Medical Expenditure Panel Survey 

Agency for Healthcare 

Research and Quality

STATISTICAL BRIEF #218 

August 2008 

Highlights 

 In 2006, 44.6 percent of 

state and local government 

employees enrolled in 

employer-sponsored health 

insurance were required to 

pay a deductible by their 

health insurance plan. 

 In 2006, state and local 

government employees 

enrolled in employersponsored health 

insurance who were 

responsible for a 

deductible had an average 

single deductible of $462 

and an average family 

deductible of $937. Both of 

these values varied 

significantly by an 

employee’s census 

division. 

 In 2006, 77.7 percent of 

state and local government 

employees enrolled in 

employer-sponsored health 

insurance paid a co-pay for 

each doctor visit. The 

average dollar co-pay 

among these enrollees 

was $16.02. These values 

varied significantly by 

census division. 

 The average coinsurance 

percentage for a doctor 

visit for employees from 

state and local 

governments enrolled in 

employer-sponsored health 

insurance with a 

coinsurance was 17.9 

percent in 2006. 

Co-pays, Deductibles, and Coinsurance 

Percentages for Employer-Sponsored 

Health Insurance in the State and 

Local Government Workforce, by 

Census Division, 2006 

John P. Sommers, PhD and Beth Levin Crimmel, MS 

Introduction 

Employer-sponsored health insurance is the primary source of health 

insurance coverage in the United States for active employees. It is 

especially important to the 19.4 million state and local government 

employees. According to data from the Insurance Component of the 

2006 Medical Expenditure Panel Survey (MEPS-IC), 99.9 percent of 

state and local government employees work where health insurance 

is offered and 65.5 percent of these employees are enrolled in 

employer-sponsored health insurance. Both these figures are 

significantly higher than the same values for private sector 

employees. 

In recent years, premiums and employee contributions for employersponsored health insurance provided by state and local governments 

have risen dramatically. For instance, annual employee contributions 

towards family coverage for state and local government employees 

rose from $1,267 to $2,058 (62.4 percent) between 2000 and 2006. 

Contribution costs are only a portion of the costs of health insurance 

for these employees. Other factors, such as whether an employee 

has a deductible, the size of deductibles, and the size of co-pays and 

coinsurance, also contribute to employees’ out-of-pocket cost of 

care. 

This Statistical Brief examines the levels of these deductibles, copays, and coinsurance for state and local government employees 

and how they vary by census division. Among the items examined 

are the percentage of enrollees who paid a deductible and the size 

of deductibles, what percentage of enrollees paid co-pays and the 

size of co-pays, and the average coinsurance percentage paid by 

enrollees. Only estimates that had a statistically significant difference 

from the national average at the 0.05 percent significance level are 

noted in the text.

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2

Findings 

Among the 12.7 million state and local government employees enrolled in employer-sponsored health 

insurance in 2006, 44.6 percent were enrolled in a plan that required they meet an annual deductible 

(figure 1). This percentage varied significantly by census division. A higher than average percentage of 

enrollees from governments in the West North Central, South Atlantic, East South Central, West South 

Central and Mountain census divisions—61.0, 56.8, 73.5, 55.3 and 57.9, percent, respectively—had 

plans with a deductible. A lower than average percentage of the enrollees in the New England, Middle 

Atlantic, and Pacific census divisions had a plan with a deductible. In these census divisions, 9.1, 18.1, 

and 29.2 percent, respectively, of the enrollees had plans with a deductible in 2006. 

In 2006, the size of both single and family deductibles varied by census division for enrollees from state 

and local governments who were responsible for a deductible. The average amount of the single 

deductible for enrolled state and local employees who paid a deductible was $462 (figure 2). Enrollees 

who were responsible for deductibles in governments in the West North Central and West South Central 

census divisions had higher than average single deductibles of $586 and $651, respectively. Enrollees 

from governments in the Middle Atlantic, South Atlantic, East South Central, and Pacific census divisions 

who were responsible for a deductible had lower than average single deductibles of $289, $391, $378, 

and $343, respectively. 

Among those enrollees who had deductibles, those in the West South Central census division had family 

deductibles higher than the national state and local government average of $937 (figure 3). These 

enrollees were responsible for an average family deductible of $1,566. Enrollees with deductibles in state 

and local governments in the Middle Atlantic census division had an average family deductible of $675. 

This value was significantly less than the national state and local government average. 

In 2006, 77.7 percent of state and local government enrollees in employer-sponsored health insurance 

paid a co-pay for an office visit (figure 4). In the New England, Middle Atlantic and South Atlantic census 

divisions, the percentages were higher than average, at 87.8, 89.2, and 89.8 percent, respectively. In the 

East North Central, West North Central, and Pacific census divisions, lower than average percentages of 

enrollees paid a co-pay. In these census divisions, 62.3, 64.0, and 69.6 percent, respectively, of enrollees 

paid a co-pay. 

