moving.
• Enroll your child in National Health Insurance or your workplace’s health insurance.
• Apply for your child’s medical certificate at the municipality’s relevant counter (it may not arrive automatically).

If you move to another municipality, your previous medical certificate stops working. Yokohama states that if you use the certificate to see a doctor after you are no longer eligible, you will be asked to repay the subsidized amount. Apply again at your new municipality.

What to check at the counter

• Up to what age (through the end of which school year) outpatient and inpatient care are covered
• Whether there is an income cap on the parent
• Whether you pay anything at the counter (how much per visit, and whether there is a cap)
• How to get reimbursed if you see a doctor outside your prefecture, or at a medical institution that does not accept the medical certificate
• Whether the guidance materials are available in Ukrainian or English