Americans receive health insurance from a variety of private and public insurance programs.

A MAJORITY OF PEOPLE IN THE UNITED STATES (54.5%) receive health insurance through employers. Under federal law, employers of 50 or more people (full-time equivalents) are required to offer health benefits. The benefits must cover 95% of full-time employees and their dependents.

Medicare

Medicare covers 66.4 million Americans (figures from 2023). Broadly speaking, Medicare offers two types of plans: original Medicare and Medicare Advantage. Original Medicare pays physicians, hospitals and other providers directly on a fee-for-service basis. Medicare Advantage plans typically are run by insurance companies, which agree to a fixed payment per year to provide for a patient’s care. The plans then pay the providers.

From a patient’s perspective, each type of plan has advantages and disadvantages. Original Medicare allows patients to go to any provider they want, assuming theprovider accepts Medicare. There is less paperwork and less need for advanced authorization for services under original Medicare.

Medicare Advantage plans generally provide services that original Medicare does not, such as prescription drugs (included in the plan as opposed to purchased separately), vision care, hearing care and dental. Medicare Advantage restricts the providers from which patients can seek treatment. If a patient obtains care out- of-network, the cost to the patient will be much higher.

As of 2023, slightly more than half of Medicare beneficiaries (51.5%) are enrolled in Medicare Advantage plans.

Medicaid and CHIP

Medicaid is the largest health insurance program in the United States, covering 76.3 million people as of February 2024. Enrollment had been several million more in recent years when, under federal regulations, states were not allowed to cut people from Medicaid during the pandemic.

After the pandemic, the restrictions on terminating coverage under Medicaid ceased, and, more than 23 million people were disenrolled because they did not meet eligibility requirements, according to KFF, a health care policy and research organization. The disrenrollment often is referred to as the “Medicaid Unwind.”

Medicaid is a joint program of the federal and state governments with the federal government providing half or more of the funding. The program was expanded in 2010 by the Affordable Care Act to provide Medicaid insurance in 40 states and the District of Columbia for non-elderly adults with incomes up to 138% of the federal poverty level. Some states provide coverage forfamilies with higher incomes. Approximately 12 million people are enrolled in both Medicare and Medicaid.

The Children’s Health Insurance Program (CHIP)— another joint federal-state program—covers 7.1 million children. Eligibility requirements permit enrollment ofchildren from families with higher income than Medicaid. For ChIp, family income eligibility ranges from 170% to 400% of the federal poverty level.

Uninsured

The combination of private and public health insurance plans cover most of the population, but not all of it. Approximately 26 million people remain uninsured.

A challenge for Congress and the new administration will be to decide the level of resources that should be devoted to health coverage for people living in the United States. •