Low-income insurance statistics show a large protection gap despite hundreds of millions of people covered by microinsurance. In 2022, participating providers reported coverage for up to 330 million people across 36 countries, but that represented only up to 11.5% of the estimated target population. Health costs remain a major source of financial pressure, while product reach, payment methods and claims performance vary by product and region.
Contents
- The low-income insurance protection gap
- Health costs and household financial pressure
- Health protection in low-income countries
- Products, premiums and customer reach
- Payment methods and claims performance
- Gender, climate and property-risk coverage
The low-income insurance protection gap
The Microinsurance Network’s 2022 study defined its low-income population as people earning Int. $2 to Int. $20 per day on a purchasing-power-parity basis. Its findings describe participating providers rather than the entire insurance market. The study covered 294 insurers and 1,040 microinsurance products, with data from 36 countries.
Those providers covered up to 330 million people in 2022. The people-covered measure includes policyholders and other people insured under a policy. Even at that level, coverage reached only up to 11.5% of the estimated microinsurance target population in the countries studied. The estimated protection gap was therefore 88.5%.
Life and accident insurance accounted for 171 million covered people, or 52% of everyone covered by microinsurance in the study. These products reached 5.9% of the target market. The estimated life and accident microinsurance market in the focus countries was USD 29.6 billion, with current penetration of 3.9%. The median premium per life covered was USD 10.30. The Landscape of Microinsurance 2023 reports these figures for 2022.
The scale of coverage and the size of the gap should be read together. A large absolute number of covered people does not mean that most eligible households have insurance. The study’s participating-provider scope also means that its 330 million figure is not a census of every insurer, product or covered person.
Health costs and household financial pressure
Health spending can create a need for insurance even when households are not formally below a poverty line. The World Health Organization and World Bank reported that impoverishing out-of-pocket health spending affected 1.6 billion people worldwide in 2022, equal to 20% of the global population. The corresponding share was 29% in 2000.
Among people already living in poverty, the share who paid out of pocket for health care increased from 64% in 2000 to 76% in 2022. Large but non-impoverishing out-of-pocket health spending affected 6% of the world’s population in 2022, compared with 5% in 2000. In absolute terms, that category represented almost 290 million people in 2000 and almost 450 million in 2022.
Medicines are a central part of this burden. Across countries, they accounted for a typical 56% of out-of-pocket health spending using the most recent available country survey years in the WHO and World Bank’s 2025 update. Among the poorest fifth of each country’s population, medicines accounted for around 60%.
The distribution of hardship was sharply unequal in 2022. Financial hardship affected 76% of people in the poorest consumption quintile, compared with 3.7% in the highest quintile. Among people facing impoverishing out-of-pocket spending, the median contribution was 22% of total out-of-pocket health spending in low-income countries, versus about 4% in high-income countries. The median survey year for that comparison was 2016, so it should not be read as a single-year 2022 estimate.
These results help explain why low-income insurance discussions often focus on health, medicines and predictable out-of-pocket costs. They do not show that insurance alone caused any change in household financial pressure; they describe the scale of the financial exposure that protection products may address.
Health protection in low-income countries
The WHO and World Bank’s revised UHC indicators show gradual movement in low-income countries, but continued distance from higher-income-country coverage levels. The UHC service coverage index for low-income countries rose from 43 in 2015 to 47 in 2023. For comparison, the index for high-income countries was 85 in both years.
Financial-hardship and out-of-pocket indicators also changed between 2015 and 2022:
| Indicator | Low-income countries, 2015 | Low-income countries, 2022 or 2023 | Comparison shown in the report |
|---|---|---|---|
| UHC service coverage index | 43 | 47 in 2023 | High-income: 85 in 2015 and 2023 |
| Financial-hardship rate | 38.5% | 34.7% in 2022 | High-income: 9.5% to 9.8% |
| Impoverishing out-of-pocket spending rate | 35.7% | 33% in 2022 | — |
| Large out-of-pocket spending rate | 2.8% | 1.8% in 2022 | — |
The same report placed the lower-middle-income UHC service coverage index at 59 in 2015 and 63 in 2023. The upper-middle-income index rose from 78 to 81. Globally, about 4.6 billion people were not fully covered by essential health services in 2023, and about 2.1 billion people faced health-related financial hardship in 2022.
