GITNUXREPORT 2025

Undercoverage Statistics

Undercoverage costs billion annually, causing significant health access disparities nationwide.

Jannik Lindner

Jannik Linder

Co-Founder of Gitnux, specialized in content and tech since 2016.

First published: April 29, 2025

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Key Statistics

Statistic 1

Approximately 10-20% of individuals eligible for Medicaid remain unenrolled due to administrative barriers

Statistic 2

Nearly 25% of adults with low income in the U.S. are uninsured, leading to gaps in preventive care

Statistic 3

The percentage of uninsured children under five is approximately 4.5%, showing persistent undercoverage in early childhood

Statistic 4

Rural populations face higher undercoverage rates, with estimates suggesting 13% of rural residents are uninsured compared to 9% in urban areas

Statistic 5

The number of individuals with limited or no insurance coverage for specialty services such as mental health or dental exceeds 30 million

Statistic 6

Addressing undercoverage through continuous coverage initiatives has been estimated to improve healthcare access for over 5 million people annually

Statistic 7

The average delay in seeking care among uninsured adults is about 5 days longer than insured counterparts, which can adversely affect health outcomes

Statistic 8

The percentage of nonelderly adults under 200% of the federal poverty level who are uninsured is approximately 15%, demonstrating persistent undercoverage among vulnerable groups

Statistic 9

The coverage gap in states that did not expand Medicaid leaves approximately 2 million low-income adults uninsured

Statistic 10

Approximately 23 million nonelderly Americans are either uninsured or underinsured, highlighting a significant coverage gap

Statistic 11

About 35% of low-income adults eligible for Medicaid are not enrolled due to lack of awareness or complex enrollment processes, contributing to undercoverage

Statistic 12

In some states, over 50% of adults under 300% of the federal poverty level are unaware of Medicaid expansion options, increasing undercoverage

Statistic 13

Around 18 million Americans are uninsurable due to pre-existing conditions, representing a significant segment of undercoverage

Statistic 14

The uninsured rate among minority populations is substantially higher; for example, 16.3% of African Americans and 20.9% of Hispanics are uninsured

Statistic 15

Approximately 12% of underinsured adults report delaying critical healthcare services due to cost concerns, impacting health outcomes

Statistic 16

In the United States, about 8.5% of children are underinsured, meaning they have coverage but face barriers to accessing necessary care

Statistic 17

Undercoverage is estimated to cost the U.S. healthcare system over $100 billion annually due to delayed or forgone care

Statistic 18

About 6 million children in the U.S. are underinsured, often due to high out-of-pocket costs or limited provider networks

Statistic 19

Nearly 20% of nonelderly adults with incomes just above the Medicaid cutoff are uninsured, due to undercoverage issues

Statistic 20

About 15% of adults report delaying or skipping medical care due to cost, indicative of undercoverage

Statistic 21

Underinsurance among adults in the U.S. has increased from 20% in 2010 to nearly 25% in 2020, indicating rising undercoverage trends

Statistic 22

About 12 million adults with comprehensive insurance still face significant out-of-pocket costs, suggesting partial undercoverage

Statistic 23

30% of uninsured individuals report that they do not know how to navigate health insurance options, contributing to undercoverage

Statistic 24

Lack of awareness about eligibility for insurance programs accounts for up to 15% of undercoverage cases, especially among immigrant populations

Statistic 25

Mental health and dental services have higher undercoverage rates due to limited provider availability, affecting about 40% of underinsured individuals

Statistic 26

Children living in low-income households are twice as likely to be underinsured compared to those in higher-income households

Statistic 27

The average out-of-pocket expenditure for insured individuals who experience undercoverage is around $2,000 annually, leading to financial strain

Statistic 28

A significant portion of underinsured individuals (nearly 60%) have a health plan with high deductibles, limiting access to care

Statistic 29

Nearly 40% of those who are underinsured experience financial hardship, such as medical debt or inability to pay bills, due to coverage gaps

