Health insurance coverage in the US remains sharply tied to income: adults below 200% of the federal poverty level face uninsured rates near 20%, compared to under 5% for those earning 400% of poverty or more. In 2025, 26.7 million Americans (7.9%) went uninsured for the full year, even as median household income hit a record $87,460.
Health Insurance by Income in US 2026 – Introduction
Health insurance by income remains one of the clearest dividing lines in American healthcare access, and the newest government data confirms the pattern has barely budged even as the broader economy improved in 2025. The Census Bureau’s September 2026 release on income, poverty, and health insurance shows median household income climbing to a historic $87,460, yet the national uninsured rate held steady at 7.9%, meaning higher aggregate income has not translated into meaningfully broader coverage. The gap sits almost entirely along income lines: lower-earning households remain far more likely to lack coverage than higher earners, a pattern that has held for over a decade of federal survey data.
2026 adds a new wrinkle to this income-coverage relationship. The Affordable Care Act’s enhanced premium tax credits expired at the end of 2025, and early data already shows subsidized marketplace enrollees paying sharply more out of pocket. This report walks through exactly how coverage rates, coverage type, and now premium costs break down by income level, drawing on the freshest Census Bureau, CDC, and CMS data available heading into the rest of 2026.
Interesting Facts About Health Insurance by Income in 2026
| Fact | Figure |
|---|---|
| US Median Household Income (2025) | $87,460, up 2.6% from 2024 |
| National Uninsured Rate (2025, full-year) | 7.9%, or 26.7 million people |
| Uninsured Rate, Under 100% of Poverty | 16.5%-18.8%, depending on survey |
| Uninsured Rate, 400%+ of Poverty | Under 5%, the lowest of any income group |
| Poverty Rate (2025) | 10.2%, a historic low, 34.5 million people |
| Poverty Threshold, Family of Four (2025) | $32,970 |
| Employer Coverage Rate, Under 200% of Poverty | 22.5% |
| Employer Coverage Rate, 400%+ of Poverty | 82.5% |
| Average Marketplace Premium After Subsidy (2026) | $178/month, up 58% from $113 in 2025 |
Source: US Census Bureau, “Income, Poverty and Health Insurance Coverage in the United States: 2025” (September 2026); CDC National Health Interview Survey; Peterson-KFF Health System Tracker.
These interesting facts about health insurance by income show a coverage system where the poverty line, not just employment status, still functions as the single strongest predictor of whether someone has insurance. Adults living below 100% of the federal poverty level face uninsured rates roughly four times higher than adults earning 400% of poverty or more, a gap that has remained remarkably stable across multiple years of Census and CDC tracking despite year-to-year swings in the overall national rate.
The 2026 addition to this picture is the sharp rise in what subsidized households now pay for marketplace coverage, following the expiration of enhanced premium tax credits at the end of 2025. That change disproportionately affects households in the middle of the income distribution, people who earn too much for Medicaid but still depend heavily on subsidies to afford a marketplace plan, adding a new layer to the long-standing income-coverage relationship this report breaks down section by section.
Health Insurance by Income 2026 | Overall US Coverage Rates
| Coverage Type | Share of Population, 2025 |
|---|---|
| Employment-Based Insurance | 53.5% |
| Medicare | 20.1% |
| Medicaid | 17.1% |
| Direct-Purchase/Marketplace Coverage | 10.5% |
| TRICARE (Military) | 2.8% |
| VA and CHAMPVA Coverage | 1.2% |
| Uninsured, Full Calendar Year | 7.9% (26.7 million people) |
Source: US Census Bureau, “Health Insurance Coverage in the United States: 2025.”
The 2025 coverage breakdown confirms that employment-based insurance remains by far the largest single coverage category in the country, covering just over half the population for at least part of the year, more than triple the share covered by Medicaid. Public coverage overall, combining Medicare, Medicaid, TRICARE, and VA benefits, reached 35.8% of the population, essentially unchanged from 2024, though the mix shifted slightly as Medicare coverage rose 0.6 percentage points while Medicaid coverage fell 0.5 percentage points.
That Medicaid decline matters directly for the income story, since Medicaid eligibility is itself income-based and tied to state poverty-level thresholds. Public coverage for adults ages 19 to 64 specifically fell 0.5 percentage points in 2025, driven almost entirely by that Medicaid pullback, a shift that likely reflects continued post-pandemic Medicaid eligibility redeterminations pushing some lower-income adults off the program’s rolls faster than they moved into alternative coverage.
Health Insurance by Income 2026 Uninsured Rates by Federal Poverty Level
| Income Group (% of Federal Poverty Level) | Uninsured Rate |
|---|---|
| Under 100% FPL | 16.5% |
| 100-199% FPL | 16.5% |
| 200-399% FPL | 11.5% |
| 400% FPL and Above | 4.5% |
| National Average, All Incomes | 9.8% |
Source: KFF State Health Facts, Uninsured Rates for People Ages 0-64 by Federal Poverty Level.
