This is a translation of the Japanese original. The Japanese version is authoritative; figures follow Japanese tax law.
Everyone who turns 75 joins the Latter-Stage Elderly Medical Care System, the public medical insurance for people aged 75 and over, and its premium rates were replaced for the two years starting in fiscal 2026 (Reiwa 8). In the Ministry of Health, Labour and Welfare's compilation, the average per insured person is 7,989 yen a month nationwide (95,875 yen a year), up 578 yen, or 7.8%, from the previous period. By prefecture the range runs from 10,352 yen in Tokyo down to 4,990 yen in Aomori, a gap of 5,362 yen a month or 64,344 yen a year. But a high average does not mean a high premium rate: on the same pension income, Osaka and Saga come out higher than Tokyo. This article lists the average premium, the per-capita levy, the income-based levy rate and the premium for someone on an 840,000 yen pension for all 47 prefectures, then explains how to read your own figure and where there is room to reduce it.
The short answer: Tokyo, Kanagawa, Aichi and Osaka have the highest averages; Aomori, Iwate and Fukushima the lowest
Lining up the average premium per insured person (monthly, projected) from "Premium rates of the Latter-Stage Elderly Medical Care System for fiscal 2026 and 2027", published by the Ministry of Health, Labour and Welfare in April 2026, gives the following[MHLW].
| Prefecture | Average premium (monthly) | Annual equivalent | |
|---|---|---|---|
| High | No.1 Tokyo | 10,352 yen | 124,224 yen |
| No.2 Kanagawa | 9,842 yen | 118,104 yen | |
| No.3 Aichi | 9,045 yen | 108,540 yen | |
| No.4 Osaka | 9,010 yen | 108,120 yen | |
| No.5 Okinawa | 8,731 yen | 104,772 yen | |
| Low | No.47 Aomori | 4,990 yen | 59,880 yen |
| No.46 Iwate | 5,496 yen | 65,952 yen | |
| No.45 Fukushima | 5,744 yen | 68,928 yen | |
| No.44 Akita | 5,847 yen | 70,164 yen | |
| No.43 Niigata | 5,852 yen | 70,224 yen |
The national average is 7,989 yen a month and the median (Oita, in 24th place) is 7,283 yen. The average is shaped strongly by the income level of the over-75s in each prefecture, so urban areas where pensions are larger come out on top. What you yourself pay is decided by the per-capita levy and the income-based levy rate in the list below.
All 47 prefectures: average premium, per-capita levy, income-based levy rate, and the premium on an 840,000 yen pension
"Change from the previous period" is the difference from the average premium for fiscal 2024 and 2025. "Person on an 840,000 yen pension" is the monthly figure the Ministry of Health, Labour and Welfare gives as a reference case for someone receiving only the basic pension, after the 72% reduction of the per-capita levy. The per-capita levy is an annual amount, and the income-based levy rate is applied to the income the levy is based on, that is, the previous year's total income less 430,000 yen.
| Rank | Prefecture | Average premium (monthly) | Annual equivalent | Change from FY2024-25 | Per-capita levy (annual) | Income-based levy rate | Person on an 840,000 yen pension (monthly) |
|---|---|---|---|---|---|---|---|
| 1 | Tokyo | 10,352 yen | 124,224 yen | +655 yen | 53,300 yen | 9.88% | 1,242 yen |
| 2 | Kanagawa | 9,842 yen | 118,104 yen | +787 yen | 52,531 yen | 10.30% | 1,225 yen |
| 3 | Aichi | 9,045 yen | 108,540 yen | +104 yen | 56,130 yen | 10.48% | 1,308 yen |
| 4 | Osaka | 9,010 yen | 108,120 yen | +733 yen | 64,931 yen | 11.51% | 1,515 yen |
| 5 | Okinawa | 8,731 yen | 104,772 yen | +292 yen | 61,000 yen | 10.81% | 1,423 yen |
| 6 | Nara | 8,622 yen | 103,464 yen | +632 yen | 57,100 yen | 10.63% | 1,325 yen |
| 7 | Fukuoka | 8,330 yen | 99,960 yen | +547 yen | 66,340 yen | 11.70% | 1,548 yen |
