How to keep your health insurance when you can’t pay for it
Last week, the Ministry of Health Labor and Welfare released the results of a survey of about 60,000 households regarding the government-run basic pension plan. The ministry found that about one-fourth of the people who are supposed to be paying into the plan had no income in 2009. In addition, 38 percent of participants made less than ¥500,000 for the year, and 54.7 percent made less than ¥1 million.
The basic pension, kokumin nenkin, is for people who don’t work for companies or organizations that contribute to their employees’ government-run pensions, meaning they are either self-employed, part-timers or unemployed (and not wives of salaried workers). In 2011 only 58.6 percent of people who were supposed to pay into the basic pension plan actually did. The obvious conclusion the ministry drew from these numbers is that the ranks of the poor are growing.
These findings are sobering, but one should keep in mind that while not paying one’s pension contributions certainly undermines the system it doesn’t affect the person in a direct way, since he or she does not benefit from those contribution until he or she is old. In any case, if a person can’t pay the monthly ¥14,980 basic pension contribution because he or she is unemployed, the person can apply for an exemption.
National health insurance is another matter, since the participant benefits from the plan right now if he or she gets sick or otherwise requires medical attention. That’s why poorer people who are not paying basic pension contributions are more likely to pay their health insurance premiums; in fact, they may forego the pension payments so that they can pay for the insurance. As with the basic pension, kokumin kenko hoken is set up for those who don’t work for a company or organization that pays for part of their health insurance. In principle, the same people belong to both the basic pension and the national health insurance plans. However, the payment delinquency rate for national health insurance is much less than it is for the basic pension, about 20 percent. But because the number of poor people is increasing, the delinquency rate for national health insurance is also going up.
In 2008 the government separated a large portion of participants from the national health insurance plan when it inaugurated the koki koreisha iryo seido, a special insurance system just for people over the age of 75. Since a substantial portion of the elderly are also poor, it was assumed that the delinquency rate for national health insurance participants would go down. But the delinquency rate in 2007 was 18.6 percent and in 2008 it went up to 20.6 percent. What’s more, starting in 2010 people who specifically became unemployed because their employers went out of business could apply for an exemption from paying health insurance premiums, but the delinquency rate has remained steady at around 20 percent.
Premiums are determined by your previous year’s salary, but even if you made no money during a given year, you still have to pay the minimum premium for national health insurance, even if you don’t have to pay local taxes. The yearly minimum for a household is about ¥30,000 multiplied by the number of household members, depending on the locality; plus premiums for long-term nursing care for household members over 40. The maximum yearly premium is about ¥600,000.
The problem with not paying your premium is that if you stop paying it long enough the government takes away your insurance, regardless of how many years previously you paid it in full and on time. However, there is a way out. If you haven’t been able to pay your premiums for less than a year and did not lose your job due to your employer shutting down you can receive a tanki hoken shasho, or short-term insurance certificate issued by your local government office, good for 3 to 6 months and renewable. The bearer uses it as he would his regular insurance card and pays 10 to 30 percent of the doctor’s fee out of pocket.
If you have been behind in your insurance payments for more than a year you can apply for a new certificate called hihokensha shikaku shomeisho. This does not replace a regular insurance card, so when you go to receive medical care you have to pay the full fee. However, once you start paying back the money you owe to the national health insurance plan you can be reimbursed for any funds you paid for medical care. You can’t be reimbursed if you don’t have the certificate.
It should be pointed out that people who are already approved to receive government assistance also receive national insurance coverage without having to pay for it. People who do not receive welfare and are delinquent on their insurance payments can probably assume their local government will contact them and explain these other measures. Medical institutions will also help them apply since it’s obviously in their interest.