Of adults with health insurance, 29% were underinsured in 2018 (up from 23% in 2014), according to The Commonwealth Fund’s Biennial Health Insurance Survey.1 Those who bought plans on their own were most likely to be underinsured, with 42% reporting inadequate coverage.

“While rates of underinsurance are highest among people with coverage through the individual market, the greatest recent growth has occurred among people who have employer plans,” says Sara Collins, PhD, lead author of the study and vice president for healthcare coverage and access at The Commonwealth Fund.

This is an important distinction, since 158 million Americans are insured by employer plans. People who are on an insurance plan all year, but are underinsured, are much more likely than those who are insured (but not underinsured) to delay or avoid needed healthcare because of the cost. “The drivers of this problem are high deductibles and cost-sharing relative to people’s income,” Collins explains. “This is leading many people to make decisions that are bad for their health.”

Employers are offering plans to people with high cost-sharing to help lower the rate of growth in premiums. “But healthcare costs are the primary driver of premium costs,” Collins says. In turn, those costs are determined by what private insurers pay hospitals and other providers. “To address the problem of underinsurance, we need to focus our attention on the overall cost drivers,” Collins says.


  1. The Commonwealth Fund; Collins SR, Bhupal HK, Doty MM. Health insurance coverage eight years after the ACA: Fewer uninsured Americans and shorter coverage gaps, but more underinsured. Feb. 7, 2019. Available at: http://bit.ly/2Yt8Wkk. Accessed June 28, 2019.