| 8 | Hyogo | 8,301 yen | 99,612 yen | +312 yen | 58,427 yen | 10.77% | 1,363 yen |
| 9 | Kyoto | 8,280 yen | 99,360 yen | +373 yen | 59,590 yen | 10.15% | 1,390 yen |
| 10 | Chiba | 8,237 yen | 98,844 yen | +851 yen | 51,000 yen | 9.40% | 1,183 yen |
| 11 | Saitama | 8,189 yen | 98,268 yen | +879 yen | 52,370 yen | 9.49% | 1,217 yen |
| 12 | Saga | 8,159 yen | 97,908 yen | +1,389 yen | 68,700 yen | 11.79% | 1,603 yen |
| 13 | Ishikawa | 8,065 yen | 96,780 yen | +1,334 yen | 57,300 yen | 11.14% | 1,337 yen |
| 14 | Shiga | 8,051 yen | 96,612 yen | +929 yen | 55,380 yen | 10.13% | 1,292 yen |
| 15 | Okayama | 7,891 yen | 94,692 yen | +975 yen | 60,100 yen | 10.88% | 1,400 yen |
| 16 | Fukui | 7,840 yen | 94,080 yen | +1,041 yen | 54,140 yen | 10.83% | 1,263 yen |
| 17 | Yamaguchi | 7,836 yen | 94,032 yen | +624 yen | 63,513 yen | 11.36% | 1,482 yen |
| 18 | Hiroshima | 7,831 yen | 93,972 yen | +728 yen | 55,090 yen | 9.93% | 1,285 yen |
| 19 | Shizuoka | 7,415 yen | 88,980 yen | +376 yen | 51,100 yen | 9.35% | 1,192 yen |
| 20 | Kagawa | 7,388 yen | 88,656 yen | +390 yen | 58,000 yen | 9.93% | 1,353 yen |
| 21 | Gifu | 7,317 yen | 87,804 yen | +638 yen | 55,385 yen | 9.71% | 1,292 yen |
| 22 | Toyama | 7,296 yen | 87,552 yen | +1,148 yen | 55,800 yen | 10.19% | 1,302 yen |
| 23 | Hokkaido | 7,295 yen | 87,540 yen | +621 yen | 59,963 yen | 11.61% | 1,392 yen |
| 24 | Oita | 7,283 yen | 87,396 yen | +543 yen | 64,200 yen | 11.25% | 1,492 yen |
| 25 | Mie | 7,263 yen | 87,156 yen | +515 yen | 54,843 yen | 9.53% | 1,280 yen |
| 26 | Kagoshima | 7,174 yen | 86,088 yen | +933 yen | 69,800 yen | 11.72% | 1,625 yen |
| 27 | Ibaraki | 7,128 yen | 85,536 yen | +289 yen | 49,500 yen | 9.32% | 1,155 yen |
| 28 | Kumamoto | 7,088 yen | 85,056 yen | +681 yen | 63,000 yen | 11.06% | 1,470 yen |
| 29 | Yamanashi | 7,070 yen | 84,840 yen | -250 yen | 52,610 yen | 9.44% | 1,228 yen |
| 30 | Miyagi | 6,933 yen | 83,196 yen | +474 yen | 52,200 yen | 9.12% | 1,216 yen |
| 31 | Gunma | 6,877 yen | 82,524 yen | +301 yen | 54,600 yen | 9.78% | 1,267 yen |
| 32 | Tokushima | 6,829 yen | 81,948 yen | +521 yen | 60,976 yen | 10.91% | 1,423 yen |
| 33 | Wakayama | 6,771 yen | 81,252 yen | +279 yen | 58,748 yen | 10.36% | 1,371 yen |
| 34 | Kochi | 6,747 yen | 80,964 yen | +438 yen | 60,400 yen | 10.31% | 1,409 yen |
| 35 | Nagano | 6,745 yen | 80,940 yen | +441 yen | 48,827 yen | 8.80% | 1,139 yen |
| 36 | Tottori | 6,568 yen | 78,816 yen | +302 yen | 52,138 yen | 10.64% | 1,217 yen |
| 37 | Shimane | 6,561 yen | 78,732 yen | +612 yen | 57,170 yen | 10.02% | 1,334 yen |
| 38 | Tochigi | 6,476 yen | 77,712 yen | +356 yen | 49,100 yen | 9.00% | 1,146 yen |
| 39 | Nagasaki | 6,192 yen | 74,304 yen | +254 yen | 56,200 yen | 9.59% | 1,308 yen |
| 40 | Ehime | 6,186 yen | 74,232 yen | +267 yen | 55,630 yen | 9.79% | 1,298 yen |
| 41 | Yamagata | 6,014 yen | 72,168 yen | +562 yen | 52,500 yen | 9.63% | 1,225 yen |
| 42 | Miyazaki | 5,875 yen | 70,500 yen | +358 yen | 56,300 yen | 10.08% | 1,300 yen |
| 43 | Niigata | 5,852 yen | 70,224 yen | +575 yen | 49,200 yen | 8.61% | 1,148 yen |
| 44 | Akita | 5,847 yen | 70,164 yen | +1,163 yen | 55,996 yen | 9.73% | 1,300 yen |
| 45 | Fukushima | 5,744 yen | 68,928 yen | +303 yen | 49,000 yen | 9.24% | 1,143 yen |
| 46 | Iwate | 5,496 yen | 65,952 yen | +623 yen | 48,800 yen | 8.50% | 1,133 yen |
| 47 | Aomori | 4,990 yen | 59,880 yen | -136 yen | 50,500 yen | 9.00% | 1,175 yen |
Note: figures for the medical portion, from the Ministry of Health, Labour and Welfare's "Premium rates of the Latter-Stage Elderly Medical Care System for fiscal 2026 and 2027" (10 April 2026). The child and childcare support levy portion (194 yen a month on the national average) is not included. Average premiums are projections.
