Public Health Insurance Covers More Than 1 in 3 Americans

Public health insurance is a cornerstone of the American healthcare system.

Medicare and Medicaid accounted for more than $2 trillion in health spending in 2024, according to a ValuePenguin study, covering tens of millions of Americans across varying income levels, age groups and health statuses.

Here’s a closer look at who relies on public coverage.

Key findings

Medicare and Medicaid account for over $2 trillion in health spending

The scale of public health insurance — like government-funded programs Medicare and Medicaid — is difficult to overstate. These programs accounted for over $2 trillion in health spending in 2024, at $1.1 trillion for Medicare and $931.7 billion for Medicaid.

That represents 38.8% of U.S. health expenditures that year.

As of November 2025, 68.4 million were enrolled in Medicare, while Medicaid and CHIP reached 76.5 million. That adds up to 144.9 million program enrollments. About 12.1 million people are enrolled in both programs.

"This high level of spending tells us that public health insurance is one of the cornerstones of health coverage in the U.S.," ValuePenguin health insurance expert Cate Deventer says. "Changes to these programs can affect not only state and federal budgets but also access to healthcare for millions of people."

Public health insurance covers 36.8% of Americans

In 2024, 36.8% of Americans relied on public health insurance. However, that figure varies significantly by state.

New Mexico has the highest rate of residents covered by public health insurance, at 51.4%, making it the only state with over half enrolled. West Virginia (46.7%) and Louisiana (46.3%) follow.

At the other end of the spectrum, Utah (22.2%), Texas (28.2%) and North Dakota (28.6%) have the lowest coverage rates.

West Virginia stands out for its high rankings for both Medicare and Medicaid. Breaking it down by program, Maine (25.2%), West Virginia (24.4%) and Vermont (24.0%) have the highest Medicare coverage rates. Meanwhile, New Mexico (32.9%), Louisiana (30.2%) and New York (29.1%) lead in Medicaid coverage rates.

Notably, Utah had the lowest coverage rates across Medicare, Medicaid and overall public health insurance in 2024.

Deventer believes the gap in public health coverage rates is probably due to several factors, including the demographics in the state and state laws around Medicaid eligibility.

"For example, if a state has an older population, more of its residents are likely to be on Medicare compared to a state with a younger population," she says. "And in some states, such as Texas, it’s very difficult to qualify for Medicaid coverage. That could account for a lower number of people who have public coverage."

Full rankings: Public health insurance coverage by state

Public health insurance coverage by program type

Health is a strong predictor of public coverage

A strong predictor of public health insurance reliance is health status. In 2024, 79.4% of people who self-reported their health as poor had public coverage. That compares with just 23.2% of those who described their health as excellent.

Aside from illness, age and income are also key factors. A whopping 94.1% of adults 65 and older had public health coverage in 2024, and about two-thirds (66.0%) of people whose income fell below 100% of the federal poverty line were covered. For reference, in 2024, those making below 100% of the federal poverty line were defined as households making less than the following amounts, according to the U.S. Department of Health and Human Services (HHS):

Public health coverage by income-to-poverty ratio

Public coverage also extended slightly into the workforce, with 9.0 million full-time, year-round workers ages 15 to 64 covered by public programs. However, a higher number — 21.6 million — of enrollees hadn’t worked at least one week in the year.

Public health coverage by work experience among those ages 15 to 64

Deventer believes this probably indicates that there are gaps in private health insurance and that public programs are targeting those in need.

Medicaid enrollment declines while Medicare grows

Enrollment in Medicaid and CHIP, which primarily cover low-income children, families, adults and people with disabilities, peaked at 92.3 million in 2022. Since then, enrollment has fallen 17.1%, or by 15.8 million enrollees.

By contrast, Medicare, which is primarily for seniors 65 or older, has grown every year since 2019, largely driven by the aging population. Medicare enrollment increased by 1.2 million between 2024 and 2025. In contrast, Medicaid and CHIP lost 3.1 million enrollees in the same time frame.

Deventer attributes declining Medicaid enrollment to the "Medicaid unwinding" process that started in 2023. This process rolled back the continuous-enrollment provision that was active during the pandemic, which kept people on Medicaid.

"Some people have likely lost Medicaid because they started a new job or purchased private coverage, but others are being disenrolled because of incorrect paperwork, outdated contact information or other administrative issues, even if they technically still qualify," she says. "The risk is that more people will be uninsured, which often leads to delaying medical care. Those people then get sicker and need more intensive care later, which contributes to higher costs across the entire healthcare system."

Understanding the public health insurance system: Top expert tips

Navigating public health insurance can be overwhelming, but a few smart moves can help you get — and keep — the coverage you need. Here’s what we recommend: