Care Premiums at 65: a 40,000-Yen Gap Between Cities

The short answer: long-term care premiums in the prefectural capitals (9th period, base amount)

Source: MHLW, "Category 1 long-term care insurance premiums for the 9th long-term care insurance business plan period", list of base amounts by insurer (14 May 2024) [MHLW]. For Tokyo, Shinjuku Ward, the seat of the metropolitan government, is shown

The base amount is the premium for "tier 5" (the person is exempt from resident tax but someone in the household is taxed), and it is the yardstick for every other premium in that municipality. What you actually pay ranges from 0.285 to 2.4 times the base amount depending on your income tier (see below). Between first-placed Osaka City (9,249 yen) and 42nd-placed Sapporo City (5,773 yen) the gap is 3,476 yen a month, or 41,712 yen a year.

The top 10 and bottom 10 among all 1,573 insurers

The expensive municipalities fall into two groups: the urban belt of Osaka Prefecture (Osaka City, Moriguchi City, Kadoma City, Matsubara City) and depopulated towns and villages where the share of older residents and the use of care services are both high (Nishiwaga Town, Shichinohe Town, Hinohara Village). The cheap ones are dominated by Hokkaido municipalities, many of which hold premiums down through the supply and take-up of care services or by drawing on reserve funds. A premium is "the municipality's projected care benefit spending over three years divided by the number of residents aged 65 and over", so the higher the rate of certified need for care and the more facilities there are, the higher the premium.

Prefectural averages (weighted)

Osaka Prefecture (7,486 yen) and Yamaguchi Prefecture (5,568 yen) are 1,918 yen a month, or about 23,000 yen a year, apart. The national weighted average is 6,225 yen, up 3.5% from 6,014 yen in the 8th period.

Examples from designated cities and other populous cities and wards

Kansai urban centres such as Amagasaki City, Sakai City and Higashiosaka City are above 7,000 yen, the 23 wards of Tokyo run from 5,600 to 6,900 yen, and Kawasaki City and Sagamihara City sit around 6,600 yen. Put that together with the municipal spread in National Health Insurance premiums (the NHI premium ranking) and social insurance costs for people aged 65 to 74 vary by more than 100,000 yen a year depending on where you live.

Your own premium: base amount multiplied by your income tier

The base amount is only a yardstick. Your actual premium is set by whether you and your household are liable to resident tax and by your income, across 13 tiers in the national standard. From the 9th period the upper tiers were split more finely, widening the range of multipliers.

Source: MHLW, Social Security Council Long-Term Care Insurance Committee, "On the adjustment of base amounts for long-term care insurance premiums" (9 October 2025) [MHLW]. Tiers 1 to 3 show the multipliers after the public subsidy. The pension income threshold is due to be revised to 826,500 yen from April 2026

Municipalities may set more tiers than the national standard or change the multipliers, so check the notice from your own city or ward for the table that applies to you. Crossing a boundary by as little as 10,000 yen can move you up a tier and change the bill by 10,000 to 20,000 yen a year. The line between tier 5 and tier 6 - whether the person is exempt from resident tax or not - is the same line as resident-tax exemption, and it is easy to cross by deferring your pension or by working. For more, see the conditions for a resident-tax-exempt household and how much your take-home pension rises if you defer it.

How deduction at source works: under 180,000 yen a year and you pay by bill

• If your pension is 180,000 yen a year (15,000 yen a month) or more, the premium comes out of the pension. Two months' worth is taken on the pension payment date in every even-numbered month. People with less than 180,000 yen a year, people in the first six to twelve months after turning 65, and people who have just moved in pay by bill or direct debit (ordinary collection).
• April, June and August are "provisional collection". The amount is taken provisionally on the basis of last year's figure, and the difference against this year's confirmed amount is settled in October, December and February. Because the premium is fixed only after resident tax is determined in June, the amount can jump in the second half of the year.
• In the year you turn 65 you are not charged twice. You become a Category 1 insured person of long-term care insurance from the month containing the day before your 65th birthday, and the care portion of your health insurance or National Health Insurance premium stops from that month.
• Non-payment restricts your benefits. After a year of arrears you pay the full cost of care services up front and claim it back later; after two years the claim lapses and your own share of the cost rises to 30% (or 40%) for the period concerned.
• The premium qualifies for the social insurance premium deduction. Premiums taken from your pension appear on your pension withholding statement and count as a social insurance premium deduction in your tax return and in the resident tax calculation. Premiums taken from a family member's pension cannot be deducted by anyone other than that person.

For withholding on pensions and filing, see tax on pensions and the tax return. The cap on what you pay out of pocket when you use care services is covered in the high-cost long-term care service benefit.

The next revision is April 2027 (the 10th period)

Long-term care premiums are revised every three years, and the 9th period ends with fiscal 2026. Premiums for the 10th period, from April 2027, will be decided by each municipality during fiscal 2026 along with its long-term care insurance business plan, and fixed by ordinance around March 2027. The national average has never fallen once, from 2,911 yen in the 1st period (fiscal 2000) to 6,225 yen in the 9th, and the 10th period - after 2025, the year in which the whole baby-boom generation turned 75 or over - is expected to rise again. The MHLW is also still debating a heavier load on high earners and premiums that take assets into account.

If you are thinking about moving, it is worth checking the base amount and the income tier table where you are going. That said, a municipality with a cheap premium sometimes has a thin supply of care services, and choosing where to live on the premium alone gets the priorities backwards.

Frequently asked questions

Summary

• From age 65, long-term care insurance premiums are set by each municipality every three years and deducted from pension payments. The nationwide average standard monthly amount for the 9th period is ¥6,225.
• Among prefectural capital cities, the gap between Osaka City (¥9,249) and Sapporo City (¥5,773) amounts to ¥41,700 per year.
• The actual premium ranges from 0.285 to 2.4 times the standard amount, depending on income bracket.
• If annual pension income is below ¥180,000, premiums are not deducted automatically; they must be paid via a payment slip or bank transfer.
• The next revision is in April 2027 (the 10th period). The amount has never decreased since the 1st period.

Sources

The figures in this article are the 9th-period base amounts for each insurer as published by the MHLW. Your actual premium depends on your income tier and on your municipality's own settings, so check the notice from your city or ward.

• MHLW, Category 1 long-term care insurance premiums for the 9th long-term care insurance business plan period (list of base amounts by insurer and by prefecture)
• MHLW, On the adjustment of base amounts for long-term care insurance premiums (Social Security Council Long-Term Care Insurance Committee, 126th meeting) (income tiers and multipliers)
• MHLW, the long-term care insurance system

Note: this article is general information. The base amounts are 9th-period (fiscal 2024-2026) figures and will be revised in April 2027.