A high average and a high rate are different things: on a 2.5 million yen pension, Osaka costs 27,000 yen a year more than Tokyo
The highest per-capita levy is 69,800 yen in Kagoshima, and the highest income-based levy rate is 11.79% in Saga. Tokyo, which tops the average table, is below the national average on both (53,300 yen and 9.88%). Tokyo's average is high because many of its residents have large pensions and incomes; compare people on the same income and the order changes.
Income the levy is based on = 2.5 million yen - 1.1 million yen public pension deduction - 430,000 yen = 970,000 yen
Osaka: 64,931 yen + 970,000 yen x 11.51% = about 176,600 yen (about 14,700 yen a month)
Aichi: 56,130 yen + 970,000 yen x 10.48% = about 157,800 yen (about 13,100 yen a month)
Tokyo: 53,300 yen + 970,000 yen x 9.88% = about 149,100 yen (about 12,400 yen a month)
Iwate: 48,800 yen + 970,000 yen x 8.50% = about 131,300 yen (about 10,900 yen a month)
On the same 2.5 million yen pension, Osaka and Iwate are more than 45,000 yen apart over a year, and even Osaka and Tokyo differ by 27,000 yen.
For people with smaller pensions the reductions of the per-capita levy (for fiscal 2026 and 2027 the medical portion is 72%, 50% and 20%) take effect, so the gap narrows a good deal. In the Ministry of Health, Labour and Welfare's reference case of a person on an 840,000 yen pension, monthly premiums run from 1,625 yen in Kagoshima to 1,133 yen in Iwate, a difference of about 6,000 yen a year.
The prefectures that rose the most: Saga, Ishikawa, Akita and Toyama are up more than 1,100 yen a month
The largest increases from fiscal 2024-25 to fiscal 2026-27 are Saga (+1,389 yen), Ishikawa (+1,334 yen), Akita (+1,163 yen) and Toyama (+1,148 yen), all of which raised their per-capita levy sharply. In the other direction, Yamanashi (-250 yen) and Aomori (-136 yen) saw their averages fall. Nationwide the per-capita levy rose 11.3%, from 50,389 yen to 56,083 yen, while the income-based levy rate edged down from 10.21% to 10.17%.
Premium rates are set every two years by each prefecture's regional union for latter-stage elderly medical care, and the next revision applies from fiscal 2028. Behind the increases lie the growth in medical spending and the 2024 reform, which raised the share borne by people aged 75 and over in order to hold down the support payments made by the working generation. On top of that, from fiscal 2026 a child and childcare support levy is added, averaging 194 yen a month nationwide (a per-capita levy of 1,351 yen plus an income-based levy of 0.25%)[MHLW]. Asking people over 75 to pay a children's portion is no small burden for someone living on a pension alone; the support levy as a whole is set out in the child and childcare support levy.
