Insured rates in the U.S. are near-record highs, but 1 in 4 Americans are underinsured, according to the Commonwealth Fund's Biennial Health Insurance Survey.
The biennial survey polls U.S. adults age 19 and older on their insurance status. The 2024 survey includes responses from more than 6,000 individuals aged 19-64. The survey does not include adults 65 and older, who are eligible for Medicare.
In 2024, 56% of adults reported being insured for the past year, and were not underinsured. Another 23% were underinsured, 12% were insured but were uninsured at some point in the past year and 9% were currently uninsured.
The Commonwealth Fund defines individuals as underinsured if:
- Their out-of-pocket costs, excluding premiums, exceeded 10% of their household income
- For individuals earning below 200% of the federal poverty level, if out-of-pocket costs, excluding premiums, were more than 5% of household income.
- If their deductible was more than 5% of household income
Here are 15 things healthcare leaders should know about insurance rates:
Access
- 2 in 3 underinsured individuals received coverage from their employer. Another 14% were enrolled in individual coverage.
- The high cost sharing rates in employer and individual plans are driven by growth in overall healthcare spending, according to the Commonwealth Fund.
- Underinsured individuals were more likely to report skipping needed medical care than those who were insured. Among underinsured individuals, 32% reported not filling a prescription in the past year, compared to 16% of those with adequate coverage. Among those uninsured at any point in the past year, 41% reported not filling a prescription.
- More than half of individuals uninsured at any point in the past year reported skipping a recommended test, treatment or follow-up or having a medical problem they did not visit a provider for.
- Four in 10 individuals surveyed said they skipped needed dental care in the past year. Among those with no dental insurance, 6 in 10 skipped dental care.
- In 2024, 1 in 5 individuals reported skipping needed mental healthcare due to cost. Among those who were underinsured, 23% reported skipping needed mental healthcare, and 34% of those uninsured said they skipped mental healthcare.
- Among those who said they delayed or skipped needed care or prescription drugs in the past year, 40% said their health problems worsened.
Debt
- In 2024, 3 in 10 people reported they were currently paying off medical debt. Among those who were underinsured, 4 in 10 were paying off debt, compared to 2 in 10 with adequate coverage.
- Individuals with employer or marketplace coverage were more likely to have medical debt than those with Medicaid.
- Of adults with Medical debt, nearly half are paying off $2,000 or more, and 21% are paying off more than $5,000 in debt.
- Hospital care was the most commonly reported source of medical debt, with 49% of those with debt citing inpatient costs as a contributor to debt. Another 36% said a physician's office visit led to debt, and 35% said emergency care contributed to the debt.
- Of those paying off debt, 36% have debt from dental care.
- Around half of adults with debt said it stemmed from an ongoing health condition, rather than a new condition.
- Current estimates of medical debt could be underestimating rates of debt, according to the Commonwealth Fund. Most estimates only include debt being paid to collection agencies. Around 3 in 4 respondents with debt reported they were paying directly to a provider.
- A small number of respondents with debt, 5%, reported being threatened with a lawsuit or arrest. Another 4% reported they had received a court order to have their wages garnished.
Because the Commonwealth Fund made adjustments to its methodology between 2022 and 2024, the results are not directly comparable, but were similar. In 2022, 23% of adults were underinsured.
Read the full report here.