Japan is reviewing whether stock dividends and capital gains that investors leave as "no filing required" in a withholding special account (tokutei koza) should count toward social insurance premiums. Three schemes are involved, and they are at very different stages. Only the late-stage elderly medical care system for people aged 75 and over has been decided: under the Ministry of Health, Labour and Welfare (MHLW) plan, the income will be reflected in premiums and co-payments from August 2029. Long-term care insurance for people aged 65 and over began its review on 26 October 2026, and National Health Insurance for people aged 74 and under has no concrete plan. [MHLW, Long-Term Care Insurance Subcommittee No. 137, Document 1 (in Japanese)]
For the 75-and-over system, dividends and gains in NISA (Japan's tax-free investment accounts) are explicitly excluded. Employees' health insurance premiums are set by salary, so they do not change however large your dividends are.
Where each scheme stands: only the 75-and-over system is decided
| Scheme (main members) | Status | From when |
|---|---|---|
| Late-stage elderly medical care (75+): premiums and co-payments | Decided by law (promulgated 5 June 2026) | From August 2029, using 2028 dividends and gains (MHLW plan) |
| Long-term care insurance (65+): premiums and co-payment share | Under review (raised at the 26 October 2026 subcommittee) | Undecided. Media report a direction by year-end |
| National Health Insurance (74 and under: self-employed, retirees and others) | No concrete plan ("start with the 75+ system") | Undecided |
| Health insurance for employees and civil servants | Premiums set by salary; not under discussion | — |
| NISA dividends and gains | Excluded in the 75+ system | — |
| Dividends and gains reported in a tax return | Already counted today | No change |
Note: the 75+ system is based on the Act Partially Amending the Health Insurance Act (Act No. 31 of 2026) and the schedule proposed to the Medical Insurance Subcommittee on 16 October 2026. The National Health Insurance position is from the subcommittee's "Summary of Discussions" of 25 December 2025. Long-term care insurance is based on a Jiji Press report of 26 October 2026. [MHLW, Medical Insurance Subcommittee, Document 3 (in Japanese)][Jiji Press, 26 Oct 2026 (in Japanese)]
Why it is not counted now: unreported dividends never reach the municipality
Premiums and co-payment shares in National Health Insurance, the 75+ system and long-term care insurance are set using the resident-tax income data held by municipalities. If you leave gains or dividends in a withholding special account as "no filing required", they do not appear in that data. Today, of two people with the same dividends, only the one who files a tax return has them counted.
The long-term care subcommittee document says that not counting income when no return is filed is "unfair treatment" that "needs to be corrected". Items not counted include unreported listed-share dividends and gains, interest on bank deposits, NISA income and assets such as savings. [Same document, pp. 7 and 9 (in Japanese)]
Conversely, people who report dividends under aggregate or separate taxation are already counted. The change affects only those who choose "no filing required". How to choose is covered in aggregate vs separate taxation.
The 75+ system: about ¥100,000 more a year on ¥1 million of dividends (Tokyo estimate)
For people aged 75 and over, the law now requires the reports financial institutions already send to the tax office, such as the annual trading report for special accounts, to go to the prefectural late-stage elderly medical care association as well. You do not need to do anything. Under the MHLW plan, online submission becomes mandatory in January 2029, and 2028 dividends and gains will be reflected in premiums and co-payments from August 2029.
- Single person in Tokyo, pension ¥2.5 million, dividends ¥1 million: premium rises from ¥152,900 to ¥254,300 a year, up ¥101,400
- Single person in Tokyo, pension ¥1.8 million, dividends ¥500,000: premium up ¥78,000 a year, and the co-payment at the clinic rises from 10% to 20%
Note: this site's rough estimate at Tokyo's FY2026 rates, assuming all dividends are added to income. The breakdown and the co-payment test are in financial income in the 75+ medical care system.
Long-term care insurance: review of premiums and co-payments for people 65+ has begun
At the long-term care insurance subcommittee on 26 October 2026, MHLW put "how to reflect financial income in long-term care insurance" on the agenda. Taking the 75+ system as a reference, it will discuss whether dividends and gains should count toward premiums for people 65 and over and toward the 10%, 20% or 30% co-payment test for care services. Jiji Press reported that a direction will be set by year-end.
