Immigrant

Lack of insurance coverage, high costs, accessibility and complexity are well-documented problems in the US health care system. The vast majority of people are hopelessly confused by what services are covered and how their insurance works. About half of consumers say they do not understand their coverage, including about one-third who do not understand what costs their plan covers or what costs they will owe.

Almost 6 in 10 people with insurance reported a problem with using their health insurance during the past year. The share increases to two-thirds for people in fair or poor health, three-fourths for those who need mental health services, and almost 8 in 10 for people who use the health system the most. The result is that many delay or skip care or accumulate bills they cannot afford.

For public programs including Medicare, Medicaid, and the ACA marketplace, the complexity also extends to signing up for coverage. Some individuals are no longer eligible for Medicaid, but about three-quarters have been terminated for “procedural” reasons, meaning they have been tangled in red tape or unable to be reached, and it is unknown whether they are still eligible for the program.

In Medicare, beneficiaries can now choose from about 43 private Medicare Advantage plans, and during open enrollment season, the airwaves are flooded with ads that may do more to confuse than illuminate. And people getting ACA coverage through healthcare.gov have a choice of more than 100 plan options on average. Choice in health care is generally believed to be a positive feature, but the complexity of too many choices can also lead to paralysis on the part of consumers or suboptimal decisions.

The idea of making the health care system simpler and more transparent certainly sounds good, at least in concept. Who could disagree with the principle that everyone should be able to learn which physicians and hospitals are in their network and taking patients, or that patients should get easily understandable explanations of benefits, statements, and medical bills?

Yet, any push for health care simplification inevitably clashes with commercial interests. The health insurance system is structured to simultaneously maximize profits, control costs, and serve consumers, which are competing goals that add to the challenge of simplifying it. For instance, limiting denials of claims or prior authorization requests will make the system more consumer friendly, but could also raise costs and might lead to care that is less grounded in evidence.

Consumers have the right to appeal denials of claims, but 60% do not know they have that right, and 76% do not know the government agency to contact for help in dealing with insurance problems. People who work for companies with well-staffed human resources departments may have access to help in navigating the health insurance maze, but others are largely on their own.

The regulatory structure largely already exists to require explanations of benefits that make sense to consumers, clinician directories that are accurate, and rights to appeal when claims are denied. What is missing is effective enforcement of these requirements and support for consumers (especially those with serious and chronic health conditions) to comprehend and navigate the complex labyrinth the US health insurance system has become.

As of 2024, there were about 50 million immigrants residing in the U.S., including 24 million noncitizen immigrants and 26 million naturalized citizens, who each accounted for about 7% and 8% of the total population, respectively. Noncitizens include lawfully present and undocumented immigrants. Many individuals live in mixed immigration status families that may include lawfully present immigrants, undocumented immigrants, and/or citizens. One in four (26%) children has an immigrant parent, including over one in ten (12%) who are citizen children with at least one noncitizen parent.

This fact sheet provides an overview of health coverage for immigrants based on data from the KFF/New York Times 2025 Survey of Immigrants and discusses implications of the current policy and immigration enforcement environment for their health and health care. It shows:

• Although the majority of uninsured people are citizens, noncitizen immigrant adults, particularly likely undocumented immigrants, are significantly more likely to report being uninsured than citizens. As of 2025, almost half (46%) of likely undocumented immigrant adults and one in five (21%) lawfully present immigrant adults reported being uninsured compared to less than one in ten naturalized citizen (7%) and U.S.-born citizen (6%) adults. These higher uninsured rates reflect a combination of more limited access to private coverage due to working in jobs less likely to offer health coverage and exclusions and limitations on eligibility for federally funded coverage options, including Medicaid, Affordable Care Act (ACA) Marketplace, and Medicare coverage.
• Reflecting their higher uninsured rate, noncitizen immigrants are more likely than citizens to report barriers to accessing health care and skipping or postponing care. Immigrants have lower health care expenditures than their U.S.-born counterparts reflecting lower use of care due to a combination of them being younger and healthier and facing more barriers to accessing care.
• Some states have expanded access to health coverage for immigrants through Medicaid options for lawfully residing immigrant children and pregnant people and fully state-funded programs, but some states have rolled back this coverage since 2025.
• Recent policy changes will further restrict lawfully present immigrants’ access to health coverage, and immigrants across all statuses have become more fearful about accessing health coverage and care due to increased immigration enforcement actions under the Trump Administration.