I have been in Japan many years but have never applied for permanent residence. I had personal insurance under Pacific Star until last year. Their present carrier will not insure past renewal at age 64. I do not know how much longer I will be in Japan but I am positive that at the time I should need nursing care I would return to the U.S. Therefore, there is no way for me to receive any benefits from the near 50,000 yen a year I am being asked to pay to the Japanese national health insurance system. Now the local office is writing, with threats of more forceful action, if their billings are not paid. How is this to be handled?

Your question raises many other questions. Simply put, you are trying to have it both ways — be in Japan without being a part of the system.

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