Health Insurance Statistics And Facts – Forbes Advisor

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Health insurance is a vital part of financial planning that helps pay for your healthcare. This can include doctor and hospital bills, annual doctor visits, specialist visits, prescription drugs, mental health services, dental care, eye care and other medical-related expenses.

However, many Americans struggle to afford the cost of healthcare insurance.[1] According to health insurance statistics from the Centers for Disease Control and Prevention, uninsured non-elderly adults (between ages 18 and 64) report that the top reason why they don’t have health insurance is that the cost is too high.[1]

Other health insurance facts suggest that health insurance costs likely won’t be coming down anytime soon. Affordable Care Act (ACA) marketplace insurers are requesting a 6% average premium hike for 2024, mostly because of inflation and higher levels of care since the pandemic in 2020.[2]

Health Insurance in the U.S. at a Glance

Most Americans have health insurance, but many people have medical debt.

  • More people had health insurance in 2022 (92.1%) than in 2021 (91.7%), according to the U.S. Census Bureau. [3]
  • An estimated 8.4% or 27.6 million American adults didn’t have healthcare coverage at some point in 2022. [1]
  • Hispanic and Black working-age adults were less likely to have healthcare coverage than White/Non-Hispanic or Asian adults in 2022.[3]
  • Nearly 25% of adults reported that either they or a member in their household has skipped doses of medicine, cut pills in half or not filled a prescription in the last year due to cost.[2]
  • About four in 10 adults (41%) reported having debt from unpaid medical or dental bills.[2]
  • Dental services are the most common type of healthcare that adults will delay due to costs (35%). That’s followed by vision services (25%) and a doctor’s visit (24%).[2]

Health Insurance Statistics

  • United States health insurance statistics show that Americans are worried about how much health insurance costs and being able to afford healthcare. Of the expenses adults are most concerned about affording, medical bills ranked second to gasoline and/or transportation expenses.[2]
  • Cost is preventing people from getting care—8.7% of adults reported not seeing a doctor in 2021 because of the expense.[2]
  • Healthcare expenditures per capita averaged $10,191 in the U.S. in 2020.[2]
  • Total national healthcare expenditures reached $4.3 trillion in 2021, slightly higher than in 2020, when expenditures totaled $4.1 trillion, and significantly higher than pre-pandemic healthcare expenditures which totaled $3.8 trillion in 2019.[4]
  • Preferred provider organizations (PPOs) are the most common type of health plan for covered workers, followed by high deductible health plans (HDHPs).[2]
  • The top three leading causes of death in 2021 were heart disease, cancer and Covid-19. [1]

Who Has Health Insurance?

More adults had health insurance in 2022 than in 2021, according to the U.S. Census Bureau. An estimated 304 million, or 92.1%, Americans had health insurance at some point in 2022, which is slightly higher than the 300.9 million, or 91.7% of people, who had health insurance at some point in 2021.[3]

  • Private health insurance was more prevalent than public health insurance in 2022, with 65.6% of insured adults having a private healthcare plan compared to 36.1% having a public healthcare plan. [3]
  • Employment-based health insurance was the most common subtype of health insurance coverage, covering 54.5% of the American population.[3]
  • Medicaid and Medicare were the second most common subtype of health insurance in 2022, covering 18.8% and 18.7% of the population.[3]
  • Direct-purchase healthcare, such as Affordable Care Act (ACA) plans, covered 9.9% of the population, followed by TRICARE (2.4%), and VA and CHAMPVA coverage (1%).[3]
  • A 2022 Forbes Advisor survey found that 85% of Americans said they are at least somewhat happy with their health insurance plans. [5]

Who Doesn’t Have Health Insurance?

Finding affordable health insurance isn’t always easy. That’s a major reason why millions of Americans aren’t covered.

  • An estimated 25.9 million, or 7.9% of Americans, didn’t have health insurance at any point during 2022, compared to 27.2 million, or 8.3%, in 2021.[3]
  • The number one reason uninsured nonelderly adults (between the ages 18 and 64) reported they don’t have health insurance is that the cost is too high (69.6%), followed by eligibility issues (26.2%) and not needing or wanting to be insured (23.5%).[2]
  • Health insurance for young adults is lacking. Young adults have the highest uninsured percentages of any age group with 14% of people 19 to 25 without health insurance and 12.5% of people 26 to 34 without coverage in 2022.[3]
  • Hispanic adults had the largest uninsured percentage (23.4%), followed by Black adults at 11.4%. Meanwhile, 7.4% of Asian adults and 6.8% of non-Hispanic White adults didn’t have health insurance in 2022.[3]
  • The region with the highest percentage of uninsured working-age adults was in the South, accounting for 7.7%, followed by the West, accounting for 4.2%. [3]

