Health Insurance Statistics and Facts (2021) | Policy Advice (2023)

With this in mind, the main purpose of thesehealth insurance statisticsis to outline the numbers and facts concerning the health insurance industry. Doing so should make it easier to identify and solve current challenges and create a better insurance system for everyone. This article covers a variety of topics, including but not limited to insurance profits, enrollment rates, fraud, and claim denial. Additionally, the statistics include several countries, with a focus on the US.

Health Insurance Statistics-2021

  • 9.4% of Americans were uninsured in 2018, thus leading to staggering health care costs in case of a medical emergency.
  • On a yearly basis, roughly 4% of uninsured Americans are forced to declare bankruptcy due to overwhelming health care costs.
  • 40%–50% of US residents rely on employer health insurance.
  • New York is known for having the highest health insurance rates, whereas New Mexico has the lowest.
  • In the US, it’s estimated that insurance fraud leads to costs of over $80 billion on a yearly basis. It’s unclear how much of the pie is owned by health insurance fraud specifically.

US Health Insurance Statistics

Health Insurance Statistics and Facts (2021) | Policy Advice (1)

1. Around 49% of the country’s total population receive employer-sponsored health insurance (also called group health insurance).

Health insurance coverage statistics show this to be the case and most of the group insurance may include life, health or some other type of personal insurance coverage.

The highest percentage of state residents that benefit from group insurance are currently working in the northeast and midwest regions. Utah and North Dakota top this list with more than half of their residents being covered by group insurance.

Additionally, California, Texas and New York respectively have the highest number of individuals receiving employer-sponsored health insurance in the United States. This is primarily because these are large and economically strong states, with almost half of their populations having group insurance.

2. In 2019 most US states eliminated the individual mandate penalty.

This is part of the many health care economic issues faced by the country today. People were concerned about paying penalties, which is why at the end of 2018, the penalty was reduced to $0 and will remain so throughout 2021.

There are, however, penalties in 2021 for not being insured in the states of New Jersey, California, Massachusetts, Rhode Island and the District of Columbia, unless you are eligible for an exemption. The penalties everywhere else are removed but the original individual mandate still exists.

3. Public health insurance in the United States covers only 34% of the population, much less than the universal coverage in countries like Canada and the United Kingdom.

Health industry facts collected from around the world show that the United States spends more of its budget on health care (around 17%) than other established countries like the United Kingdom (around 10%) and Canada, which offer universal health care.

The US public health insurance only covers 34% of the population. This despairing statistic makes it clear that it is more expensive to provide healthcare coverage in the US system than anywhere else in the world.

(Video) The real reason American health care is so expensive

4. Statistics show that there are more women enrolled in Medicaid – 17% women compared to only 12% men.

Health insurance data certainly suggests that women are less likely to be uninsured, especially when we compare Medicaid enrolment.

This is primarily because women have lower incomes on average and are more likely to qualify Medicaid eligibility in the categories of parent of children under 18, pregnant, over 65 or disabled.

5. Roughly 21% of Americans were insured by Medicare in 2019.

This totals roughly 72 million Americans. The numbers have definitely changed a bit since then, yet they show that insurance enrollment within the US is far from reaching an optimal rate. Millions of people remain uninsured, thus bringing along massive debt that’s difficult to repay. In fact, studies have also indicated that health care represents one of the leading causes of poverty within the US, alongside smoking, drugs, mortgages, and education.


6. In 2019, 9.2% of Americans were uninsured.

In other words, in the unfortunate case of an accident or disease, 9.2% of Americans will have to pay the full cost out-of-pocket, according to the health insurance statistics. Health care costs in the US are already sky-high when compared to other regions of the world.

Have in mind that quality healthcare is a necessity, not a luxury. Emergencies don’t happen just to other people and as we age the risk increases. With the rising costs of healthcare, it is a sound decision to consider health insurance and define your healthcare and financial needs. Informing yourself about choosing the right health insurance plan is the first step in finding the balance of all factors mentioned above.


Health Insurance Statistics and Facts (2021) | Policy Advice (2)

7. 4% of Americans are forced to declare bankruptcy due to unpaid medical bills.

High insurance costs, low income, and huge medical expenses lead to bankruptcy. This is currently the case for over 4% of US residents.

Source:New England Journal of Medicine

8. By 2026 in the US, thehealth insurance statisticsand data indicate that the hospital insurance trust fund may become depleted.

This will make it even harder for uninsured Americans to get access to quality health care. Experts are hopeful that a new hospital insurance trust fund will be reinstated, to ensure all expenses are covered.

Source:Jama Network

9. Private health care plans are seeing an increase in popularity, as the number of people enrolled has tripled since 2004.

