Health Insurance Coverage in Rural and Urban Areas in the U.S., 2023
Link
Date
09/2025
Description
This brief outlines the health insurance status of people in the U.S., by residence (rural and urban) in 2023, with additional breakdowns by age groups. The analysis is based on data from the 2024 American Community Survey (ACS), released September 2024 by the U.S. Census Bureau, providing a snapshot of coverage for a point-in-time with national data.
Key Findings:
- Uninsured rates in 2023 were higher in rural areas (8.4 percent), as compared to urban areas (7.8 percent).
- People in rural areas were less likely to hold private sources of coverage than urban Americans (61.8 percent as compared to 68.0 percent), and people in rural areas were much less likely to hold employer-sponsored insurance (ESI) compared to those living in urban areas (47.8 percent compared to 56.0 percent). In contrast, people living in rural areas were more likely (45.2 percent) than people in urban areas (36.1 percent) to hold public sources of coverage.
- Insured rates varied significantly by age group in rural and urban areas. Uninsured rates were lowest for those age 65 or older, due to near universal coverage from Medicare. Uninsured rates were highest within the 19-64 age group in all areas.
- The source of coverage varied significantly for persons living in rural areas compared to those living in urban areas. For example, ESI coverage rates were higher in urban areas relative to rural areas in all age groups. Medicaid coverage rates were higher for people younger than age 65 (children as well as those age 19-64) living in rural areas compared to urban areas.
Center
RUPRI Center for Rural Health Policy Analysis
Authors
Sarah Eisenstein, Xiaoyu Huang, Timothy McBride, Keith Mueller