The average co-pay for an office visit for enrollees among state and local government employees in plans 

with co-pays was $16.02 (figure 5). Enrollees with co-pays in the West North Central ($19.25), South 

Atlantic ($17.33), East South Central ($17.90), West South Central ($21.52), and Mountain ($18.52) 

census divisions paid higher than average amounts. Enrollees from state and local governments in the 

New England ($10.72), Middle Atlantic ($12.48), East North Central ($14.47), and Pacific ($12.86) census 

divisions paid lower than average co-pays. 

Persons who do not have co-pays generally have a coinsurance percentage to pay. For state and local 

government enrollees in 2006, the average coinsurance percentage for an office visit for those enrollees 

who paid a coinsurance percentage was 17.9 percent (figure 6). Enrollees from governments in the East 

South Central and Pacific census divisions who had a coinsurance paid lower than average rates of 16.7 

and 15.1 percent, respectively, while those from the Middle Atlantic, West North Central, South Atlantic, 

and Mountain census divisions paid higher than average coinsurance rates of 19.7, 19.2, 19.0, and 20.4 

percent, respectively. 

 

Data Source 

This Statistical Brief summarizes data from the 2006 MEPS-IC. The data are available on the MEPS Web 

site at http://www.meps.ahrq.gov/mepsweb/data_stats/quick_tables.jsp or have been produced using 

special computation runs on the confidential MEPS-IC data available at the U.S. Census Bureau. 

Definitions 

Deductible 

A deductible is a fixed dollar amount during the benefit period, usually a year, that an insured person pays 

before the insurer starts to make payments for covered medical services. Plans may have both per 
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individual and family deductibles. Some plans may have separate deductibles for specific services. For 

example, a plan may have a hospitalization deductible per admission. Deductibles may differ if services 

are received from an approved provider or if received from providers not on the approved list. 

Co-pay 

A co-pay is a form of medical cost sharing in a health insurance plan that requires an insured person to 

pay a fixed dollar amount when a medical service is received, regardless of the total charge for service. 

The insurer is responsible for the rest of the reimbursement. There may be separate co-pays for different 

services. For example, an enrollee may pay a $10 co-pay for each doctor's office visit, $75 for each day in 

the hospital, and $5 for each prescription. Some plans require that a deductible first be met for some 

specific services before a co-pay applies. 

Coinsurance 

Coinsurance is a form of medical cost sharing in a health insurance plan that requires an insured person 

to pay a stated percentage of medical expenses after the deductible amount, if any, has been paid. Once 

any deductible amount and coinsurance are paid, the insurer is responsible for the rest of the 

reimbursement for covered benefits up to allowed charges; the individual could also be responsible for 

any charges in excess of what the insurer determines to be “usual, customary, and reasonable.” 

Coinsurance rates may differ if services are received from an approved provider (i.e., a provider with 

whom the insurer has a contract or an agreement specifying payment levels and other contract 

requirements) or if received by providers not on the approved list. In addition to overall coinsurance rates, 

rates may also differ for different types of services. 

Census division 

States were grouped into nine census divisions as follows: 

– New England: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont 

– Middle Atlantic: New Jersey, New York, Pennsylvania 

– East North Central: Illinois, Indiana, Michigan, Ohio, Wisconsin 

– West North Central: Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota 

– South Atlantic: Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South 

Carolina, Virginia, West Virginia 

– East South Central: Alabama, Kentucky, Mississippi, Tennessee 

– West South Central: Arkansas, Louisiana, Oklahoma, Texas 

– Mountain: Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, Wyoming 

– Pacific: Alaska, California, Hawaii, Oregon, Washington 

About MEPS-IC 

The MEPS-IC is a survey of business establishments and governments that collects information on 

employer-sponsored health insurance, such as whether insurance is offered, enrollments, types of plans, 

and premiums. The survey is conducted annually by the U. S. Census Bureau under the sponsorship of 

the Agency for Healthcare Research and Quality (AHRQ). A total sample of 3,000 units was selected for 

state and local governments for 2006. The yearly response rate for the government sample has 

averaged 92 percent. 

For more information on this survey, see MEPS Methodology Reports 6, 8, 10, 14, 17, and 18 on the 

MEPS Web site at http://www.meps.ahrq.gov/mepsweb/data_stats/publications.jsp and Insurance 

Component Survey Basics at http://www.meps.ahrq.gov/mepsweb/survey_comp/Insurance.jsp. 

Suggested Citation 

Sommers, J. P. and Crimmel, B.L., Co-pays, Deductibles, and Coinsurance Percentages for EmployerSponsored Health Insurance in the State and Local Government Workforce, by Census Division, 2006. 

