How Many People Don’t Have Health Insurance in the U.S.? A Clear, Practical Guide

Understanding how many people don’t have health insurance in the United States is about more than just a number. It affects how people access care, handle medical bills, and make everyday decisions about work and family.

This guide breaks down what “uninsured” really means, how many people are affected, who is most likely to be uninsured, and what it can mean for your health and finances.

The Big Picture: How Many People Are Uninsured?

In a country of over 330 million people, tens of millions live without health insurance in any given year.

Commonly cited national estimates indicate that:

• Roughly 1 in 10 people in the U.S. are uninsured at any point in time.
• That translates to around 25–30 million people without health coverage in a typical recent year.

These numbers can shift slightly from year to year, depending on:

• Changes in the economy (job gains or losses)
• Policy changes at the federal and state level
• Shifts in how people enroll in public and private health insurance

Even though most people in the U.S. do have some form of health insurance, the uninsured population remains large enough that almost everyone knows someone affected.

What Does It Mean To Be “Uninsured”?

Someone is considered uninsured if they:

• Do not have any private health plan (such as employer coverage or an individual plan), and
• Do not have any public coverage (such as Medicare, Medicaid, or coverage for military members and veterans).

Common Types of Coverage People Might Be Missing

When a person is uninsured, they are not covered by:

• Employer-sponsored insurance
• Individual or family plans bought through an insurance company or marketplace
• Medicaid or the Children’s Health Insurance Program (CHIP)
• Medicare
• TRICARE or other military-related coverage

Some people may have very limited discount plans or health-sharing arrangements, but these are generally not considered full health insurance because they may not cover major medical needs consistently.

Who Is Most Likely To Be Uninsured?

People of all ages, backgrounds, and incomes can be uninsured, but some groups are more likely to lack coverage.

By Age

• Adults 19–64 are the most commonly uninsured age group.
• Children are less likely to be uninsured than adults because there are more public coverage options for kids in many states.
• Adults 65 and older often have access to Medicare, so they are less likely to be uninsured, though gaps can occur for people who delay enrollment or do not qualify under standard rules.

By Employment and Income

• Workers in small businesses and certain industries (like hospitality, construction, agriculture, and some service jobs) may be less likely to be offered employer coverage.
• People with lower or modest incomes but who do not qualify for public programs may find coverage costs difficult to afford.
• People working multiple part-time jobs often fall through the cracks if none of their employers offer benefits.

By Immigration and Residency Status

• Some noncitizens, especially those without permanent legal status, may have limited access to public coverage and may also work in jobs that do not offer health benefits.

Geographic Differences

Insurance access can vary widely based on where you live:

• States that have expanded certain public health programs tend, on average, to have lower uninsured rates.
• Rural areas may have fewer employers that offer comprehensive health insurance, and fewer plan options overall.

Why Do So Many People Still Lack Health Insurance?

There isn’t just one reason people end up uninsured. Common factors include:

1. Cost and Affordability

Many uninsured people say that cost is the main barrier. Even when coverage is available, premiums, deductibles, and copays can feel out of reach, especially for:

• People who earn too much to qualify for public programs but not enough to comfortably afford private coverage
• Families who must pay for coverage for multiple household members

2. Losing or Changing Jobs

Because many people get health insurance through work, job changes can lead to losing coverage. Common scenarios include:

• Being laid off or having hours reduced
• Changing employers and facing a waiting period before new coverage starts
• Leaving a job with benefits to become self-employed

Some people may be eligible to continue previous coverage for a time or buy a marketplace plan, but not everyone knows that or can afford it.

3. Not Being Eligible for Public Coverage

Eligibility for Medicaid and other public programs varies by state and by:

• Income
• Family size
• Disability status
• Age and pregnancy status

Where eligibility is more limited, more people may fall into a “coverage gap”: making too much to qualify for public coverage, but not enough to afford private plans easily.

4. Confusion and Complexity

The health insurance system is often confusing. People sometimes remain uninsured because:

• They are unsure where to apply or what they qualify for
• They misunderstand enrollment deadlines
• They assume they don’t qualify based on older rules or information

5. Personal Preferences and Perceptions

A smaller share of people remain uninsured by choice, believing they:

• Are healthy enough to “take the risk”
• Prefer to pay only when they need care
• Do not trust insurance companies or dislike dealing with paperwork

However, unexpected illnesses or injuries can be financially overwhelming, even for people who are generally healthy.

What Being Uninsured Can Mean in Daily Life

Going without health insurance affects more than just medical bills. It can shape decisions about when, where, and whether to seek care.

