Most Americans rely on health insurance coverage to pay for some portion of their health care, and most who are younger than age 65 obtain coverage through the private insurance market.
The majority of people age 50–64 have health insurance coverage through their employer, although the share of people with such coverage has been declining. Prior to the 2010 Affordable Care Act (ACA), 50- to 64-year-olds often had difficulty obtaining health care coverage if they did not have access to it through their employer. The ACA has provided new opportunities for health coverage for this population through health insurance benefit exchanges, as well as through Medicaid (see this chapter: Expanding Health Care Coverage).
Some Americans have access to private coverage through former employers that offer retiree health benefits. In addition, many Medicare beneficiaries enrolled in traditional Medicare purchase private Medicare supplement (Medigap) policies to supplement their Medicare coverage.
Ensuring that everyone has access to private coverage has been the primary focus of past efforts to reform the practices of health insurers and private health care plans, including self-insured employer plans. The ACA made a number of changes to address practices in the private market that have been barriers to coverage or posed other concerns for consumers.