Statistical Brief #218. August 2008. Agency for Healthcare Research and Quality, Rockville, MD, 

http://www.meps.ahrq.gov/mepsweb/data_files/publications/st218/stat218.pdf 

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AHRQ welcomes questions and comments from readers of this publication who are interested in 

obtaining more information about access, cost, use, financing, and quality of health care in the United 

States. We also invite you to tell us how you are using this Statistical Brief and other MEPS data and 

tools and to share suggestions on how MEPS products might be enhanced to further meet your needs. 

Please e-mail us at mepsprojectdirector@ahrq.hhs.gov or send a letter to the address below: 

Steven B. Cohen, PhD, Director 

Center for Financing, Access, and Cost Trends 

Agency for Healthcare Research and Quality 

540 Gaither Road 

Rockville, MD 20850 
Source: Center for Financing, Access, and Cost Trends, AHRQ, Insurance Component of the Medical Expenditure Panel Survey, 2006

55.3 57.9

29.2

44.6

73.5

61.0

56.8

46.6

18.1

9.1

0

20

40

60

80

New

England

Middle

Atlantic

East North

Central

West North

Central

South

Atlantic

East South

Central

West South

Central

Mountain Pacific National

Average

Percentage

Figure 1. Percentage of state and local government enrollees

in a plan with a deductible, by census division, 2006

Source: Center for Financing, Access, and Cost Trends, AHRQ, Insurance Component of the Medical Expenditure Panel Survey, 2006

$651

$513

$343

$462

$378

$586

$394 $391

$289

$463

0

200

400

600

800

New

England

Middle

Atlantic

East North

Central

West North

Central

South

Atlantic

East South

Central

West South

Central

Mountain Pacific National

Average

Dollars

Figure 2. Average single deductible for state and local 

government employees enrolled in a plan with a deductible,

by census division, 2006

Statistical Brief #218: Co-pays, Deductibles, and Coinsurance for Employer-Sponsored Health 

Insurance in the State and Local Government Workforce, by Census Division, 2006 

5
Source: Center for Financing, Access, and Cost Trends, AHRQ, Insurance Component of the Medical Expenditure Panel Survey, 2006

$1,566

$985

$773

$937

$833

$1,094

$825 $864

$675

$890

0

500

1,000

1,500

2,000

New

England

Middle

Atlantic

East North

Central

West North

Central

South

Atlantic

East South

Central

West South

Central

Mountain Pacific National

Average

Dollars

Figure 3. Average family deductible for state and local 

government employees enrolled in a plan with a deductible,

by census division, 2006

 

Source: Center for Financing, Access, and Cost Trends, AHRQ, Insurance Component of the Medical Expenditure Panel Survey, 2006

82.0

75.4

69.6

77.7

70.2

64.0

89.8

62.3

87.8 89.2

0

20

40

60

80

100

New

England

Middle

Atlantic

East North

Central

West North

Central

South

Atlantic

East South

Central

West South

Central

Mountain Pacific National

Average

Percentage

Figure 4. Percentage of state and local government enrollees

in a plan requiring a co-pay for an office visit, 

by census division, 2006

Statistical Brief #218: Co-pays, Deductibles, and Coinsurance for Employer-Sponsored Health 

Insurance in the State and Local Government Workforce, by Census Division, 2006 

6
Source: Center for Financing, Access, and Cost Trends, AHRQ, Insurance Component of the Medical Expenditure Panel Survey, 2006

$21.52

$18.52

$12.86

$16.02

$17.90

$19.25

$17.33

$14.47

$12.48

$10.72

0

5

10

15

20

25

New

England

Middle

Atlantic

East North

Central

West North

Central

South

Atlantic

East South

Central

West South

Central

Mountain Pacific National

Average

Dollars

Figure 5. Average co-pay for an office visit for state and local 

government employees enrolled in a plan with a co-pay for an 

office visit, by census division, 2006

Source: Center for Financing, Access, and Cost Trends, AHRQ, Insurance Component of the Medical Expenditure Panel Survey, 2006

19.0

20.4

15.1

17.9

16.7

19.2 19.0

16.9

19.7 18.8

0

5

10

15

20

25

New

England

Middle

Atlantic

East North

Central

West North

Central

South

Atlantic

East South

Central

West South

Central

Mountain Pacific National

Average

Percentage

Figure 6. Average coinsurance rate for an office visit for state

and local government employees enrolled in a plan with a 

coinsurance for an office visit, by census division, 2006

Statistical Brief #218: Co-pays, Deductibles, and Coinsurance for Employer-Sponsored Health 

Insurance in the State and Local Government Workforce, by Census Division, 2006 

7