Who has health insurance? Are rates going up?

More Americans had health insurance in 2022 than the year before. According to the Census Bureau, 92.1% of people in the US had health insurance in 2022 — an all-time high — up from 91.7% in 2021.

Health insurance helps Americans access healthcare and helps people maintain economic stability during medical emergencies. Most Americans are insured, but insurance rates still change from year to year due to economic trends (including ones related to COVID-19), demographic shifts (including an aging population), and public policy changes.

How common are private and public health insurance plans?

The Census Bureau estimates that 65.6% of Americans were covered by a private health insurance plan in 2022, and 36.1% had a public plan. (Yes, that’s more than 100%; the categories are not mutually exclusive and some people have both types.)

Employment-based plans are the nation’s most common type of insurance: 54.5% of Americans were insured through an employer or labor union in 2022. People can also purchase plans on their own, either directly from an insurance company or through a government marketplace like HealthCare.gov. In 2022, 9.9% of Americans purchased healthcare on their own and 2.4% were covered by Tricare, the insurance plan for military members and their families.

Public insurance plans include Medicare for people 65 and over, Medicaid for low-income individuals, and Department of Veterans Affairs (VA) coverage. In 2022, 18.7% of Americans used Medicare, 18.8% had Medicaid, and 1% had VA coverage. People can also be simultaneously eligible for both Medicare and Medicaid — 12 million Americans, or about 15% of all Medicaid enrollees, are enrolled in both programs.

An estimated 7.9% of all people were uninsured in 2022.

How did health insurance rates change from 2021 to 2022?

From 2021 to 2022, the share of people with public health insurance increased from 35.7% to 36.1%, driven by the increase in people using Medicare, from 18.4% to 18.7% of Americans. The share of people with private health insurance decreased from 66.0% in 2021 to 65.6% in 2022.

How do uninsured rates differ by race and ethnicity?

Hispanic adults have the highest uninsured rate in the US: In 2022, 23.4% of Hispanic adults were uninsured, more than twice the national rate of 10.8% for all adults. Black adults are also more likely to be uninsured, with an uninsurance rate of 11.4%. Asian adults were uninsured at a rate of 7.4%, and white, non-Hispanic adults had the lowest uninsured rate at 6.8% in 2022.

The trends were similar for children in each race or ethnicity group (though children have lower uninsured rates generally).

How do uninsured rates differ by age?

Children (under 19) and older adults (65 and older) are more likely to have health insurance than people ages 19 to 64. In 2022, 1.1% of seniors and 5.4% of children were uninsured, compared with 10.8% of adults between 19 and 64.

The Census Bureau attributes this to public insurance plans and provisions in health insurance laws. Seniors can receive health insurance through Medicare. Children often receive insurance through their parents’ plans, and public programs like Medicaid and the Children’s Health Insurance Program provide coverage for children in lower-income families. Young adults may also receive coverage from their parents’ insurance through age 25 (though people between 19 and 25 had the highest uninsured rates of any age group in the Census data).

How do uninsured rates differ by state?

In 2022, the share of people without health insurance ranged from 2.4% in Massachusetts to 16.6% in Texas. Nine states had uninsured rates above 10% in 2022, while nine states plus Washington, DC, had rates below 5%.

State-level data on insurance coverage comes from the American Community Survey, which has a different methodology than the Census, but data from both sources show that uninsured rates are generally higher in the South. The Census Bureau notes that states with expanded access to Medicaid under the Affordable Care Act collectively have lower uninsured rates for children (under 19) and working-age adults (19 to 64) compared with states that have not expanded access to Medicaid. (The Affordable Care Act permits states to change Medicaid eligibility so anyone under a certain income level can qualify. In states without expanded access, eligibility may depend on factors like household size, disability, and family status.)

In 2022, 4.1% of children and 8.4% of working-age adults lacked health insurance across all states with expanded Medicaid access. In states that hadn’t, those numbers almost doubled, to 8.1% of children and 16.2% of working-age adults. The states without expanded access at the time of the survey were Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming.

What does the data on health insurance miss?

The Census Bureau’s data comes from household surveys of the civilian, noninstitutionalized population in the US. That means it doesn’t include people in institutions such as prisons, long-term care hospitals, or nursing homes.

Because surveys are taken at the household, students living in dormitories may also be excluded if data about them is not reported from their parents’ homes. Additionally, people who are homeless and not in a shelter are omitted, as are many military personnel -— they’re only included if they live in a household (on post or off) with at least one civilian adult.

Survey data is collected in the 50 states and Washington, DC, but not Puerto Rico, the US Virgin Islands, Guam, American Samoa, or the Northern Mariana Islands.

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