This statistic helps underline a critical fact. While public health insurance is available, many Americans see it as insufficient, thus choosing to opt for private plans. Despite being more expensive, private health care plans usually offer access to quicker and better health care when compared to public-run hospitals.

Source:2018 Medicare Trustees Report

Health Insurance Statistics by State

10. On a state-wide level, 40%–50% of US residents rely on employer health insurance.

In a study carried out in 2013, the percentage of residents relying on employer health insurance was calculated. As such, states like Colorado, Connecticut, Delaware, Iowa, Kansas, Maryland, Massachusetts, Minnesota, North Dakota, and Wisconsin had some of the highest rates (all above 50%).


11. Texas, Oklahoma, Georgia and Florida had the highest percentage of uninsured Americans in 2019.

This showcases how essential it is for governments to figure out ways to make sure that more people are insured in these areas.


Health Insurance ProfitsandStatistics

12. In 2017, the top US health insurance companies made roughly $6 billion in profits.

This also upped their stock prices. Higher profits for insurance companies means they tend to rely more on actual payments made by clients, rather than government-sponsored incentives.


13. An illness that entails intensive care for a prolonged period generally brings medical bills of over $1 million.

It’s difficult to imagine having to pay over $1 million because of a disease that nobody has any control over. However, this is the unfortunate case within the US health care system, thus showcasing why insurance is mandatory. Similarly, another study shows that hospitals overcharge Americans by roughly $10 billion on a yearly basis.

Source:Business Insider

Mental Health Insurance Coverage Statistics

Health Insurance Statistics and Facts (2021) | Policy Advice (3)

14. Health insurance statistics show that the US state of Massachusetts ranks first for access to mental health care, whereas Mississippi is last.

This study covered the number of adults with mental health conditions who didn’t receive treatment, in some cases because of the general poor availability of a mental care workforce. There were also those who reported an unmet need, were uninsured, or weren’t able to see a doctor because of the large costs.

Source:MHA National

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Health Insurance Claim Denial Statistics

15. Over 19% of the insurance claims submitted via in-network services in 2017 were denied by insurers.

This statistic sheds some light on claim denial by US health insurers, which seems to be quite prevalent. It is, however, important to mention that denial rates are based on a series of factors, including the medical conditions stipulated in the contract, alongside health care availability and funding.


Health Insurance Industry Employment Statistics

16. In 2018 health insurance statistics data, the number of health insurance home-office employees reached 528,000 in the US.

This is representative of a general growth trend, granted that the first studies in this regard were carried out back in 1960. While 2018 marks the largest number of employees so far, there is still no data for 2020 where it is expected that this statistic reaches it all-time high.


Health Insurance Fraud Statistics

17. In the US, it’s estimated that insurance fraud leads to costs of over $80 billion on a yearly basis.

This trend has caused over 49% of US adults to worry over the safety of their health care data, considering that identity theft is becoming a country-wide problem.

Source:Insurance Fraud

Health Insurance Statistics and Facts (2021) | Policy Advice (4)

18. 22% of Americans are worried that health insurance fraud can lead to having their policies canceled by insurers.

At this time, the tools designed to recover stolen medical identities are still in their infancy. Meanwhile, the need for fraud protection is constantly growing bigger.

Source:Insurance Fraud

(Video) Health Insurance Customer Response Prediction - Data Every Day #220

Health Insurance Cost Statistics

19. Roughly 800 million people worldwide spend 10% of their household budget on health care.

The study concluded that half of the world’s population lacks essential and basic health care services. While the world’s population has increased exponentially, the prevalence of health care is still far behind.


Health Insurance Enrollment Statistics

20. Between 2014 and 2019, a total of 11.4 million Americans selected a Marketplace health insurance plan.

These plans were purchased thanks to the Affordable Care Act’s Health Insurance Marketplace, which allows US residents to buy insurance during an established open enrollment period.

Source: KFF


Based on everything that has been outlined here, several points are worth noting. First, health insurance is necessary to ensure that an unexpected disease or accident doesn’t lead to impoverishment. On the other hand, insurance premiums remain fairly low, but costs are continuing to increase. This shows that additional regulation is necessary to ensure that the main goal of health insurance providers is to help the needy, rather than to get higher profits. Second, health insurance statistics indicate that health care worldwide remains underdeveloped—hundreds of millions of people lack access to basic health care services.

In the future, it’s essential for political leaders and civil society to focus on making affordable, high-quality health care a reality for people throughout the world. Failure to do so will impede the efforts to extend life expectancy and potentially lead to the appearance of more diseases that can’t be treated.


How much does private health insurance cost?

Costs in this scenario depend on a variety of factors, yet according to the private health insurance statistics from 2018, the total is situated at roughly $166 on a monthly basis.

What percent of the US has health insurance?