Statistic 30

The penetration of high deductible health plans (HDHPs) is increasing, with over 30% of employer-sponsored plans now being HDHPs, leading to higher undercoverage issues

Statistic 31

More than 20% of those with insurance experience some form of undercoverage, such as inadequate provider networks or uncovered services

Statistic 32

Hispanic and Black adults are 1.5 times more likely to be underinsured compared to White adults, highlighting racial disparities

Statistic 33

Preventive services such as screenings and vaccinations are underutilized by up to 40% among underinsured populations, increasing health risks

Statistic 34

Coastal and urban areas tend to have lower undercoverage rates compared to inland and rural regions, where healthcare access challenges are more pronounced

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Key Highlights

  • Approximately 10-20% of individuals eligible for Medicaid remain unenrolled due to administrative barriers
  • In the United States, about 8.5% of children are underinsured, meaning they have coverage but face barriers to accessing necessary care
  • Nearly 25% of adults with low income in the U.S. are uninsured, leading to gaps in preventive care
  • Undercoverage is estimated to cost the U.S. healthcare system over $100 billion annually due to delayed or forgone care
  • About 6 million children in the U.S. are underinsured, often due to high out-of-pocket costs or limited provider networks
  • The coverage gap in states that did not expand Medicaid leaves approximately 2 million low-income adults uninsured
  • Nearly 20% of nonelderly adults with incomes just above the Medicaid cutoff are uninsured, due to undercoverage issues
  • About 15% of adults report delaying or skipping medical care due to cost, indicative of undercoverage
  • The uninsured rate among minority populations is substantially higher; for example, 16.3% of African Americans and 20.9% of Hispanics are uninsured
  • Underinsurance among adults in the U.S. has increased from 20% in 2010 to nearly 25% in 2020, indicating rising undercoverage trends
  • About 12 million adults with comprehensive insurance still face significant out-of-pocket costs, suggesting partial undercoverage
  • The percentage of uninsured children under five is approximately 4.5%, showing persistent undercoverage in early childhood
  • 30% of uninsured individuals report that they do not know how to navigate health insurance options, contributing to undercoverage

Despite more than 20 million Americans being uninsured or underinsured—facing barriers that delay care, worsen health disparities, and cost the healthcare system over $100 billion annually—undercoverage remains a hidden crisis affecting vulnerable populations across the nation.

Access to Health Insurance Coverage

  • Approximately 10-20% of individuals eligible for Medicaid remain unenrolled due to administrative barriers
  • Nearly 25% of adults with low income in the U.S. are uninsured, leading to gaps in preventive care
  • The percentage of uninsured children under five is approximately 4.5%, showing persistent undercoverage in early childhood
  • Rural populations face higher undercoverage rates, with estimates suggesting 13% of rural residents are uninsured compared to 9% in urban areas
  • The number of individuals with limited or no insurance coverage for specialty services such as mental health or dental exceeds 30 million
  • Addressing undercoverage through continuous coverage initiatives has been estimated to improve healthcare access for over 5 million people annually
  • The average delay in seeking care among uninsured adults is about 5 days longer than insured counterparts, which can adversely affect health outcomes
  • The percentage of nonelderly adults under 200% of the federal poverty level who are uninsured is approximately 15%, demonstrating persistent undercoverage among vulnerable groups

Access to Health Insurance Coverage Interpretation

Despite ongoing efforts, millions in the U.S. remain on the sidelines of coverage—bogged down by bureaucratic barriers and persistent gaps—highlighting that access to healthcare is still more barrier than bridge for many, especially vulnerable populations.

