Women’s Health Insurance Coverage

Health insurance coverage is an important factor in making health care affordable and accessible to women.1 Among the 97.3 million women ages 19 to 64 residing in the U.S., most had some form of coverage in 2021. However, gaps in private sector and publicly-funded programs and lack of affordability left a little over one in ten women uninsured. Over the past decade, the Affordable Care Act (ACA) has expanded access to affordable coverage through a combination of Medicaid expansions, private insurance reforms, and premium tax credits. This factsheet reviews major sources of coverage for women residing in the U.S. in 2021, as the coronavirus pandemic continued in the U.S. and globally, discusses the impact of the ACA on women’s coverage, and the coverage challenges that many women continue to face.

Sources of Health Insurance Coverage

Employer-Sponsored Insurance

Approximately 58.1 million women ages 19-64 (60%) received their health coverage from employer-sponsored insurance in 2021 (Figure 1).2

Non-Group Insurance

The ACA expanded access to the non-group or individually purchased insurance market by offering premium tax credits to help individuals purchase coverage in state-based health insurance Marketplaces. It also included many insurance reforms to alleviate some of the long-standing barriers to coverage in the non-group insurance market. In 2021, about 8% of women ages 19 to 64 (approximately 8.2 million women) and 8% of their male counterparts purchased insurance in the non-group market.4 This includes individuals who purchased private policies from the ACA Marketplace in their state, as well as those who purchased coverage from private insurers that operate outside of Marketplaces.


The state-federal program for low-income individuals, Medicaid, covered 18% of adult women ages 19 to 64 in 2021, compared to 14% of men. Historically, to qualify for Medicaid, women had to have very low incomes and be in one of Medicaid’s eligibility categories: pregnant, mothers of children 18 and younger, a person with a disability, or over 65. Women who didn’t fall into these categories typically were not eligible regardless of how poor they were. The ACA allowed states to broaden Medicaid eligibility to most individuals with incomes less than 138% of the FPL regardless of their family or disability status, effective January 2014. As of December 2022, 39 states and DC have expanded their Medicaid programs under the ACA—one state, South Dakota, has adopted but not yet implemented Medicaid expansion.

Uninsured Women

Women are less likely than men to be uninsured, as a higher share of adult women are enrolled in Medicaid. On average, women have lower incomes and have been more likely to qualify for Medicaid than men under one of Medicaid’s eligibility categories; pregnant, parent of children under 18, disabled, or over 65. In 2021, 14% of men ages 19-64 were uninsured compared to approximately 11% of women in the same age bracket (10.3 million women). In spite of significant job losses, uninsured rates among women held steady during the second year of the COVID-19 pandemic, in part due to the continuous coverage requirements under Medicaid and the ongoing availability of subsidized coverage through the state-based health insurance exchanges.

Uninsured women often have inadequate access to care, get a lower standard of care when they are in the health system, and have poorer health outcomes. Compared to women with insurance, uninsured women have lower use of important preventive services such as mammograms, Pap tests, and timely blood pressure checks. They are also less likely to report having a regular doctor.

Scope of Coverage and Affordability

The ACA set national standards for the scope of benefits offered in private plans. In addition to the broad categories of essential health benefits (EHBs) offered by marketplace plans, all privately purchased plans must cover maternity care which had been historically excluded from most individually purchased plans. In addition, most private plans must cover preventive services  without co-payments or other cost sharing. This includes screenings for breast and cervical cancers, well woman visits (including prenatal visits), prescribed contraceptives, breastfeeding supplies and supports such as breast pumps, and several STI services. There have been several legal challenges over elements of the preventive services policy, including in the currently pending case, Braidwood Management Inc. v. Becerra, which could affect whether the preventive services requirement remains intact in the future. Twenty-six states have laws banning coverage of most abortions from the plans available through the state Marketplaces. These restrictions were in place prior to the Supreme Court’s decision to overturn Roe v Wade.

Affordability of coverage continues to be a significant concern for many women, both for those who are uninsured as well as those with coverage. The leading reason why uninsured adults report that they haven’t obtained coverage is that it is too expensive. Under employer-sponsored insurance, the major source of coverage for women, 61% of all covered workers with a general annual deductible have deductibles of at least $1,000 for single coverage. Thirty-seven percent of women with employer sponsored coverage report that it is difficult to meet their deductibles.9

Looking Forward

Health coverage matters for women. Those with health coverage are more likely to obtain needed preventive, primary, and specialty care services, and have better access to new advances in women’s health. Today, because of the ACA, most women can get coverage without worrying that they will be charged more for insurance than men, have insurance that provides them with no-cost coverage for a wide range of recommended preventive services, and coverage for critical services for women such as maternity care. The uninsured rate has declined significantly over the past decade; however, 10 million women remain uninsured, with rates highest in states that have not expanded Medicaid eligibility.

  1. This factsheet is based on KFF analysis of data from the American Community Survey (ACS), which stratifies data by an individual's sex as male or female. Throughout this brief we refer to “women” but recognize that not all people who are born as females identify as "women."

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  2. KFF estimates based on 2021 American Community Survey, 1-Year Estimates.

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  3. Ibid.

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  4. Ibid.

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  5. Ibid.

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  6. National LTSS expenditures totaled $379 billion, including spending on residential care facilities, nursing homes, home health services, HCBS waivers, ambulance providers, and some post-acute care. Medicare post-acute care spending ($83.3 billion) is excluded. LTSS payers include Medicaid (52%), other public and private insurance (20%), out-of-pocket spending (16%), and private insurance (11%). All HCBS waivers are attributed to Medicaid. KFF estimates based on 2018 National Health Expenditure Accounts data from CMS, Office of the Actuary.

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  7.  KFF estimates based on 2021 American Community Survey, 1-Year Estimates.

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  8. Ibid.

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  9. KFF June 2019 Health Tracking Poll.

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