Healthcare Expenses

Healthcare expenses can range anywhere from the cost of a medication to an overnight stay at a hospital, and about half of U.S. adults say they have difficulty affording healthcare costs.[2]

  • Dental services are the most common type of care adults will forgo or delay due to costs (35%), followed by vision services (25%) and a doctor’s visit (24%). [2] Dental insurance is one way to pay for dental care. Dental insurance plans are typically much cheaper than health insurance, but they also have more limitations and exclusions, too.
  • Nearly 25% of adults reported either they or a member in their household, skipped doses of medicine, cut pills in half or didn’t fill a prescription in the last year due to cost. [2]
  • Low-income families and Black and Hispanic families account for larger percentages of adults who reported difficulty affording healthcare costs. [2]
  • Of the top expenses adults are worried about being able to afford, unexpected medical expenses were second to gasoline or other transportation costs. [2]
  • Healthcare expenditures per capita averaged $10,191 in the U.S. in 2020, with Utah having the lowest expenses, averaging $7,522 per capita, and Washington, D.C. having the highest expenses per capita, averaging $14,381.[2]

Cost of Hospital Stays

  • The average hospital-adjusted expenses per inpatient day is $2,883, according to KFF. [2]
  • Mississippi has the cheapest inpatient hospital expenses per day, averaging $1,305/day, and California averages the most expensive, at $4,181/day.[2]

Medical Debt

  • An estimated 41% of adults reported having medical or dental debt, with disproportionate percentages of Black and Hispanic adults, women, parents, low-income adults and uninsured adults. [2]
  • A quarter of respondents (26%) in a 2022 Forbes Advisor survey thought a medical bill under $500 is “unaffordable” if they were paying out of pocket. [6]
  • An estimated 40% of survey respondents said they used a credit card to pay for a medical bill that was more than $500. [6]

Challenges of Affording Healthcare

  • Americans are delaying care because of costs, including 8.7% of adults reporting not seeing a doctor in 2021 because of the cost. [2]
  • Hispanic adults shared the highest percentage of the population who reported not seeing a doctor in 2021 due to cost, at 16.9%, followed by American Indian/Alaska Native adults, who represented 13.4%. [2]

Cost of Health Insurance

  • The average annual single premium per enrolled employee for employer-based health insurance is $7,590/year in the U.S., with employees contributing $1,637 and employers contributing $5,953 annually. [2]
  • The average annual deductible per enrolled employee in employer-based health insurance is $3,811/year for families and $1,992/year for single coverage. [2]
  • An average premium increase of 6% is expected among ACA health insurance marketplace insurers in 2024, according to KFF. [2] Those higher costs not only put a strain on individuals, but can also hurt small businesses. Many of the same insurers that provide health plans to individuals also offer health insurance for small businesses.

Factors That Influence Health Insurance Costs

Factors such as the state where you live, how you get coverage, the type of plan and how many people are on your plan can all influence the cost of your health insurance plan. ACA plans also factor in your age, the plan’s metal tier (bronze, silver, gold and platinum) and your smoking status. You may also get reduced health insurance costs based on your household size and income if you have an ACA plan. [7]

  • For a 30-year-old adult, the average monthly cost for a PPO plan in the ACA marketplace is $458. The same plan for a 60-year-old adult is $1,095/month. [7]
  • The ACA allows health insurance companies to set higher rates for smokers, costing up to 50% more. [7]
  • For a couple aged 30 with two children, a silver ACA plan would be $1,557/month. For the same plan, but where the couple’s ages are 50, the average monthly premium increases to $2,092. [7] Standard health insurance can be pricey, but one low-cost option in most states is short-term health insurance. Short-term plans don’t offer the comprehensive coverage found in standard health insurance, but they can be a cheap solution to get some level of health coverage between jobs or if you can’t find a viable stopgap option.

