By xajikh786123 
Health Insurance vs Medical Insurance: What is the difference between medical insurance and health insurance?
Medical insurance provided by private insurance companies and national health insurance (public health insurance system) have different roles and characteristics.
While some argue that private insurance is unnecessary due to the extensive coverage provided by the national health insurance system, there are still costs that aren’t fully covered by the public health insurance program. cannot cover, so the decision depends on the situation.
This article explains the differences between medical insurance and health insurance (public health insurance system), including the roles and characteristics of each. If you are unsure about whether to sign up for private health insurance, please use this article as a reference.
What is medical insurance?
What is insurance (public medical insurance system)?
What is private medical insurance?
Differences between private medical insurance and insurance (public medical insurance system)
Obligation to join
Insurance premiums and coverage
How to receive insurance benefits
Should I get private medical insurance?
It can supplement the parts that cannot be covered by health insurance (public medical insurance system).
Expanding treatment options
Compensate for the parts that public health insurance does not cover with private health insurance
What is medical insurance?
Many insurances, including medical insurance, are operated based on the spirit of mutual aid (helping each other). Medical insurance is a system in which many insured people pool their money together to receive coverage when they need money to treat illness or injury.
There are two types of medical insurance: insurance (public medical insurance system) which all citizens are required to join, and medical insurance offered by private insurance companies.
What is health insurance (public medical insurance system)?
Health insurance is a public medical insurance that all citizens are required to join. You can choose from three different types of insurance based on your job and age.
- Employee insurance for company employees, civil servants, and teachers (Kyokai Kenpo, Association Health Insurance, Mutual Aid Association)
- National health insurance is available for self-employed individuals through municipal health insurance or the national insurance association.
- The medical care system for the elderly, which is for people aged 75 or older
Employees’ insurance is a public insurance system that salaried workers and other people who work for private companies and their families join, and the employer and employee (or public servant, teacher, or other staff member) share the insurance premiums. Family members earning less than 1.3 million yen annually are classified as dependents under social insurance and are exempt from paying insurance premiums.
Please check your insurance card (insured person certificate) to see which insurance you are enrolled in.
Differences between employee insurance and national health insurance
There are some differences in the coverage between employee insurance and national health insurance, with employee insurance offering more generous coverage. The following two coverages are available under employee insurance but not under national insurance.
- Sickness and injury benefits (provided when you’re unable to work due to illness or injury)
- Maternity allowance (paid during maternity leave)
On the other hand, both systems have a “high-cost medical care system” that covers medical expenses that exceed the monthly self-payment limit when you receive a medical examination or undergo surgery at a hospital.
A portion of the expenses may be covered by national health insurance.
What is private medical insurance?
Private medical insurance is a product offered by private insurance companies. It can be used
to cover expenses that cannot be covered by public medical insurance, such as the difference in bed charges when requesting a private room or a small room during hospitalization.
Differences between private medical insurance and health insurance (public medical insurance system)
There are three differences between private medical insurance and insurance.
- Is there a requirement to join?
- Insurance premiums and coverage
- How to receive insurance payments (benefits)
Obligation to join
There is no obligation to join private medical insurance. On the other hand, insurance is a universal health insurance system established by the government, so all citizens are required to join.
Medical insurance has conditions for joining and screening at the time of joining, and you may not be able to join depending on your chronic illness, occupation, etc. Screening at the time of joining is generally done based on a “disclosure” such as your medical history in addition to the application form.
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Health insurance is compulsory regardless of circumstances, so there is no screening process, but the type of insurance you can get is determined by your age and occupation, so in principle you cannot choose for yourself.
Health insurance coverage rate
Although there is no obligation to enroll, the enrollment rate for private medical insurance is high, with 93.6% of households enrolled in a survey conducted by the Life Insurance Cultural Center in 2021. The enrollment rate by age is also very high, at over 90% in almost all age groups.
The government is gradually taking measures to reduce medical expenses, such as partially raising the out-of-pocket medical expenses rate for the elderly. The high rate of people taking out medical insurance is also an indication of the anxiety many people feel about the future of the public medical insurance system.
Insurance premiums and coverage
Medical insurance and insurance have different premiums and coverage. While private medical insurance allows you to choose coverage that suits you, national insurance determines the insurance you join based on your occupation and age.
How insurance premiums are determined
The premiums for private medical insurance are determined by age, gender, medical history (chronic illness), and the coverage. Therefore, younger, healthier people tend to pay lower premiums for the coverage they receive.
National insurance premiums are determined by the insured’s income and the local government, union, or association to which they are enrolled, and cannot be adjusted by the insured.
For national insurance, premiums can change if you move or join a national health insurance association, and for employee insurance, premiums can change if you change jobs, but it is probably not realistic to change your residence or workplace just to pay insurance premiums.
Coverage
Private medical insurance companies offer a variety of products and plans, so you can change the coverage within the limits set by each product or plan. For example, you can choose to keep your insurance premiums low with a daily hospitalization benefit of 5,000 yen, or to increase your coverage to 10,000 yen.
On the other hand, the coverage of national health insurance is determined by the local government, union, or association to which you join.
How to receive insurance payments (benefits)
With private medical insurance, you submit a claim application to the insurance company and receive the insurance money or benefits if you meet the payment requirements. Some companies accept online applications 24 hours a day.
National health insurance has a system that provides fixed amounts such as emotional illness benefits, a high-cost medical care system, etc. Also, if you present your insurance card at a hospital to receive treatment for an illness or injury, your out-of-pocket expenses will be reduced.
Should I get private medical insurance?
Whether or not you should enroll in private medical insurance depends on the risk of illness or injury and the extent to which you want to cover the financial burden that comes with it. Some people say that there is no need to enroll in private medical insurance in Japan because the national health insurance is so generous, but there are two benefits to enrolling.
It can supplement the parts that cannot be covered by health insurance (public medical insurance system).
By joining private medical insurance, you can supplement the areas that are not covered by health insurance (public medical insurance system).
For example, you will have to pay for the extra bed charges and food costs when you are hospitalized. If you need to visit a hospital after being discharged, you will also have to pay for the transportation costs. There are also other costs besides treatment, and national health insurance basically only covers a part of the medical expenses.
Expanding treatment options
Private health insurance gives you more treatment options.
Under the public health insurance system, not all medical treatments are covered by a fixed percentage of the medical expenses. For example, the technical fees for advanced medical treatments, such as proton beam therapy used in cancer treatment, are covered in full by the insurer. If you add an “advanced medical treatment rider” to your private health insurance, you can receive benefits when you receive advanced medical treatment as specified by each insurance company.
Private medical insurance helps cover expenses that aren’t included in the public health insurance system.
The national health insurance system, to which all citizens are enrolled under the universal health insurance scheme, seems to offer generous coverage, with reduced out-of-pocket expenses and a “high-cost medical A system that covers medical expenses exceeding a certain threshold.
However, you will be responsible for the cost of technology when receiving advanced medical treatment and transportation costs required to go to the hospital. There are some expenses that cannot be covered by national health insurance (public medical insurance system) alone, so you should consider supplementing the uncovered portion with private medical insurance.