With this in mind, the main purpose of these health insurance statistics is 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
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.
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.
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, the health insurance statistics and 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 Profits and Statistics
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
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
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
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
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.
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.