According to data released from the 2024 American Community Survey (ACS) 1-year estimates by KFF, population coverage analyses utilize zip codes and rural-urban commuting area codes to track how Americans secure medical benefits.
Understanding Urban and Rural Coverage Dynamics
The U.S. Department of Agriculture defines urban and rural categories using 2020 Rural-Urban Commuting Area (RUCA) codes. Urban or metropolitan areas encompass zip codes with a primary RUCA code of 1, 2, or 3, indicating an urban core or strong commuting connections. The U.S. Census Bureau gathers this foundational population data through the American Community Survey, utilizing Public Use Microdata Areas (PUMAs)—non-overlapping statistical geographic entities.
Because the Census Bureau restricts these specific estimates to the civilian, non-institutionalized population, figures may differ from yearly population publications released by the agency. Analysts obtain PUMA-to-zip code crosswalks from the Missouri Census Data Center to map insurance distribution accurately, rounding population numbers to the nearest 100.
The Health Insurance Hierarchy Framework
The ACS surveys respondents regarding health insurance coverage throughout the preceding calendar year, allowing individuals to report multiple types of coverage. To prevent double-counting, analysts sort individuals into a single mutually exclusive category using a strict hierarchy established in the data methodology:
- Medicaid: Includes individuals covered by Medicaid, Medical Assistance, the Children’s Health Insurance Plan (CHIP), or any government-assistance plan for low-income individuals or those with disabilities. This category also captures dual-eligible beneficiaries who hold both Medicaid and Medicare.
- Employer: Covers individuals receiving benefits through a current or former employer or union, functioning either as the primary policyholder or as a dependent.
- Medicare: Encompasses those covered by Medicare, with exceptions made for dual eligibles and full-time workers maintaining both Medicare and employer-sponsored insurance.
- Military: Includes beneficiaries covered under military health programs or the Veterans Administration.
- Non-Group: Captures policies purchased directly from an insurance company by an individual policyholder or dependent.
- Uninsured: Comprises individuals lacking health insurance entirely, alongside those whose only coverage stems from the Indian Health Service.
Data Reliability and Limitations
To maintain statistical integrity, the analysis applies strict filtering thresholds. Estimates carrying relative standard errors greater than 30% or unweighted counts totaling fewer than 100 are suppressed and marked as not provided.
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