The report uses revised UHC indicators. Its financial-hardship measure is based on out-of-pocket spending above 40% of a household’s discretionary budget, and the report cautions that the revised indicator is not directly comparable with the original SDG 3.8.2 definition. WHO statistics combine country survey data with modeled or global estimates where stated, so the measurement period and indicator definition matter when comparing results.
Products, premiums and customer reach
Life insurance was the largest microinsurance product line in the 2022 landscape study, covering 80.7 million people. Credit-life or loan-protection products covered 34.9 million. Agriculture, aquaculture and livestock microinsurance covered 33.6 million people through 85 reported products.
India’s PMFBY crop-insurance scheme covered almost 27.8 million people in 2022. It collected USD 3.66 billion in gross premiums, including farmer contributions and government subsidy. Fully subsidised schemes accounted for 11% of the agriculture schemes recorded in the study. Agriculture products covered 29 million people in Asia and the Pacific, compared with 3.6 million in Africa.
Premium levels differed substantially by product. The median premium per person for motor products was USD 73.5, the highest among the product lines reported. For life and accident products, the median premium per life covered was USD 10.30. These are different measures and should not be treated as directly interchangeable.
Health products reached a median of 12,504 people per product in 2022, up from 7,798 in 2021. Median premiums collected per health product were USD 136,598 in 2022, up from USD 76,723 in 2021. The figures show growth in the reported product-level medians, not necessarily growth for every health product or every market.
Payment methods and claims performance
Payment design is a practical part of access. Direct debit and standing orders were the primary payment method for 35% of products in 2022. Cash was primary for 29%, credits and loans for 12%, and mobile money or e-wallets for 11%. Products offered free or completely subsidised represented 3% of products.
The claims data show a median claims ratio of 21.7% across all reported products and regions. The median claims acceptance ratio was 98%. A claims ratio and a claims acceptance ratio measure different parts of product performance: one describes claims relative to premiums under the study’s reporting framework, while the other describes the share of submitted claims accepted.
Regional medians also differed. The claims ratio was 22.9% in Africa, 29.8% in Asia and the Pacific, and 13.9% in Latin America and the Caribbean. Median total claims turnaround time was 15 days across the three regions, with a regional median of 4.5 days in Africa, 22 days in Asia and the Pacific, and 30 days in Latin America and the Caribbean.
These statistics describe reported medians across products and regions. They do not establish that one region’s products are universally faster or more generous, because product mix, claims processes and reporting coverage can differ.
Gender, climate and property-risk coverage
Women represented a median 50% of microinsurance policyholders in 2019, 45% in 2020 and 49% in 2021. In 2022, women represented 51% of health-microinsurance policyholders, while women were 49% of people covered by those products. The distinction between policyholders and all people covered matters when interpreting gender statistics.
Climate-risk protection was present in 89 products covering 116 million people in 2022. Agriculture products accounted for 68 of those 89 products, linking climate-related protection closely with farming, aquaculture and livestock coverage in the reported portfolio.
Property and income risks were covered at a smaller scale. Direct property and income products covered approximately 2.4 million people. Protection for property and income risks through other product lines reached approximately 10.6 million people. Together, almost 13 million people received property or income-risk protection through microinsurance, equal to 4% of people covered in the study.
Regional coverage was concentrated in Asia and the Pacific, where 9.3 million people received property or income-risk protection. The corresponding figures were 2.8 million in Latin America and the Caribbean and 0.9 million in Africa. As with the wider landscape, these are participating-provider figures for 2022 rather than a complete count of all low-income insurance activity.
The combined picture is specific: microinsurance already reaches hundreds of millions of people, but most of the estimated target population remains outside the participating providers’ reported coverage. Health-related financial hardship affects billions globally, while life, agriculture and climate-risk products account for much of the observed reach. Payment channels, premiums, claims handling and the distribution of property protection remain important indicators when assessing how low-income insurance works in practice.