The federal poverty level breakdown is the clearest single lens for understanding health insurance by income in the United States. People earning under 200% of the federal poverty level, roughly $32,150 for a single adult or $66,250 for a family of four in 2025, face uninsured rates more than three times higher than people earning 400% of poverty or above. That gap persists even though the lowest income bracket technically qualifies for Medicaid in most states, since eligibility gaps, enrollment friction, and coverage churn all still leave a meaningful share of the poorest Americans without any coverage at all.
CDC’s more recent 2025 survey of working-age adults specifically shows an even sharper version of this pattern: adults between 100% and 200% of poverty actually posted a slightly higher uninsured rate, 21.3%, than adults below 100% of poverty, at 18.8%, largely because the poorest group includes more Medicaid-eligible adults in expansion states while the next income tier up often earns just enough to lose Medicaid eligibility without yet reliably affording marketplace coverage, even with subsidies. Adults between 200% and 400% of poverty posted a lower uninsured rate of 13.1%, and those above 400% of poverty recorded the lowest rate of any group tracked.
Health Insurance by Income 2026 Coverage Type Breakdown by Income
| Metric | Figure |
|---|---|
| ESI Coverage, Under 200% of Poverty | 22.5% |
| ESI Coverage, 400%+ of Poverty | 82.5% |
| Overall Worker ESI Offer Rate | 80% |
| ESI Offer Rate, Lower-Paid Workers | 60% |
| Marketplace Enrollees, 100-150% of FPL | 46% of all enrollees |
Source: Peterson-KFF Health System Tracker; CMS Health Insurance Exchanges 2026 Open Enrollment Report.
Employer-sponsored insurance, the largest coverage category overall, is itself heavily stratified by income. Just 22.5% of people living under 200% of the federal poverty level have employer coverage, compared to 82.5% of those earning 400% of poverty or more, a nearly fourfold gap that mirrors the broader uninsured-rate pattern almost exactly, since employer-based health insurance tends to concentrate heavily among higher-wage, full-time positions that lower-income workers are less likely to hold.
Marketplace coverage tells a different but related income story. 46% of all 2026 ACA marketplace enrollees fall between 100% and 150% of the federal poverty level, a share that has grown steadily from just 32% in 2021, showing the exchanges have increasingly become a coverage option used overwhelmingly by lower-income households rather than a broad cross-section of the population. That concentration also explains why changes to marketplace subsidy rules hit low- and moderate-income enrollees hardest, since this income band makes up nearly half the entire marketplace risk pool.
Health Insurance by Income 2026 Medicaid Expansion Coverage Gap
| State Medicaid Status | Adult (18-64) Uninsured Rate |
|---|---|
| States That Expanded Medicaid | 9.0% |
| States That Did Not Expand Medicaid | 18.1% |
| Gap Between Expansion Status | 9.1 percentage points, roughly double |
| Coverage Gap Population (Est.) | Roughly 1.4 million Americans |
Source: CDC National Center for Health Statistics, “U.S. Uninsured Rate Unchanged in 2025.”
Whether a state expanded Medicaid under the Affordable Care Act remains one of the single biggest determinants of low-income coverage access in 2026. Working-age adults in states that expanded Medicaid faced an uninsured rate of just 9.0% in 2025, almost exactly half the 18.1% rate recorded among adults in the 10 states that have not expanded the program. Since Medicaid eligibility is explicitly income-based, this expansion gap is really a specific, geographically concentrated version of the broader income-coverage divide covered throughout this report.
An estimated 1.4 million Americans fall into what policy researchers call the Medicaid coverage gap: people who earn too much to qualify for their state’s traditional, non-expanded Medicaid program but too little to qualify for ACA marketplace subsidies, which generally begin at 100% of the federal poverty level. This population exists almost entirely in non-expansion states, meaning a family with the exact same income can be fully covered in one state and completely uninsured in another, purely based on which side of a state border they happen to live on.
This state-by-state variation makes Medicaid expansion status one of the few coverage factors that policymakers can point to as a clear, measurable policy lever rather than a purely structural economic outcome. Unlike broader labor-market or wage trends, which shift gradually and depend on countless economic forces outside any single state’s control, a state’s Medicaid expansion decision is a discrete policy choice with a directly measurable coverage effect. That is part of why the 9.1-percentage-point gap between expansion and non-expansion states has remained so stable over multiple years of CDC tracking, even as national uninsured rates have shifted modestly up and down with broader economic and policy conditions.
Health Insurance by Income 2026 ACA Marketplace Subsidy Cliff & Premium Changes
| Subsidy Metric | Figure |
|---|---|
| Average Monthly Premium After Subsidy, 2025 | $113 |
| Average Monthly Premium After Subsidy, 2026 | $178, up 58% |
| Projected Annual Increase, Subsidized Enrollees | +114%, or roughly +$1,016/year |
| Enrollees Who Received a Tax Credit in 2025 | 92%-93% of all enrollees |
| 2026 Open Enrollment Total | 23.1 million, down from 24.3 million |
Source: KFF Affordable Care Act Premium Tax Credit Analysis, 2026; CMS Health Insurance Exchanges 2026 Open Enrollment Report.
