What are the recent trends in employer-based health coverage?

Employer-sponsored health insurance (ESI) is the largest source of health coverage for people under 65, covering 165.6 million people in March 2025, but its reach is uneven. Not all workers have access to ESI. Some workers are in jobs where the employer does not offer coverage (usually smaller employers), and some workers are not eligible for the coverage that is offered. Additionally, some workers do not enroll in ESI offered at their job. In particular, ESI covered only 22.5% of people under 65 with incomes less than 200% of poverty, compared to 82.5% of people with incomes of at least 400% of poverty.

People’s access to ESI depends on the availability and cost of coverage where they or a family member work. A large share (74.6%) of workers are eligible for coverage offered at their job, but this again is uneven. Workers with low incomes as well as workers who are younger, identify as women, work part-time, or are non-citizens were each less likely to be eligible for ESI at their jobs compared to their counterparts. There were also differences across racial and ethnic groups, where Hispanic people and Non-Hispanic American Indian/Alaskan Native people had much lower rates of eligibility for ESI. Additionally, some workers eligible for ESI at work chose not to take it because they felt it was too expensive. For many workers, particularly those at small employers, average contributions for family coverage can be expensive.

This chart collection uses the Annual Economic and Social (March) Supplements (ASEC) of the Current Population Survey (CPS) to examine who among people under 65 have ESI and which workers are offered and eligible for coverage at their current jobs. Worker coverage, whether the worker’s employer offers coverage, and worker eligibility for offered coverage are each measured at the point in time of the survey.[1] A more complete description of the methods for this chart collection is included below.

Key takeaways include:

• In March 2025, 60.0% of the non-elderly, or about 165.6 million people, had ESI. 
• About four in five (80.4%) adult non-elderly workers worked for an employer that offered ESI to at least some employees, a share that has been consistent over recent years. 
• The share of workers eligible for ESI at their job declined slightly over the past few years, from 75.3% in March 2023 to 74.6% in March 2025. 
• Most eligible workers who do not take up ESI offered at work cite other coverage (63.0%) and cost (30.2%) as the reason.  

The share of adults under 65 with ESI remained stable in recent years

The workplace has long been a significant source of coverage for those in working families. A previous chart collection, analyzing the National Health Interview Survey (NHIS), showed a nine percentage-point decline in the share of people under 65 with ESI between 1998 and 2018. The data from 2021 ASEC shows that the share of people under 65 with ESI has been largely stable over the last few years.

In March 2025, 60.0% of people under age 65, or about 165.6 million people, had ESI. Of these, 85.7 million (51.8%) had ESI from their own job, 73.6 million (44.4%) were covered as a dependent by someone within their household, and 6.3 million (3.8%) were covered as a dependent by someone living outside of their household.

Low- and moderate-income people under 65 are less likely to have ESI

ESI coverage varied dramatically with income. More than four in five (82.5%) adults under 65 with incomes 400% of the federal poverty level or more had ESI, compared to 57.2% with incomes between 200% and 399% of poverty and 22.5% with incomes below 200% of poverty.

ESI coverage varies with age and other characteristics

Among people under 65 in March 2025, people in younger age groups were less likely than those in older age groups to have had ESI, and U.S. citizens were much more likely than non-citizens to have had ESI. ESI coverage also varied across race and ethnic categories: compared to Non-Hispanic White people, Hispanic people are almost half as likely to have ESI. Non-Hispanic people who are Black, American Indian or Alaskan Native, Native Hawaiian or Other Pacific Islander, or of mixed race were also less likely to have had ESI.

Three-in-four workers ages 18-64 years are eligible for ESI at their job

For workers to have access to ESI at their job, they need to both work for an employer that offers ESI and be eligible to enroll in their ESI. About four in five (80.4%) adult workers under 65 worked for an employer that offered ESI to at least some employees in March 2025. A large majority (92.8%) of these workers were eligible for the ESI offered at their job, so that, overall, about three in four workers were eligible to enroll in ESI offered at their job.

Both the share of workers working for employers offering coverage and the share eligible for coverage at their jobs vary significantly by income. Among adult workers under 65, the share working for an employer offering ESI ranged from 60.4% for workers with incomes under 200% of poverty to 87.5% for workers with incomes at least 400% of poverty, while the share eligible for coverage ranged from 48.9% for workers with incomes under 200% of poverty to 83.4% for workers with incomes at least 400% of poverty.

The share of adult workers under 65 working for an employer that offers ESI was steady between 2023 and 2025. The share of these workers eligible for ESI at their job followed a similar trend, albeit with a small decline, from 75.3% in March 2023 to 74.6% in March 2025.

Some occupations have much lower ESI offer and eligibility rates

Among adult workers under 65, those working in construction, service, sales, and farm, fishing and forestry-related occupations were less likely to be working for an employer offering ESI and to be eligible for ESI at their jobs in March 2025. Full-time workers were much more likely to be working for an employer offering ESI and to be eligible for coverage at their job compared to part-time workers.

Eligibility for ESI at work varies across population groups

Among adult workers under 65; women, non-citizens, and younger workers were less likely than their counterparts to be eligible for ESI at their jobs in March 2025. Compared to White Non-Hispanic people; Hispanic, Non-Hispanic Black, and American Indian/Alaskan Native people were less likely to be eligible for ESI at work. Eligibility rates were particularly low for younger and non-citizen workers.

Three in four adult workers under 65 and eligible for ESI chose to take up coverage at work

Among adult workers under 65 who were eligible for ESI at their jobs in March 2025, 75.5% were ESI policyholders. Of those who did not have ESI from their own job, 13.6% had ESI as a dependent, 3.9% had Medicaid or other public coverage, 2.2% had non-group coverage, 1.1% had some other coverage, and 4.1% were uninsured.

A small share of workers with ESI from their job also had other coverage at the same time: 2.2% also had Medicaid or other public coverage, and 0.7% also had non-group coverage.

Most eligible workers who do not take up ESI offered at work cite other coverage and cost as reasons

Among adult workers under 65 who were eligible for ESI at work but did not enroll, 63.0% said the reason was that they had other coverage, and 30.2% said the reason was that it was too expensive, and small shares cited other reasons.

Adult workers under 65 in construction occupations are least likely to be eligible for employer-sponsored health insurance, with one in nine workers not eligible

About 34.7 million adult workers under 65 were not eligible for ESI at their job in March 2025. Of these workers, about 22.2 million worked full-time and 12.4 million worked part-time. Fewer than one in four (22.9%) worked for an employer that offered coverage to other workers that were considered eligible.

Among adults under 65 who are full-time workers but were not eligible for ESI at their job in March 2025, more than half worked in one of six occupations: construction and extraction, food preparation and serving, transportation and material moving, sales, office and administration, and management. One in nine of these workers, or 2.8 million people, work in construction and extraction occupations alone.

Methods

[1] The ASEC asks about each type of health coverage held at the time of the survey and at any time during the prior year. This brief uses the time of survey response, which is consistent with the time period for the questions about offer and eligibility. The ASEC is collected between February and April of each year, with most of the interviews conducted in March. This chart collection refers to March as the timing of the survey for convenience.