Access to Care

People without insurance are more likely to:

• Delay or skip care for non-urgent issues
• Avoid regular checkups, screenings, or preventive visits
• Rely on urgent care or emergency rooms for problems that could have been handled earlier in a clinic setting

This can sometimes lead to more serious health issues that require more complex and costly treatment later.

Financial Impact

Without insurance:

• A single emergency room visit, surgery, or hospital stay can lead to large medical bills.
• People may face medical debt, payment plans, or collections.
• Some households must choose between paying for medical care and other essentials, like rent, utilities, or food.

Even for those who negotiate bills or receive financial assistance, the process can be stressful and time-consuming.

Emotional and Practical Stress

Living without health insurance can bring:

• Worry about what will happen if a serious illness or accident occurs
• Hesitation to seek care even when symptoms are concerning
• Extra time spent looking for low-cost clinics or charity programs

How Has the Number of Uninsured Changed Over Time?

The number of uninsured people in the U.S. has not stayed constant. It has moved in recognizable patterns:

• Earlier decades: Higher uninsured rates, especially among low-income adults and workers in jobs without benefits.
• After major health policy changes in the 2010s: National uninsured rates declined, and millions gained coverage through:
  • Public program expansions in many states
  • Health insurance marketplaces and financial assistance
• Recent years: The uninsured rate has generally remained lower than historical peaks, though there have been small ups and downs as:
  • Job markets shifted
  • Temporary policy protections began or ended
  • States made decisions about expanding or tightening coverage programs

Even with these gains, the U.S. still has millions of uninsured adults and children, and coverage remains closely tied to employment, income, and state policy.

Uninsured vs. Underinsured: An Important Distinction

Sometimes people ask about the uninsured and the underinsured together, but they’re not the same.

• Uninsured: No health insurance coverage at all.
• Underinsured: Has a plan, but:
  • Out-of-pocket costs are very high compared to income, or
  • Coverage is very limited, leaving large gaps for common needs.

Both groups can struggle to afford care, but discussions about “how many people don’t have health insurance” usually focus specifically on those with no coverage.

Quick Snapshot: Health Insurance Status in the U.S.

Here’s a simple way to visualize the landscape in a typical recent year:

The uninsured are a minority, but a very significant one, considering the size of the country.

Why This Matters Even If You’re Insured

Understanding how many people are uninsured—and why—can be useful even if you currently have coverage.

• It explains why some clinics, hospitals, and community organizations focus heavily on financial assistance and outreach.
• It highlights the importance of knowing your options when your life changes (job loss, marriage, divorce, turning 26, moving states).
• It can help families support relatives or friends who may quietly be going without coverage because they’re unsure where to start.

Practical Steps If You’re Currently Uninsured

If you or someone you know doesn’t have health insurance, some general steps can help you get oriented:

1. Check if you qualify for public coverage

   • Eligibility depends on income, age, disability status, pregnancy, and where you live.
   • Many families are surprised to learn that their children qualify even when adults in the household do not.

2. Explore marketplace or individual plans

   • Look at total costs, including premiums, deductibles, and expected out-of-pocket spending.
   • Pay attention to which doctors and hospitals are in-network.

3. Look for special enrollment opportunities

   • Certain life events (job loss, marriage, birth, moving) can allow you to enroll outside the usual sign-up periods.

4. Use low-cost or sliding-scale clinics while you search

   • Many communities have health centers that adjust fees based on income.
   • Some hospitals have financial assistance or charity-care policies.

5. Stay organized 📝

   • Keep copies of pay stubs, tax information, and ID documents handy; they’re often needed for applications.

These steps do not replace personalized guidance, but they offer a starting point for moving from being uninsured toward more stable coverage.

Key Takeaways

• Millions of people in the U.S. still do not have health insurance, even though most of the population has some form of coverage.
• A commonly cited estimate is that around 1 in 10 people in the United States are uninsured, which amounts to roughly 25–30 million people in a typical recent year.
• Adults under 65, workers in jobs without benefits, people with lower incomes above public-program thresholds, and some noncitizens are more likely to be uninsured.
• Being uninsured can mean delayed care, higher financial risk, and greater stress, especially when unexpected health issues arise.
• The number of uninsured people has declined from past peaks due to major policy changes, but coverage still varies widely by state, income, and employment.

Understanding how many people don’t have health insurance in the U.S.—and why—can help you better navigate your own coverage choices, recognize potential gaps, and support others who may be trying to find a path to more secure health care access.