Travel insurance for Japan when your health is part of the plan

Since my stroke in 2016, planning a slower Japan trip has meant planning for heat, stairs and rest stops. It also means asking a less fun question: what happens if one of us needs a doctor while we're there?

Joanna and I did carry travel insurance. We found our plan through Squaremouth, a site that compares plans from different insurers side by side.

This guide covers why travel insurance matters for health care abroad, especially if you have a health condition, travel with older parents, or use a cane, walker or wheelchair. It's general information, not advice about your own health or any specific policy. Read the policy itself before you buy.

Disclosure: some insurance links on this page may be affiliate links. If you buy through one, I may earn a commission at no extra cost to you. I'm not a licensed insurance agent, and I can't tell you which policy is right for you.

Your health plan at home may not travel with you

If you're on Medicare, this part matters most. Medicare's own page on travel says it usually doesn't cover health care while you're traveling outside the U.S., and that in most cases you pay all the costs. Medicare drug plans don't cover prescriptions bought abroad. Some Medicare supplement (Medigap) policies may cover emergency care abroad, and Medicare itself points out that travel insurance doesn't necessarily include health coverage, so read the conditions carefully.

Private health plans vary a lot. Before you book, call yours and ask:

Does it pay for emergency care in Japan, and up to what amount?
Does it pay the hospital, or do I pay first and claim later?
Does it cover a medical evacuation or a flight home with medical help?

What Japan's tourism agencies say

Japan's official tourism sites are unusually direct about this. The JNTO travel insurance page says medical service in Japan is advanced but treatment can be expensive, and cites a Japan Tourism Agency survey finding that one in twenty people get sick or injured while abroad. It also notes that since 2021, foreigners with unpaid medical bills in Japan may be restricted or refused entry.

A few practical points from JNTO's guide for when you feel ill:

Credit cards are only accepted at major hospitals. Clinics generally take cash only.
Without travel insurance that includes cashless (direct billing) service, you may be charged the full amount on the spot.
If you go by ambulance, you can't choose which hospital you're taken to.
One example case JNTO lists, from Tokio Marine International Assistance: surgery, a 19-day hospital stay and a flight back to the U.S. with an attending physician, totaling 7.5 million yen.

JNTO also says that if you have a chronic disease, it will affect your travel insurance coverage. That's the part most of us need to read twice.

Pre-existing conditions: the part to read twice

Most travel insurance excludes pre-existing conditions by default. What counts as pre-existing, and whether you can get that exclusion removed, depends on the policy. The comparison site Squaremouth's pre-existing conditions guide lists strokes and neurological conditions, heart conditions, diabetes medication changes and arthritis among its common examples.

Here's how it generally works, based on what the insurers and comparison sites publish:

The look-back period. Insurers check your medical history for a set window before you bought the policy, often 60 to 180 days. Treatment, a new diagnosis or symptoms in that window can make a condition pre-existing.
Stable isn't always safe. A condition controlled by the same medication is often not treated as pre-existing, but a change in medication or dose during the look-back period can change that. Squaremouth's own tip: check whether your condition counts as "stable" under that policy's definition.
The waiver. Many comprehensive plans offer a pre-existing condition waiver if you buy within a set number of days of your first trip deposit (often 14 to 21 days), are medically able to travel when you buy, and insure the full prepaid, non-refundable cost of the trip. Some windows are shorter: World Nomads' U.S. Explorer and Epic plans use 7 days.
What the waiver covers varies. On some plans it reaches emergency medical care and evacuation. Faye, for example, says its waiver applies to trip cancellation and interruption.
Some conditions are excluded anyway. Squaremouth lists mental health conditions, Alzheimer's and dementia, terminal illness, pregnancy and travel against a doctor's advice among the usual exclusions, even with a waiver.
Acute onset is a different benefit. Some travel medical plans cover only the "acute onset" of a pre-existing condition, meaning a sudden flare-up, often with a lower limit than the rest of the policy.

When we bought our plan, we weren't asked about my stroke. Don't take that as a promise that you'll be covered, though. Not being asked isn't the same as being covered, and the pre-existing condition rules are where policies differ most. Before you buy, read each plan's rules: how long its look-back period is, whether it offers a waiver, and whether that waiver requires you to buy within a set number of days of your first trip payment. I'm not a licensed insurance agent, so I can't tell you whether a plan will cover your condition. If you're not sure, ask the insurer before you buy.

