About 43 Million People in the U.S. Had Multiple Health Plans in 2021

While the majority of people in the United States have private health insurance — primarily through an employer — many others have coverage through programs offered by the government or no coverage at all. 

But a large number of mostly older individuals have more than one plan, according to a recent report that provides estimates of health insurance coverage in 2021. Single service plans, such as vision, dental or prescription drug, are not considered comprehensive and are not counted as health insurance coverage.

Individuals with multiple coverage include anyone who was enrolled in more than one plan at the same time in 2021. For example, some low-income people with a disability may qualify for both Medicaid and Medicare coverage if they meet eligibility requirements. Others may hold multiple coverage because they change their type of health insurance plan over the course of the year.

Adults 65 years and older were the age group most likely to be covered by more than one plan because many supplemented Medicare coverage with privately purchased plans or coverage through a current or previous employer.

In 2021, about 29.2 million people with multiple coverage were 65 or older, representing more than half (51.9%) of adults in this age group. In contrast, about 5.5% of adults ages 19 to 64 and 4.1% of individuals under age 19 had more than one type of health coverage (Figure 2). 

The likelihood of having multiple coverage also varied by income. Family resources may determine the ability to afford private health insurance and families below certain income-to-poverty thresholds may qualify for public health insurance options.

People are classified as being in poverty if their family income is less than 100% of the poverty threshold. Family resources are classified by the ratio of family earnings to the poverty threshold. In 2021, the poverty threshold for a family with two adults and two children was $27,479.

About 13.7% of people with incomes between 100% and 399% of their poverty threshold had more than one type of coverage in 2021, followed by 12.9% of those with incomes at or above 400% of the federal poverty level and 12.1% of those in poverty.  

Most individuals (75.5%) with more than one type of coverage in 2021 had both private and public coverage.

About 25.7 million people (59.6% of those with multiple coverage) had both Medicare and some type of private coverage, reflecting the high percentage of multiple coverage holders age 65 and older.

About 6.8 million (15.7%) multiple coverage holders had Medicaid and private coverage and another 15.7% were covered by both Medicaid and Medicare (Figure 3).