Special Report

US Metros With the Best Health Insurance Coverage

The United States is the only industrialized country in the world without universal health care — and as a result, most Americans under age 65 receive employer-based health insurance coverage. Under this system, an estimated 28.9 million Americans under 65 were uninsured in 2019 — before the COVID-19 pandemic put over 22 million Americans out of work. 

While most of those jobs have since been restored, the official nonelderly rate for Americans under 65 in 2020 will likely be higher than the 10.8% rate in 2019 — a continuation of the three-year trend of declining insurance coverage that began in 2017. Still, there are parts of the country where nearly every American under 65 is insured, either through their employer, Medicaid, or directly-purchased coverage. 

Using data from the U.S. Census Bureau, 24/7 Wall St. identified the 50 metropolitan areas with the best health insurance coverage. Metro areas are ranked based on the share of residents under age 65 — the age of eligibility for Medicare — who are uninsured. 

Nearly half of the metropolitan areas on this list are concentrated in the Northeastern United States, including all five metro areas in Massachusetts. Massachusetts was a national leader in health care reform, enacting laws that led to near-universal coverage almost half a decade before the Affordable Care Act was signed into law under the Obama Administration. 

Click here to see the U.S. metros with the best health insurance coverage.

To determine the metros with the best health insurance coverage in the nation, 24/7 Wall St. reviewed one-year estimates of the percentage of the noninstitutionalized civilian population under 65 without health insurance from the U.S. Census Bureau’s 2019 American Community Survey. 

We used the 384 metropolitan statistical areas as delineated by the United States Office of Management and Budget and used by the Census Bureau as our definition of metros. 

We selected the under 65 age group because Americans become eligible for Medicare at age 65, and the uninsured rate for the population above this age is less than 1% nationwide. However, because the census doesn’t publish insurance coverage estimates specifically for the under 65 age group, we aggregated the data from more granular age breakdowns. 

Each metro was ranked based on its under 65 uninsured rate. The share of the population covered by each type of insurance — Medicare, Medicaid, VA, employer, direct-purchase, and Tricare/military — are for the same cohort and are also aggregated from one-year ACS estimates. The estimates reflect people who are covered by that type of insurance alone or in combination with other types on the list. So, when a person is covered by more than one type of insurance, they are included in each group.