How the premium is worked out: per-capita levy plus income-based levy, with reductions judged on household income
- The per-capita levy is the same amount for every member. Households with low income in the previous year receive a reduction, judged on the combined income of the head of the household and every insured member. The largest reduction for fiscal 2026 and 2027 is 72% on the medical portion (the usual 70% plus a further 2 percentage points); the child-rearing support portion stays at 70% [Ministry of Health, Labour and Welfare]. On pension income alone, a single person on roughly 1.68 million yen or less gets the 72% reduction, moving to the 50% and 20% reductions as the pension rises.
- The income-based levy is the income-based levy rate applied to the previous year's total income less 430,000 yen. On a pension income of 2.5 million yen, the income the levy is based on is 970,000 yen.
- A cap on the levy applies. The medical portion is capped at 850,000 yen a year, raised from 800,000 yen by 50,000 yen in fiscal 2026 [Ministry of Health, Labour and Welfare]. The child-rearing support portion has a separate cap, which is 21,000 yen in Tokyo [Tokyo Federation of Latter-Stage Elderly Medical Care]. However large the income, the premium stops at these two caps.
- People whose pension is 180,000 yen a year or more are in principle subject to deduction from pension (special collection). You can switch to direct debit by applying for it.
- The premium qualifies for the social insurance premium deduction. An amount taken out of a pension can only be claimed by the person themselves, but if you switch to direct debit and a child living in the same household pays it, the child can claim the deduction. The higher the child's tax rate, the more the household's take-home pay improves (paying a family member's premiums is fully deductible).
| Combined total income of the household | Reduction of the per-capita levy |
|---|---|
| 430,000 yen or less | 72% (medical portion; 70% for the child-rearing support portion) |
| 430,000 yen + 310,000 yen x number of insured members or less | 50% |
| 430,000 yen + 570,000 yen x number of insured members or less | 20% |
Where the household has two or more people with pension or employment income, add "(that number minus one) x 100,000 yen" to each line above. For people aged 65 and over, pension income is judged after deducting the 150,000 yen special allowance for older people. The test uses the household as it stands on 1 April of the fiscal year.
Because the reduction of the per-capita levy is judged household by household, a child who is the head of the household and has a large income can leave the parent without a reduction, even when the parent's own pension is small. Splitting the household registration sometimes brings the reduction back, but it affects the dependant deduction, dependant status under health insurance and the household aggregation for the high-cost medical expense benefit, so weigh it together with whether claiming a parent as a dependant pays off.
If you want the whole system in one place — joining, how the 10%, 20% and 30% out-of-pocket rates are decided, and the high-cost medical expense benefit — see how the Latter-Stage Elderly Medical Care System works from 75. Regional differences in National Health Insurance premiums before 75 are covered in how National Health Insurance premiums are calculated, and the municipal differences in the long-term care insurance premium charged separately from 65 in the ranking of long-term care insurance premiums from 65. For the cap that applies when out-of-pocket medical costs run high, see the high-cost medical expense benefit.
Frequently asked questions
Does the premium under the Latter-Stage Elderly Medical Care System differ from one municipality to another?
No. The system is run by a regional union for latter-stage elderly medical care in each prefecture, so within the same prefecture both the per-capita levy and the income-based levy rate are identical (apart from the uneven levies applied on remote islands and the like). National Health Insurance does differ by municipality, so at 75 the basis switches to a prefecture-wide one.
Would moving to a prefecture with cheaper premiums lower what I pay?
Move your residence registration and that prefecture's rates apply. But the gap in the per-capita levy is about 20,000 yen a year and the widest gap in the income-based levy rate is 3.3 points, which comes to about 45,000 yen a year even on a 2.5 million yen pension. Resident tax, long-term care insurance premiums and access to medical care change too, so this is not a decision to make on the premium alone.
Why is the amount deducted from my pension different from last year?
Besides the new rates from April 2026, the April, June and August payments are a provisional collection based on the previous year's amount, while from October the real collection takes the amount fixed on this year's income, so the figure changes during the year. The child and childcare support levy added from fiscal 2026 also plays a part.
Do I still pay a premium if I am a dependant of my child?
Yes. People aged 75 and over cannot be dependants under health insurance; everyone joins the Latter-Stage Elderly Medical Care System and pays a premium. Someone who had been a dependant of a child working as an employee starts paying from the month they turn 75 (the per-capita levy is reduced by 50% for the first two years after joining).
Reference links (sources)
This article is based on the materials below. For the premium you actually pay, check the decision notice sent by your prefecture's regional union or by your municipality.
Note: this article is general information. The premium estimates assume a single person with pension income only and no reduction of the per-capita levy.