Traveling with older relatives

Multi-generational trips raise a few extra questions.

Age limits. Some plans stop selling at a certain age. SafetyWing's Nomad Insurance Essential, for example, can be bought up to age 69.
Shrinking coverage. VisitorsCoverage notes that many plans reduce or remove pre-existing condition coverage above a certain age. On one plan Insubuy lists for travel outside the U.S., the acute onset limit for U.S. citizens drops to a small fixed cap from age 65 to 69.
Premiums rise with age, so get a quote with everyone's real ages before you compare.
Family back home. Trip cancellation can cover the sudden illness of a family member who isn't traveling with you. Pre-existing rules can apply to them too, so check how the policy handles it.

Accessible travel: medications, mobility aids and getting home

Bring your medications legally. Japan's Ministry of Health says you can bring up to a one-month supply of prescription drugs for personal use without an import certificate (Yunyu Kakunin-sho). For more, apply before you leave home. Narcotics and some stimulant ingredients need separate advance permission, and some are prohibited outright. See the Ministry of Health page. Insurance doesn't replace this paperwork.
Refills usually aren't covered. VisitorsCoverage notes that travel medical plans typically don't pay for routine refills of medication you already take, so pack enough to last the trip.
Keep essentials in your carry-on. World Nomads suggests keeping medications, glasses, hearing aids and similar items in your carry-on, since they may be excluded from baggage coverage.
Mobility aids. Baggage benefits often have per-item limits. If a wheelchair, scooter or walker is essential to your trip, check how the policy treats it before you rely on it.
Evacuation and the trip home. Plans that include medical evacuation cover transport to a suitable hospital, and sometimes home, when it's medically necessary. Read the conditions: SafetyWing, for one, requires a doctor to certify it and the insurer to approve and arrange it in advance, so call the assistance line first.
Primary or secondary. Primary coverage pays first. Secondary coverage asks you to claim from your own health plan before the travel policy pays the rest. Know which one you have.

Questions to ask before you buy

Does it cover emergency medical care in Japan?And is that coverage primary or secondary?
Will it pay the hospital directly?JNTO calls this a cashless service. Otherwise, plan to pay first and claim later.
Is there a 24/7 assistance line with interpreters?Save the number and your policy number in your phone, and on paper.
How does it define a pre-existing condition?Look for the look-back period and what counts as a change in treatment.
Is there a waiver, and what's the deadline?Count the days from your first trip deposit, not from your flight.
Are there age limits or lower caps for older travelers?Check each traveler, not just yourself.
Does it cover medical evacuation and repatriation?And what does it need from you before it will arrange one?
How does it treat medications and mobility aids?Especially lost, stolen or damaged equipment.

Where to compare plans

Comparison sites let you see several insurers side by side. For U.S. travelers, three to start with:

Squaremouth compares plans from about 20 U.S. insurers and has a "Pre-existing Medical" filter that hides plans without a waiver.
VisitorsCoverage lists plans for U.S. travelers going abroad and explains the difference between pre-existing and acute onset coverage.
Faye sells its own plans to U.S. residents, with a pre-existing condition waiver for trip cancellation and interruption if you buy within 14 days of your first deposit.

Whatever you choose, compare the policy wording, not just the price.

If something happens in Japan

Emergency: dial 119 for an ambulance, 110 for police.
Japan Visitor Hotline: 050-3816-2787 (from overseas +81-50-3816-2787), run by JNTO 24 hours a day in English, Chinese and Korean, for accidents, illness and disasters. Details on the JNTO hotline page.
Call your insurer's assistance line early, ideally before treatment if you can, and ask whether they can arrange direct payment.
Ask for a cost estimate at hospital reception. JNTO suggests this.
Keep every receipt and medical report. You'll need them for a claim.
A useful phrase: JNTO's guide suggests showing a nearby person 救急車を呼んでください (kyukyusha o yonde kudasai, "Please call an ambulance").

On one of our Japan trips, Joanna got sick with what we believe was COVID. It was before testing was widespread. We didn't have to go to the hospital, but knowing we were covered made a stressful event a little less stressful.

Opening hours, routes and rules change; check before you go.