Medicaid Statistics

  • About one in five (21%) of the U.S. population is enrolled in Medicaid/CHIP health coverage plans. [2]
  • Medicaid covers one in six adults between the ages 19 and 64, two in five children, five in eight nursing home residents and one in three people with disabilities. [2]
  • An estimated 41% of births in the U.S. were covered by Medicaid as of June 2023. [2]
    Maine has the highest percentage of medicare beneficiaries as a share of the total population (26%) and Utah has the lowest percentage (13%). [2]

Birth and Death Rates in America

  • Life expectancy at birth among the U.S. population in 2021 was 76.4 years, down about half a percentage point (0.6%) from 2020. [1]
  • Life expectancy decreased for both women and men in 2021. [1]
  • The top three leading causes of death in 2021 were heart disease, cancer and Covid-19. [1]
  • The total number of deaths in 2021 in America was over 3.4 million, with a per capita rate of 879.7 deaths per 100,000 people. [2]
  • Hawaii had the lowest number of deaths per capita (630 per 100,000 people) among the U.S., and West Virginia had the highest (1,229 per 100,000 people). [2]
  • The average infant mortality rate in 2021 was 543.6 infant deaths per 100,000 live births, which was very similar to the infant mortality rate in 2020. [1]
  • The leading causes of infant mortality in the United States in 2021 were congenital malformations, low birth weight and sudden infant death syndrome. [1]

Open Enrollment

  • Nine in 10 organizations have an open enrollment period for employees to sign up for, or elect new health benefits, according to the International Foundation of Employee Benefit Plans. [8]
  • Most organizations report beginning open enrollment in the fall: October (34%) or November (43%). [8]
  • On average, employees spend 18 minutes selecting their benefits, and 42% wait until the last minute to enroll. [9]
  • Companies with 1000+ employees offer their staff an average of 21 different benefits (including medical, dental, vision and voluntary benefits, such as a health savings account).
  • Companies with between 200 – 999 employees offer their staff an average of 18 different benefits, and small companies, with 200 employees or less, offer their staff an average of 13 different benefits. [10] Vision insurance is often a free or cheap coverage option for employees.

Types of Health Insurance Plans

When you’re researching how to get health insurance, you’ll discover there are many different types of health insurance plans to choose from. Some offer lower deductibles but higher health insurance premiums. Each plan has different benefits, and figuring out what’s best for you and your medical needs is an important step.

  • PPO plans are the most common type of health plan in group health insurance offered by employers, with 49% of covered workers enrolled in PPOs, according to KFF. [2]
  • HDHPs are the next most common type of health plan, with 29% of covered workers enrolled in this plan type, followed by health maintenance organizations (HMOs) (12%), point-of-service (POS) plans (9%) and conventional plans (1%). [2]

Preferred Provider Organization (PPO)

  • A PPO health insurance plan allows you to get healthcare outside of your provider network, and see a specialist without a referral. [11]
  • Typically have higher health insurance premiums than other health insurance plans. [13]

Health Maintenance Organization (HMO)

  • An HMO health insurance plan limits policyholders to seeing only providers in their network. [11]
  • You will likely need a referral to see a specialist. [11]
  • An HMO won’t cover your care if you see a provider or receive care outside of your network, except for emergency care. [11]
  • Typically have lower health insurance premiums than other types of health insurance plans. [11]

Exclusive Provider Organization (EPO)

  • An EPO health insurance plan limits policyholders to seeing only providers in their network. [11]
  • You likely won’t need a referral to see a specialist. [11]
  • An EPO won’t cover your care if you see a provider or receive care outside of your network, except for emergency care. [11]
  • Typically pay less in premiums with an EPO than you would with a PPO, but more than you would with an HMO. [11]

Point-of-Service (POS)

  • With a POS health insurance plan, you pay less for healthcare services when you visit a medical provider in your network. [11]
  • You will need a referral to see someone outside of your network and this will cost you extra funds. [11]
  • You will need a referral to see a specialist. [11]

High Deductible Health Plan (HDHP)

  • HDHP health insurance plans have a health insurance deductible of at least $1,500 for an individual or $3,000 for a family in 2023. [11]
  • Total out-of-pocket costs for in-network health services cannot exceed $7,500 for an individual, or $15,000 for a family in 2023. [11]
  • Premiums are typically low with an HDHP, but out-of-pocket costs can be high if you need regular healthcare. [11]
  • You can use a health savings account, called an HSA, to pay for healthcare services via an HDHP tax-free. [11]

Find The Best Health Insurance Companies Of 2024

Sources:

  1. Centers for Disease Control and Prevention
  2. Kaiser Family Foundation (KFF)
  3. U.S. Census Bureau
  4. Healthcare Systems Tracker
  5. Forbes Advisor Survey, June-July 2022
  6. Forbes Advisor Survey, October-November 2022
  7. Forbes Advisor: How Much Does Health Insurance Cost?
  8. International Foundation of Employee Benefit Plans
  9. HR Dive
  10. PlanSource
  11. Forbes Advisor: Types Of Health Insurance Plans

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