Most people ask this before they ask anything else, and it is a fair question. Therapy in Japan is not cheap, and the rules about what public insurance pays for are genuinely confusing — even for people who have lived here for years.
Here is the short answer. Japanese public health insurance covers treatment by a doctor for a mental health condition. It does not cover private counselling or psychotherapy outside a medical setting. The longer answer matters, because the rules changed in June 2026, and because the cheapest route is not always the right one.
How Japanese health insurance works
If you live in Japan and are enrolled in either National Health Insurance (国民健康保険) or employees’ health insurance (健康保険), the system pays 70 per cent of the cost of covered treatment. You pay the remaining 30 per cent at the clinic.
The word doing the work in that sentence is covered. Japanese insurance covers specific, listed medical treatments. A treatment is either on the list or it is not. There is no partial or discretionary coverage, and no process for claiming back something that falls outside it.
What is covered
An appointment with a psychiatrist (精神科) or at a psychosomatic medicine clinic (心療内科) is covered. These are medical doctors. They can diagnose, they can prescribe medication, and they can issue the medical certificate (診断書) that an employer may ask for if you need time off work.
A first appointment typically runs longer than the ones that follow. Follow-up appointments are often short — five to fifteen minutes is common — and are principally about reviewing how you are and adjusting medication. That is not a criticism of the system. It is simply what it is designed to do.
What changed in June 2026
This is the part most guides have not caught up with. From June 2026, counselling delivered by a Certified Public Psychologist (公認心理師) became eligible for insurance coverage in a wider range of circumstances than before, including for stress-related and somatoform conditions.
It is a real change and a welcome one, but it comes with conditions. The counselling must be judged appropriate by a doctor as part of your treatment, and it must be delivered within a medical institution. Coverage is for a defined course of treatment rather than open-ended, and the usual 30 per cent co-payment applies.
What it means in practice: if you are already seeing a psychiatrist and they judge that structured psychological work would help, you may now be able to have some of that work covered. It does not mean that counselling in general is now covered, and it does not extend to a private practice.
If you are having ongoing psychiatric treatment
There is a separate scheme worth knowing about, called 自立支援医療 (Services and Supports for Persons with Disabilities). For people receiving continuing outpatient psychiatric treatment, it reduces the co-payment from 30 per cent to 10 per cent, and in some cases to nothing at all.
You apply through your local ward or city office, and you will need a form completed by your treating doctor. If you are in ongoing psychiatric care and paying 30 per cent, it is worth asking your doctor whether you qualify. Many people never hear about it.
What is not covered
Private psychotherapy and counselling — the kind offered by a practice like ours, outside a medical institution — is not covered by Japanese public health insurance. Nor is counselling you arrange for yourself without a doctor’s involvement, even where the person providing it holds a Japanese qualification.
We would rather say that plainly than let you discover it at the point of payment. Our fees are published in full, so you can see exactly what a session costs before you contact anyone.
International and employer insurance
This is where many international residents do find help with the cost. Policies from Cigna, Allianz, Aetna and similar insurers frequently include outpatient mental health cover, and some employer packages do as well — particularly for people on assignment.
Three things worth checking on your own policy, because they vary enormously:
- Whether outpatient mental health is included at all, and how many sessions a year it allows
- Whether the provider must be licensed in a particular country, or whether the policy accepts a qualified practitioner wherever they are
- Whether you claim afterwards with a receipt, or whether the insurer must be arranged in advance
Most international policies work on reimbursement: you pay, you send a receipt, they pay you back. If you think your policy might cover therapy with us, ask — we will provide a receipt with whatever details your insurer requires.
Which route makes sense
The honest answer depends on what you actually need, not on what costs least.
Start with a doctor if you think medication may help, if you need a medical certificate for your employer, or if cost is the deciding factor and you are able to work in Japanese — or can bring someone who can. Appointments are covered, and the 30 per cent co-payment is far less than any private fee.
Consider private therapy if you want sustained conversation rather than short medication reviews, if working in your own language matters to you, or if what you are dealing with is relational — a marriage, a family, the strain of living between cultures. These are things a fifteen-minute covered appointment is not designed to hold.
The two are not alternatives. A good many of our clients see a psychiatrist for medication and work with us alongside it. We do not prescribe and we do not diagnose, and we are glad to work in parallel with a doctor who does.
A note on language
Covered care in Japan is overwhelmingly delivered in Japanese. There are English-speaking psychiatrists in Tokyo, but there are not many, waiting times can be long, and the same is true across the country. This is the practical reason many international residents end up paying privately — not because they did not know about the public system, but because they could not use it in a language they think and feel in.
If you are struggling right now
None of the above matters if you need help today. BeyondBleu is not an emergency service. In Japan, よりそいホットライン (Yorisoi Hotline) offers free and confidential support in English and other languages on 0120-279-338, and emergency services are on 119.
Where to go from here
If you have decided that private therapy is the right route, our fees are set out in full here, and our frequently asked questions cover booking, languages and what happens in a first session. You can read about each clinician and their training on meet your therapists, and book a session online when you are ready. No referral and no diagnosis is needed to begin.
If you are still weighing it up, that is a reasonable place to be. Ask us the question you have not been able to get answered — including whether we are the right people at all. We will give you an honest answer.
This article explains how the Japanese insurance system works in general terms. It is not financial, legal or medical advice, and coverage rules change. Confirm your own position with your insurer, your employer, or your local ward office.