The single biggest 2026 development affecting health insurance by income is the expiration of the ACA’s enhanced premium tax credits at the end of 2025. These credits, first introduced in 2021 and extended through 2025 by the Inflation Reduction Act, had expanded subsidy eligibility above 400% of the federal poverty level and boosted subsidy amounts for lower earners; without an extension from Congress, they reverted to their original, less generous 2020 levels starting January 1, 2026. The ACA Marketplace’s enrollment data already shows the early effects, with total open enrollment falling to 23.1 million from the prior year’s record of 24.3 million.
For the roughly 92% to 93% of enrollees who received some form of tax credit in 2025, the financial impact is substantial. The average monthly premium payment net of subsidies rose 58%, from $113 to $178, in early 2026 data, and KFF’s fuller-year projection puts the average annual increase at 114%, or about $1,016 more per year, for subsidized households trying to keep the exact same plan they had in 2025. Because marketplace enrollment skews so heavily toward lower- and moderate-income households, this subsidy cliff represents one of the most significant income-linked coverage cost shifts in the program’s history.
Health Insurance by Income 2026 Household Income & Poverty Context
| Metric | 2025 Figure |
|---|---|
| Median Household Income | $87,460, highest on record |
| Poverty Rate | 10.2%, historic low |
| People in Poverty | 34.5 million |
| Poverty Threshold, Family of Four | $32,970 |
| Median Income Growth, 2024-2025 | +2.6% |
Source: US Census Bureau, “Income in the United States: 2025” and “Poverty in the United States: 2025.”
The broader household income and poverty picture heading into 2026 shows an economy that, at least by headline numbers, improved substantially in 2025. Median US household income climbed to $87,460, the highest level on record since the Census Bureau began tracking the measure in 1967, while the official poverty rate fell to a historic low of 10.2%, with 34.5 million Americans still counted as living in poverty. Yet as this report has shown throughout, that overall income and poverty improvement did not translate into a lower national uninsured rate, which held essentially flat at 7.9%.
That disconnect between rising median income and a stagnant uninsured rate underscores why aggregate economic indicators alone can obscure what is happening at the bottom of the income distribution. A rising median can coexist with persistent, even worsening, coverage gaps for the lowest-income households if income growth concentrates among people who already had insurance while the poorest households see little improvement, exactly the pattern reflected in the uninsured-rate-by-poverty-level data throughout this report.
Regional and demographic breakdowns add further texture to this picture. Census Bureau data shows that between 2024 and 2025, median income grew 4.8% for Black households and 2.9% to 3.0% for White households, while changes for Asian and Hispanic households were not statistically significant. Because income and insurance status are so closely linked, these uneven income gains likely translate into uneven coverage gains as well, even though the Census Bureau’s health insurance report does not break out uninsured rates by race and income simultaneously in the same release. The Supplemental Poverty Measure, which factors in taxes, tax credits, and near-cash government benefits, came in at 13.1% for 2025, notably higher than the official poverty rate, a reminder that a meaningful share of Americans sit just above the official poverty line but still rely heavily on government assistance to stay there.
Health Insurance by Income in US 2026 FAQ
How does income affect health insurance coverage in the US?
Income is one of the strongest predictors of coverage. Adults under 200% of the federal poverty level face uninsured rates of 16% to 21%, compared to under 5% for those earning 400% of poverty or more.
What percentage of Americans are uninsured in 2025?
7.9% of Americans, or 26.7 million people, were uninsured for the full year in 2025, according to Census Bureau data released in September 2026.
What is the uninsured rate for low-income Americans?
Adults below 100% of the federal poverty level have an uninsured rate between 16.5% and 18.8%, depending on the survey, while those between 100% and 200% of poverty face a similar or even slightly higher rate.
Does living in a Medicaid expansion state affect coverage rates?
Yes, significantly. Adults in Medicaid expansion states had a 9.0% uninsured rate in 2025, compared to 18.1% in states that have not expanded Medicaid.
How much do ACA marketplace premiums cost after subsidies in 2026?
The average monthly premium after subsidies rose to $178 in 2026, up 58% from $113 in 2025, following the expiration of enhanced premium tax credits.
What income level uses ACA marketplace coverage the most?
46% of all 2026 marketplace enrollees fall between 100% and 150% of the federal poverty level, the largest single income band in the program.
What is the Medicaid coverage gap?
The Medicaid coverage gap refers to roughly 1.4 million Americans who earn too much for traditional Medicaid in non-expansion states but too little to qualify for ACA marketplace subsidies.
What is the median US household income in 2025?
Median household income reached $87,460 in 2025, up 2.6% from $85,210 in 2024, the highest level on record since 1967.
Why did marketplace premiums increase so much in 2026?
Enhanced premium tax credits, first introduced in 2021 and extended through 2025, expired on December 31, 2025, reverting subsidies to their original, less generous levels for most enrollees.
What percentage of Americans have employer-based health insurance?
53.5% of the population had employer-based coverage for some or all of 2025, though access remains far higher for higher-income workers than lower-paid ones.
Disclaimer: The data research report we present here is based on information found from various sources. We are not liable for any financial loss, errors, or damages of any kind that may result from the use of the information herein. We acknowledge that though we try to report accurately, we cannot verify the absolute facts of everything that has been represented.