The document notes that people in their 60s have the highest share of individual shareholders by age group, 16.8%, and that listed-share holdings average about ¥16 million per person for those in their 70s and older.
- Single person aged 65+, pension ¥2.4 million, dividends ¥500,000 in a special account
- Now: total income is ¥1.3 million (¥2.4 million − ¥1.1 million pension deduction), below the ¥1.6 million threshold for 20%, so 10%
- With dividends counted: total income ¥1.8 million and pension plus other income ¥2.9 million, both above the 20% thresholds (¥1.6 million and ¥2.8 million), so 20%
- For care level 3 using ¥270,000 a month of home services, the co-payment rises from ¥27,000 to ¥44,400 (the high-cost care cap), up ¥17,400 a month
The same subcommittee is also discussing lowering the 20% threshold itself from ¥2.8 million to as low as ¥2.3 million. If both happen, even more people will move from 10% to 20%. The threshold proposals are covered in expanding the 20% long-term care co-payment.
National Health Insurance and employees' health insurance: working-age people are not covered for now
"Gains in special accounts will be charged social insurance" can sound as if working-age people will be covered soon, but only people aged 75 and over are decided. In December 2025 the Medical Insurance Subcommittee listed National Health Insurance as a candidate but, noting the need to balance it with employees' health insurance and the schedule for standardising municipal systems, decided to "start with the late-stage elderly medical care system". [Medical Insurance Subcommittee, Summary of Discussions (in Japanese)]
What surprised me in researching this is that employees' health insurance has no room for financial income at all. Premiums are set by salary and bonuses, and one subcommittee member said it is "extremely difficult in practice for insurers to track financial income". Long-term care premiums for employees aged 40 to 64 are also deducted from pay (long-term care premiums from age 40).
On the other hand, some members argued that "the financial income of working-age people should also be considered". National Health Insurance, which covers self-employed people and retirees aged 74 and under, may be discussed after the 75+ system starts.
NISA and bank interest are not counted
In the 75+ system, MHLW states that NISA dividends and gains are not counted because they are tax-free. [MHLW, fair reflection of financial income (in Japanese)] Bank deposit interest is not counted either, because it is not among the three types of report the law lists. How long-term care insurance will treat NISA is not decided, but NISA income is not counted in long-term care insurance today.
Whether you use your NISA allowance fully may affect future premiums. Using the accounts well is covered in tax returns for shares and NISA.
Summary
- Of the reviews to count unreported dividends and gains toward premiums, only the 75+ medical care system is decided. MHLW plans to reflect them from August 2029
- Tokyo estimate: a single person with a ¥2.5 million pension and ¥1 million of dividends pays ¥101,400 more a year
- Long-term care insurance for 65+ began its review on 26 October 2026. Even under current thresholds, a ¥2.4 million pension plus ¥500,000 of dividends would move from 10% to 20%
- National Health Insurance for 74 and under has no concrete plan, and employees' health insurance is set by salary, so it is not covered
- NISA dividends and gains are excluded in the 75+ system. People who file returns are already counted today
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References (sources)
- MHLW, Social Security Council Long-Term Care Insurance Subcommittee (No. 137), Document 1 "Ensuring sustainability (benefits and burdens)" (26 October 2026) (in Japanese)
- MHLW, 218th Medical Insurance Subcommittee, Document 3 "Schedule for fair reflection of financial income in the late-stage elderly medical care system" (16 October 2026) (in Japanese)
- Medical Insurance Subcommittee, "Summary of Discussions" (25 December 2025) (in Japanese)
- MHLW, "Fair reflection of financial income in the late-stage elderly medical care system" (in Japanese)
- House of Representatives, text of the bill to partially amend the Health Insurance Act (in Japanese)
- Jiji Press, "Financial income to be reflected in long-term care co-payment shares; MHLW considers for fairness" (26 October 2026) (in Japanese)
The timing for the 75+ system is an MHLW proposal; the official effective date will be set by cabinet order. The long-term care illustration is this site's own, assuming all dividends are added to income under the current 20% thresholds, and may differ from the actual design. This article is general information as of 4 November 2026. For individual decisions, consult your municipality, the regional association or a licensed tax accountant.