It is estimated that roughly 91.2% of Americans had some form of health insurance within 2016. Bringing this number to 100% should remain a top goal for the US Federal Government.

Which state has the lowest health insurance rates?

Recent studies indicate that New Mexico has the lowest rates for health insurance in the United States. Other states renowned for low rates include Utah, California, and Texas. You’ll find the highest rates in New York, South Carolina, and Alabama.

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Which state has the highest uninsured rate?

As mentioned earlier on in our health insurance statistics, Texas has the highest number of uninsured residents in the United States.

List of Sources:


Which health insurance is best in 2021? ›

The Best 5 Health Insurance Plans in India in 2021
  • Aditya Birla Activ Assure Diamond.
  • Aditya Birla Group Activ Health Plan.
  • Aditya Birla Super Top-up.
  • Bajaj Allianz Health Guard.
  • Niva Bupa Health Plus.
  • Manipal Cigna Pro-Health Group.
  • Manipal Cigna Super Top-up Group.
  • Bajaj Allianz Global Personal Guard Policy.

What does the average American pay for health insurance in 2021? ›

Average health insurance rates by plan type
Type2022 monthly premium2021 monthly premium
Jul 27, 2022

What are the 3 pillars of universal coverage? ›

Definition and Concept of Universal Health Coverage

The main concepts of UHC include 1) population coverage, 2) range of health services provided, and 3) out-of-pocket expenditure (Figure). Figure. The 3 dimensions of universal health coverage.

How do I get universal health coverage? ›

To accelerate global progress toward UHC, PATH and our partners are supporting governments and health departments in five key ways:
  1. Increasing health system resilience.
  2. Investing in subnational health systems.
  3. Digitalizing health systems.
  4. Prioritizing self-care.
  5. Focusing on people-centered care.
  6. A healthier world is possible.
Apr 6, 2022

Which health insurance is most widely accepted? ›

Blue Cross Blue Shield (BCBS) is a widely used health insurance provider available in all 50 states. They've been serving people in the United States for more than 90 years.

Which health insurance has highest claim settlement ratio 2021? ›

Oriental Insurance is at top with 92.71% and New India Insurance with 91.99% claim settlement ratios.

What is a good deductible for health insurance? ›

Any health plan carrying a deductible of at least $1,400 for an individual or $2,800 for a family. Total out-of-pocket expenses for the year can't exceed $7,050 for an individual or $14,100 for a family, including deductibles, copayments and coinsurance.

How much is a good health insurance plan? ›

In 2020, the average national cost for health insurance is $456 for an individual and $1,152 for a family per month. However, costs vary among the wide selection of health plans.

How can I lower my health insurance costs? ›

How can I lower my monthly health insurance cost?
  1. You can't control when you get sick or injured. ...
  2. See if you're eligible for the tax credit subsidy. ...
  3. Choose an HMO. ...
  4. Choose a plan with a high deductible. ...
  5. Choose a plan that pairs with a health savings account. ...
  6. Related Items.

What are the negatives of universal health care? ›

Disadvantages of universal healthcare include significant upfront costs and logistical challenges. On the other hand, universal healthcare may lead to a healthier populace, and thus, in the long-term, help to mitigate the economic costs of an unhealthy nation.

WHO pays for universal healthcare? ›

California's health care system is paid for by multiple entities — patients, insurance companies, employers and governments. But a universal health care system would be paid for by a single entity — the government, or the “single payer.”

What is universal health care PROs and cons? ›

Here are a few pros and cons of universal healthcare.
  • PRO: Make It Easier for Patients to Seek Treatment. ...
  • CON: Doctors Have Less Flexibility in Negotiating Rates. ...
  • Must Read: What Does Universal Healthcare Means for Medical Practices. ...
  • PRO: It Could Increase Demand for Medical Services.

How can I get free healthcare in America? ›

Medicaid & CHIP coverage. Medicaid and the Children's Health Insurance Program (CHIP) provide free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities.

Which country has the best healthcare system 2022? ›

Countries with the best healthcare systems in the world in 2022
  • Countries with the best healthcare systems in the world in 2022. The following 10 countries have been seen as providing the best healthcare for their population. ...
  • Singapore. ...
  • Australia. ...
  • Switzerland. ...
  • The Netherlands.
Jun 15, 2022

Which countries do not have free healthcare? ›

Here are ten notable countries that are still without universal health care.
  1. United States. The United States remains the only country in the developed world without a system of universal healthcare.
  2. China. China is coming close to a universal healthcare model. ...
  3. Syria. ...
  4. Yemen. ...
  5. Afghanistan. ...
  6. Pakistan. ...
  7. Nigeria. ...
  8. Egypt. ...
May 30, 2020

Which health insurance company has the highest customer satisfaction? ›

Twenty-four Humana plans received a four-star or better rating from the NCQA in 2022. 1 Humana led the pack for customer satisfaction among health insurers in 2020, according to data from the ACSI survey.

