Japan is preparing significant changes to its national health insurance system that will affect both families with children and patients using common medications. Two major reforms announced by the Ministry of Health, Labour and Welfare signal a shift in how healthcare costs are distributed among residents, including foreign families living in Japan. According to NHK, the ministry is coordinating plans to expand premium relief measures under the National Health Insurance (Kokumin Kenko Hoken) system, which covers self-employed workers, part-time employees, and others not enrolled in employer-sponsored insurance. Currently, premium reductions apply only to households with children under school age. The proposed expansion would extend these benefits to cover children up to high school age, with implementation potentially beginning as early as April 2027. This reform represents a substantial change for families enrolled in National Health Insurance. The current system reduces premiums by half for preschool-age children, helping to lower the financial burden on households. By extending this relief to high school students, the government aims to address the growing costs of raising children in Japan. Importantly, the expansion will not include income restrictions, meaning all households with children in the eligible age range would qualify regardless of their earnings. For expat families, this change could provide meaningful financial relief, particularly for self-employed foreign residents, freelancers, or those working for smaller companies that don't offer employer-sponsored health insurance. National Health Insurance premiums are calculated based on household income and the number of household members, so families with multiple children could see notable reductions in their annual healthcare costs. Meanwhile, a separate reform is moving forward that could increase out-of-pocket costs for certain medications. According to NHK's business reporting, a Ministry of Health, Labour and Welfare committee has decided to maintain insurance coverage for over-the-counter (OTC) similar drugs—medications with ingredients and effects similar to those available without prescription—while adding a surcharge to patients' co-payments. Currently, Japan's health insurance system covers these medications at the standard co-payment rate of 30 percent for most working-age adults, 20 percent for children and those aged 70-74, and 10 percent for those 75 and older. The proposed change would add an additional charge on top of these percentages, though specific amounts have not yet been announced. This approach represents a compromise between completely removing insurance coverage for these drugs and maintaining the current system. The rationale behind this policy stems from the argument that if medications are available over-the-counter, patients should bear more of the cost when obtaining them through prescription. Examples of OTC-similar drugs include certain pain relievers, cold medications, antihistamines, and topical treatments for minor conditions. For patients who regularly receive prescriptions for these types of medications, the change could result in higher costs at the pharmacy counter. For foreign residents, understanding these changes is crucial for healthcare planning. Those with families should evaluate whether switching to National Health Insurance might become more advantageous after the premium relief expansion. Self-employed expats, in particular, should calculate potential savings once the reform takes effect. Regarding prescription medications, patients may want to discuss alternatives with their doctors or consider purchasing OTC versions directly if the surcharge makes prescriptions more expensive. Keeping informed about which medications fall under the OTC-similar category will help residents make cost-effective healthcare decisions. These reforms reflect Japan's ongoing efforts to balance healthcare accessibility with the financial sustainability of its insurance system. While the premium relief expansion offers support to families, the medication surcharge shifts some costs back to patients. Foreign residents should monitor official announcements for implementation dates and specific details as these policies develop, ensuring they can adjust their healthcare and financial planning accordingly.