Tokyo NHI Premium Ranking 2026: All 62 Wards, Cities & Towns

How NHI Premiums Work — From FY2026, a "Four-Tier" Structure

National Health Insurance premiums are the sum of an income-based portion, levied on last year's income minus a ¥430,000 deduction, and a flat-rate per-capita portion charged per enrolled person (some island municipalities also add a per-household portion and a property-based portion tied to fixed-asset tax). From FY2026, a new child and childcare support portion has been added to the previous three tiers, making it a four-tier structure.

The 23 wards use a "unified premium" system, with 20 wards charging exactly the same rate. The three exceptions are Nakano Ward (a higher income-based rate under its own schedule), Edogawa Ward, and Meguro Ward (whose long-term care income-based rate alone is slightly lower). Outside the wards, the Tama-area cities and the towns and villages — including the remote islands — each set their own rates independently, which is where the big differences come from. The annual cap on premiums for the 23 wards is ¥1.13 million (¥670,000 + ¥260,000 + ¥170,000 + ¥30,000). Low-income households qualify for a 70%, 50%, or 20% reduction of the per-capita portion (no application needed, but income must be reported), and pre-school children get an additional 50% reduction on their per-capita portion.

NHI Premium Simulator — Calculate All 62 Municipalities at Once

Enter your age, income, and household makeup, and the tool estimates the FY2026 premium for the municipality you choose, along with a ranking of all 62 municipalities at the same time.

Ranking: Model Case of a 40-Year-Old Single Person Earning ¥4 Million a Year in Salary

As a benchmark, here is the annual premium calculated for all 62 municipalities for a 40-year-old single person with ¥4 million a year in salary income (¥2.76 million in salary-derived taxable income).

※ Municipalities marked ※ also charge a property-based portion (an add-on tied to fixed-asset tax). If you own your home, your premium will be higher than the table shows.

Why Does It Vary So Much Within Tokyo?

The insurance benefits you receive are the same nationwide. Out-of-pocket medical costs are 30% (varying by age), and the high-cost medical expense system is the same everywhere. In other words, the same service comes with a different price tag depending on the municipality. There are three main reasons for the gap:

1. How much each municipality transfers in from its general account (subsidies funded by taxes) — municipalities use their own general-account transfers to hold down premiums, and the scale of these transfers varies
2. Enrollees' income levels, age mix, and medical-cost levels — areas with more elderly residents or higher medical costs need to collect more
3. The 23 wards' unified premium system — the 20 wards align on a common standard, while cities and towns set their rates individually

One thing to note: a policy of phasing out these independent general-account transfers has been signaled (under Tokyo's NHI Fiscal Health Plan for its wards, cities, and towns). Even municipalities that are cheap today could see their premiums rise gradually.

Practical Points to Know — Moving, Leaving a Job, and Reductions

• Your premium is calculated by the month, based on the municipality where you're registered. When you move, you switch to the new municipality's rate from the month you move in, and the old municipality's portion is prorated by month (you must file your move-in/move-out notice within 14 days).
• This doesn't affect company employees (who are on employer health insurance), but if you leave your job and join NHI, you suddenly face this gap. When you leave a job, compare your three options — voluntary continued coverage, NHI, or being a dependent on a family member's insurance (see 3 health insurance options after leaving a job and taxes and procedures when changing or leaving jobs).
• The reductions (70%/50%/20%) don't require an application, but they depend on every household member having reported their income. Even with no income, you may miss out on the reduction if you don't file a resident-tax return.
• For how premiums are structured and national-level rates, see calculating National Health Insurance. If you're self-employed and premiums feel heavy, a micro-corporation and social insurance premiums is also worth a look.
• We don't recommend choosing where to live based on NHI premiums alone. For the full picture including housing costs, commuting, and childcare support, see Tokyo vs. the regions: which is the better deal. For a cross-comparison of all 212 municipalities in the greater Tokyo area, including Saitama, Chiba and Kanagawa, see Kanto NHI Premium Rankings: 212 Municipalities Compared.

Summary

• National Health Insurance premiums combine an income-based levy and a per-capita levy. From fiscal 2026, a child and childcare support contribution was added, making it a four-tier structure.
• For a single 40-year-old earning ¥4 million a year, the cheapest on the Japanese mainland is Hinohara Village at about ¥270,000, followed by Fuchu City at about ¥277,000. In Tokyo's 23 wards, 20 wards charge about ¥388,000, and Nakano Ward charges about ¥405,000.
• Twenty of the 23 wards share the same rate. Cities and towns each set their own rates, which is why the amounts differ.
• The main reason for the gap is how much each municipality transfers in from its general account. Since that practice is being phased out, premiums in currently cheap municipalities may rise.
• Moving changes your rate to the new municipality's from the month you move in. The 70%/50%/20% reductions require reporting the income of every household member.