Which is the No 1 health insurance company in USA? ›

UnitedHealth Group

What insurance is accepted in all 50 states? ›

Most Blue Cross Blue Shield members can rest easy since Blue Cross Blue Shield coverage opens doors in all 50 states and is accepted by over 90 percent of doctors and specialists.

Which insurance has best claim settlement ratio? ›

Top General Insurance Companies with Best Claim Settlement Rate
  • Reliance General Insurance Co. ...
  • SBI General Insurance Company Ltd. ...
  • Shriram General Insurance Co. ...
  • Tata AIG General Insurance Company Ltd. ...
  • United India Insurance Company Ltd. ...
  • Universal Sompo General Insurance Company Ltd.

Which is the best health insurance company claim settlement? ›

List of Claim Settlement Ratio of Health Insurance Companies (2019-2020)
Insurer NameClaim Settlement RatioIncurred Claim Ratio
Reliance Health Insurance100%89.36%
Star Health Insurance90%65.91%
SBI Health InsuranceN/A50.54%
Tata AIG Health Insurance96%66.61%
20 more rows

Which insurance is best in claim settlement? ›

The highest claim settlement ratio is of the public insurance company LIC at 98.31%.

What is a good out-of-pocket maximum? ›

The maximum out-of-pocket limit is federally mandated. The most that individuals will have to pay out-of-pocket in 2021 is $8,550 and $17,100 for families. However, your plan may have a lower out-of-pocket maximum — most do.

Is it better to have a high or low medical deductible? ›

Key takeaways. Low deductibles are best when an illness or injury requires extensive medical care. High-deductible plans offer more manageable premiums and access to HSAs.

What is the downside of having a high-deductible? ›

The cons of high-deductible health plans

Yes, HDHPs keep your monthly payments low. But they can also put you at risk of facing large medical bills that you may not be able to afford. Since HDHPs generally only cover preventive care, an accident or emergency could result in very high out-of-pocket costs.

What state has cheapest health insurance? ›

The five cheapest states for premiums in 2021 are:
  • Minnesota: $292.
  • New Hampshire: $325.
  • Rhode Island: $328.
  • New Mexico: $329.
  • Michigan: $335.

Is it worth getting private health insurance? ›

Private health insurance helps people avoid long wait times for non-urgent procedures and lets them access services that Medicare does not cover. But out of pocket costs may be a deterrent for many people to use it to pay for their medical costs.

Why health insurance is so expensive? ›

The price of medical care is the single biggest factor behind U.S. healthcare costs, accounting for 90% of spending. These expenditures reflect the cost of caring for those with chronic or long-term medical conditions, an aging population and the increased cost of new medicines, procedures and technologies.

Can you negotiate health insurance premiums? ›

And though you can't haggle over the rate, there's some wiggle room around premiums. "In general, you cannot use a competitor's rates to negotiate lower premiums with another carrier," said Donahue. "However, many insurance companies will aim to cut premium costs for nearly anything that could lower your risk profile."

Is it a good idea to use tax credit for health insurance? ›

The premium tax credit helps lower-income Americans pay for health insurance but, if you're not careful, you could end up owing money at tax time. Designed to help people who aren't insured through an employer-sponsored plan, the credit is available to anyone making less than 400% of the official federal poverty level.

How much more do smokers pay for health insurance? ›

The ACA allows for insurance companies to charge smokers up to 50% more (or premiums that are 1.5 times higher) than non-smokers through a tobacco surcharge.

Which company has best health insurance? ›

Top 10 Best Health Insurance Companies in India
  • Care Health Insurance (Formerly Religare Health Insurance)
  • Manipal Cigna Health Insurance Company Limited.
  • Bajaj Allianz Health Insurance Company Limited.
  • New India Assurance Company Limited.
  • Oriental Insurance Company Limited.
  • National Insurance Company Limited.
Aug 9, 2022

Which is the No 1 health insurance company in India? ›

Best Health Insurance Companies in India
RankHealth Insurance CompanyNetwork Hospitals
1IFFCO Tokio General Insurance1416
2Care Health Insurance2500
3Magma HDI Health Insurance5016
4The Oriental Insurance CompanyNA
24 more rows

Which is the No 1 health insurance company in USA? ›

UnitedHealth Group

Which health insurance company has the highest customer satisfaction? ›

Kaiser Permanente is perpetually ranked as having the highest customer satisfaction, and it especially stands out for its Medicare Advantage plans. However, Kaiser Permanente is only available in eight states and Washington, D.C.


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