Adults ages 19 to 34 had the highest uninsured rates of any age group in the United States, according to the 2019 American Community Survey (ACS).

People in this age group had an average uninsured rate of 15.6% compared to 5.7% for those under 19, 11.3% for adults ages 35 to 64, and 0.8% for individuals 65 and older in 2019.

Younger populations may be healthier than older ones in general but they may have medical problems, which can lead to poor health and disability in later adulthood. Health insurance coverage for young adults ensures access to preventive health services and promotes well-being.

In 2010, the Young Adult Provision of the Affordable Care Act (ACA) allowed young adults up to age 26 to remain as dependents on their parents’ health insurance plans.

Prior to implementation, health insurers set an age limit for children to be covered as dependents on their parents’ plan. For some plans, that age was age 19, or in other cases, it was age 22 for full-time students.

All adults may receive coverage through their employer, through public coverage or through purchase on the healthcare marketplace. However, young adults may be less likely to purchase health insurance coverage, and therefore more likely to be uninsured than other age groups.

The 2019 ACS lets us examine differences in health insurance coverage by age for the nation and across all 50 states and the District of Columbia a decade after the Young Adult Provision of the ACA was implemented.

Young adults now face changes in eligibility for health coverage at ages 19 and 26.

For instance, young adults lose eligibility for public coverage under CHIP (Children’s Health Insurance Program) in most states at age 19. The 14.3% uninsured rate for 19-year-olds was 4.8 percentage points higher than that of 18-year-olds in 2019 (Figure 1).

And as stated earlier, at age 26, young adults are no longer eligible for dependent coverage under their parents’ health insurance under the ACA.

The uninsured rate of 18.3% for 26-year-olds was 3.6 percentage points higher than the uninsured rate for 25-year-olds.

In addition, 26-year-olds had the nation’s highest uninsured rate among all single years of age, followed by 17.5% of 27-year-olds (Figure 1).

In 2019, adults ages 26 to 34 had higher uninsured rates (16.1%) than those ages 19 to 25 (14.9%) in 22 states.

In three states (Missouri, New Mexico and Texas), uninsured rates were lower for those ages 26 to 34 than for those ages 19 to 25. There was no statistical difference between these age groups in the remaining 25 states and District of Columbia (Figure 2).

In 2019, the District of Columbia and Massachusetts had among the lowest uninsured rates for adults between the ages of 19 and 34.  

Five southern states — Florida, Georgia, Oklahoma, Mississippi, and Texas– had uninsured rates of 23% or higher (Figure 3).

Under the Patient Protection and Affordable Care Act (ACA), 32 states and the District of Columbia expanded Medicaid eligibility on or before January 1, 2019 (“expansion states”), while 18 states opted not to (“nonexpansion states”).

The uninsured rates for people ages 19 to 34 was 10.5 percentage points higher in states that did not expand eligibility than in expansion states: 22.3% compared with 11.8%, respectively.

Between 2018 and 2019, the uninsured rate for people ages 19 to 34 increased 0.4 percentage points to 15.6%. The uninsured rate increased in 10 states and decreased in four states (Figure 3).

Young adults in Delaware, Louisiana, and Mississippi experienced among the largest increases in the uninsured rate.

Montana, North Dakota, and Virginia had among the largest decreases in the uninsured rate for young adults.  Notably, Virginia expanded Medicaid eligibility in 2019.

Douglas Conway is a survey statistician in the Census Bureau’s Health and Disability Statistics Branch.