Coverage Gaps and Policy Implications

  • The coverage gap in states that did not expand Medicaid leaves approximately 2 million low-income adults uninsured
  • Approximately 23 million nonelderly Americans are either uninsured or underinsured, highlighting a significant coverage gap
  • About 35% of low-income adults eligible for Medicaid are not enrolled due to lack of awareness or complex enrollment processes, contributing to undercoverage
  • In some states, over 50% of adults under 300% of the federal poverty level are unaware of Medicaid expansion options, increasing undercoverage
  • Around 18 million Americans are uninsurable due to pre-existing conditions, representing a significant segment of undercoverage

Coverage Gaps and Policy Implications Interpretation

The stark undercoverage statistics reveal that despite billions spent on healthcare, millions of low-income and vulnerable Americans remain in the shadows—uninsured, underinsured, and often left unaware—highlighting that policy gaps and complex enrollment processes continue to deny affordable coverage to those who need it most.

Economic and Demographic Disparities

  • The uninsured rate among minority populations is substantially higher; for example, 16.3% of African Americans and 20.9% of Hispanics are uninsured

Economic and Demographic Disparities Interpretation

These stark disparities in uninsured rates among minority groups highlight that healthcare access remains a glaring, systemic inequity that demands urgent and targeted policy solutions.

Impact on Healthcare Utilization and Costs

  • Approximately 12% of underinsured adults report delaying critical healthcare services due to cost concerns, impacting health outcomes

Impact on Healthcare Utilization and Costs Interpretation

Nearly 1 in 8 underinsured adults are forced to postpone essential healthcare because of cost, revealing that affordable coverage remains a critical gap in safeguarding public health.

Undercoverage and Underinsurance Issues

  • In the United States, about 8.5% of children are underinsured, meaning they have coverage but face barriers to accessing necessary care
  • Undercoverage is estimated to cost the U.S. healthcare system over $100 billion annually due to delayed or forgone care
  • About 6 million children in the U.S. are underinsured, often due to high out-of-pocket costs or limited provider networks
  • Nearly 20% of nonelderly adults with incomes just above the Medicaid cutoff are uninsured, due to undercoverage issues
  • About 15% of adults report delaying or skipping medical care due to cost, indicative of undercoverage
  • Underinsurance among adults in the U.S. has increased from 20% in 2010 to nearly 25% in 2020, indicating rising undercoverage trends
  • About 12 million adults with comprehensive insurance still face significant out-of-pocket costs, suggesting partial undercoverage
  • 30% of uninsured individuals report that they do not know how to navigate health insurance options, contributing to undercoverage
  • Lack of awareness about eligibility for insurance programs accounts for up to 15% of undercoverage cases, especially among immigrant populations
  • Mental health and dental services have higher undercoverage rates due to limited provider availability, affecting about 40% of underinsured individuals
  • Children living in low-income households are twice as likely to be underinsured compared to those in higher-income households
  • The average out-of-pocket expenditure for insured individuals who experience undercoverage is around $2,000 annually, leading to financial strain
  • A significant portion of underinsured individuals (nearly 60%) have a health plan with high deductibles, limiting access to care
  • Nearly 40% of those who are underinsured experience financial hardship, such as medical debt or inability to pay bills, due to coverage gaps
  • The penetration of high deductible health plans (HDHPs) is increasing, with over 30% of employer-sponsored plans now being HDHPs, leading to higher undercoverage issues
  • More than 20% of those with insurance experience some form of undercoverage, such as inadequate provider networks or uncovered services
  • Hispanic and Black adults are 1.5 times more likely to be underinsured compared to White adults, highlighting racial disparities
  • Preventive services such as screenings and vaccinations are underutilized by up to 40% among underinsured populations, increasing health risks
  • Coastal and urban areas tend to have lower undercoverage rates compared to inland and rural regions, where healthcare access challenges are more pronounced

Undercoverage and Underinsurance Issues Interpretation

Despite having coverage, nearly 8.5% of U.S. children and 20% of nonelderly adults with incomes just above Medicaid limits face undercoverage that costs the nation over $100 billion annually—a stark reminder that the healthcare safety net often catches the vulnerable but too frequently lets them slip through the cracks due to high costs, limited provider networks, and a confusing maze of options, thus keeping millions in a cycle of delayed care, financial hardship, and persistent disparities.