Foreign residents in Japan should prepare for significant changes to healthcare costs as the Ministry of Health, Labour and Welfare moves forward with plans to expand self-payment requirements for elderly care services and prescription medications. These reforms, aimed at sustaining Japan's strained social security system amid rapid population aging, will affect both current and future users of the country's healthcare infrastructure. According to NHK, the Ministry of Health, Labour and Welfare is adjusting policies to expand the proportion of people required to pay 20 percent of their long-term care insurance service costs, up from the current standard 10 percent co-payment. This adjustment comes as Japan grapples with demographic pressures from its aging society and the increasing burden on social security programs. The ministry is determining eligibility for higher co-payments based on ability to pay, though specific income thresholds have not yet been publicly announced. Currently, most users of Japan's long-term care insurance services pay 10 percent of costs out-of-pocket, with the insurance system covering the remaining 90 percent. Higher-income individuals already face 20 percent or 30 percent co-payment rates, but the government now plans to expand the 20 percent category to include more people. This change reflects the government's strategy to shift more healthcare costs to those deemed financially capable of bearing them, rather than implementing across-the-board increases. For expats planning long-term residence in Japan, these changes carry important implications. Foreign residents enrolled in Japan's social insurance system—which is mandatory for most visa holders—will be subject to the same co-payment rates as Japanese citizens when they reach eligibility age for long-term care insurance, typically 40 years old for premium payments and 65 for service access. Those approaching retirement age should factor potential increased out-of-pocket costs into their financial planning. Separately, the Japan Innovation Party has proposed reforms targeting over-the-counter (OTC) similar medications—prescription drugs with ingredients and effects similar to those available without prescription. According to NHK, the party's proposal would maintain insurance coverage for these medications while adding a "special fee" to be paid directly by patients on top of standard co-payments. This represents a middle-ground approach between full insurance coverage and complete removal from the national health insurance formulary. The proposal aims to reduce overall insurance expenditures without entirely eliminating coverage for commonly prescribed medications that have OTC equivalents, such as certain pain relievers, cold medications, and stomach remedies. If implemented, patients would continue receiving insurance benefits but would pay additional fees, effectively increasing their medication costs. These policy discussions occur against the backdrop of Japan's intensifying demographic crisis. With over 29 percent of the population now aged 65 or older—one of the highest rates globally—and a shrinking working-age population, the sustainability of Japan's universal healthcare and long-term care systems faces mounting pressure. The government must balance maintaining service quality and accessibility while ensuring the systems remain financially viable. For foreign residents, particularly those from countries with different healthcare models, understanding these changes is crucial. Unlike private insurance systems common in some countries, Japan's social insurance is mandatory and comprehensive, but evolving cost-sharing arrangements mean residents should anticipate gradual increases in out-of-pocket healthcare expenses. Expats should monitor official announcements from the Ministry of Health, Labour and Welfare regarding implementation timelines and specific income thresholds for expanded co-payment requirements. Consulting with employers' human resources departments or social insurance advisors can provide personalized guidance on how these changes might affect individual circumstances. Additionally, reviewing and adjusting personal health savings or considering supplementary private insurance may help offset increased costs as these reforms take effect.