Insurance for Care: How Japan, Korea and Germany Share the Cost
Each collects money from workers and older people in advance, and pays for care when a person is assessed as needing it.
Picture a couple named Myron, 68, and Lila, 66. Lila's sister lives in Germany, and Myron has been reading about how other countries pay for the help older people need with daily life. In the United States, they know, Medicare does not pay for custodial care when that is the only care a person needs.
"So who pays in Japan?" Lila asked.
"Everyone does, ahead of time," Myron said. "Like insurance."
"And then?"
"And then the person pays a share."
Three countries do it this way. Each collects money from workers and older people in advance, and pays for care when a person is assessed as needing it. The details differ.
| Japan | Korea | Germany | |
|---|---|---|---|
| Who is covered | People 65 and older, and people 40 to 64 with age-related illness | People 65 and older, or younger with illnesses such as dementia or stroke, who need care for 6 months or more | People insured in the German system, by grade of need |
| The person pays | 10%, 20% or 30%, by income | 15% for care at home and 20% in an institution. Lower-income groups get discounts of 40% and 60% | Costs above the benefit amounts |
| Paid in advance by | About half premiums, half taxes | About two-thirds premiums in 2025, the rest from government and medical-aid funds | Insurance contributions |
| Size | 6.91 million people certified in April 2022 | 1.26 million people approved in April 2026, against 214,000 in 2008 | About 5.7 million people in need of care in 2023, 86% of them at home (reported) |
Germany pays a monthly cash amount to a person cared for at home, and the amount rises with the grade of need. In 2026 it is 347 euros a month at grade 2, 599 at grade 3, 800 at grade 4 and 990 at grade 5. A family can use it to thank a relative or pay a helper. If the person uses professional home care instead, the insurance pays up to a higher limit, between 796 and 2,299 euros a month depending on the grade.
Korea began its program in 2008. A person receiving care at home pays 15%. The same person in an institution pays 20%. Japan asks for 10%, 20% or 30% depending on income.
China is the newest example. In March 2026 the State Council and the national health insurance administration issued a guideline to build a national long-term care insurance system over three years. Pilot programs had begun in 2016. Sources differ on how many people were covered, from nearly 300 million to nearly 310 million.
Insurance does not make care free. Each person still pays a share, and each country decides who counts as needing care.
"That sounds fair to me," Myron said.
"It sounds expensive," Lila said. "I would like to know what the premiums are."
You could…
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Look up the co-payment in each country before picturing the bill, since 10% and 30% are very different.
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Ask whether a public system covers foreign residents. For Japan or Germany, ask the office, or a paid professional.
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Add up what a month of care costs in the country you are considering, and compare it with the share a person would pay under insurance.
What did you learn when you compared how another country pays for care? Share it here. Someone reading may find a door.
Figures are estimates for planning, based on public data. Sources: Japan Ministry of Health, Labour and Welfare, long-term care insurance outline; OECD Korea paper (2021) and Asian Development Bank presentation (July 2026); German Federal Ministry of Health, 2026 benefit table; Destatis via dpa (December 2024); State Council of China (March 2026); policycn.
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