Quick answer
Most people in the U.S. do have health insurance: 92% had coverage for at least part of 2025, and 26.7 million people went the whole year without it, according to the Census Bureau. The main reason people stay uninsured is cost. Others don’t know they qualify for help, live in a state that didn’t expand Medicaid, are between jobs, or aren’t eligible because of their immigration status.
Key takeaways
- The uninsured rate was 7.9% in 2025, about the same as in 2024.
- 61.7% of uninsured adults said they were uninsured because coverage wasn’t affordable (KFF, 2024 data).
- About half of uninsured people could get Medicaid or subsidized marketplace coverage.
- Uninsured rates are nearly twice as high in states that didn’t expand Medicaid.
- Premiums rose sharply in 2026 after enhanced tax credits expired, and marketplace sign-ups fell.
On this page
Why people go without coverage
- Cost. It’s the top reason by far. After the enhanced premium tax credits expired, the average marketplace enrollee paid 58% more in 2026, and sign-ups fell to 23.1 million from 24.1 million in 2025. See why health insurance is so expensive.
- Not knowing about help. Just over half of uninsured people in 2024 were eligible for Medicaid or subsidized marketplace coverage, according to KFF.
- Living in a non-expansion state. In the 10 states that haven’t expanded Medicaid, many adults earn too little for marketplace subsidies and don’t qualify for Medicaid. These states’ uninsured rate (14.5%) was nearly double that of expansion states (8.0%) in 2024.
- Job changes. Losing a job often means losing coverage. See health insurance for the unemployed.
- Missing enrollment windows. Marketplace plans can only be bought during open enrollment or after a qualifying life event. See the open enrollment period.
- Immigration status. Some immigrants can’t get Medicaid or marketplace subsidies, and more restrictions start in 2027.
- Paperwork. Medicaid renewals and income verification cause some people to lose coverage even when they still qualify.
Where Americans get coverage
| Type of coverage | Share of people covered in 2025 |
|---|---|
| Job-based | 53.5% |
| Medicare | 20.1% |
| Medicaid | 17.1% |
| Coverage bought directly, including the marketplace | 10.5% |
| Military (TRICARE) | 2.8% |
Why going without is risky
Without insurance, you pay full price for care, and one hospital stay or surgery can cost tens of thousands of dollars. See the worst that can happen if you get sick without health insurance. ACA plans can’t turn you down for a pre-existing condition, but you usually have to wait for open enrollment to sign up.
How to get covered if you’re uninsured
- Check Medicaid. You can apply any time. In most states, adults qualify with incomes up to 138% of the federal poverty level. See health insurance for low-income families.
- See what you’d pay on the marketplace after a premium tax credit. Many people pay much less than the full price.
- Check for a special enrollment period if you recently lost coverage, moved, married or had a baby. See qualifying events.
- Look at every low-cost option, from job-based coverage to catastrophic plans. See the cheapest ways to get health insurance.
See what coverage would cost you: compare quotes by ZIP code.
Frequently asked questions
How many Americans don’t have health insurance?
About 26.7 million people, or 7.9% of the population, were uninsured for all of 2025, according to the Census Bureau.
What’s the main reason people don’t have health insurance?
Cost. In 2024, 61.7% of uninsured adults said coverage wasn’t affordable.
Is there still a penalty for not having health insurance?
There’s no federal penalty. California, Massachusetts, New Jersey, Rhode Island and DC have their own penalties.
Sources
This article is general information, not insurance advice. Last reviewed September 2026.