Medical Expenditure Panel Survey Agency for Healthcare 

Research and Quality

STATISTICAL BRIEF #185 

September 2007 

Co-pays, Deductibles, and Coinsurance 

for Employer-Sponsored Health 

Insurance in the State and Local 

Government Workforce, by Census 

Division, 2005 

John P. Sommers, PhD 

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 19.05 million state and local 

government employees. According to data from the Insurance 

Component of the 2005 Medical Expenditure Panel Survey (MEPSIC), 99.9% of state and local government employees work where 

health insurance is offered and 66.8 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 

employer-sponsored 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 2005. 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. 

Highlights 

 In 2005, 47.1 percent of state 

and local government employees enrolled in employersponsored health insurance 

were required to pay a deductible by their health insurance 

plan. 

 In 2005, state and local government employees enrolled 

in employer-sponsored health

insurance who were responsible for a deductible had an 

average single deductible of 

$430 and an average family

deductible of $885. Both of 

these values varied significantly by an employee’s census division.

 In 2005, 78.2 percent of state 

and local government employees enrolled in employersponsored health insurance 

paid a co-pay for each doctor 

visit. The average dollar copay among these enrollees 

was $15.59. 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 17.7 percent in 2005. 

Findings 

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

insurance in 2005, 47.1 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 and West 
South Central census divisions, 60.2, 56.2, 74.9, and 57.1 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, 12.7, 28.0, and 34.9 

percent, respectively, of the enrollees had plans with a deductible in 2005. 

Among enrollees from state and local governments who were responsible for a deductible, the size of 

both single and family deductibles varied by census division in 2005. The average amount of the single 

deductible for enrolled state and local employees who paid a deductible was $430 (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 $587 and $647, respectively. Enrollees 

from governments in the New England, Middle Atlantic, East North Central, East South Central, and 

Pacific census divisions who were responsible for a deductible had lower than average single deductibles 

of $318, $209, $321, $367, and $345, respectively. 

Among those enrollees who had deductibles, those in the West North Central and West South Central 

census divisions had family deductibles higher than the national state and local government average of 

$885 (figure 3). These enrollees were responsible for average family deductibles of $1,042 and $1,581, 

respectively. Enrollees with deductibles in state and local governments in the New England, Middle 

Atlantic, East North Central, and Pacific census divisions had average family deductibles of $692, $542, 

$676, and $724, respectively. These values were all significantly less than the national state and local 

government average. 

In 2005, 78.2 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, South Atlantic, and West South Central 

census divisions, the percentages were higher than average, at 86.5, 89.3, and 85.9 percent, 

respectively. In the East North Central, West North Central, East South Central, and Pacific census 

divisions, lower than average percentages of enrollees paid a co-pay. In these census divisions, 65.4, 

69.0, 71.4, and 72.9 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 $15.59 (figure 5). Enrollees with co-pays in the West North Central, East South Central, 

West South Central, and Mountain census divisions paid higher than average amounts of $18.12, $17.98, 

$21.87, and $18.53, respectively. Enrollees from state and local governments in the New England, Middle 

Atlantic, East North Central, and Pacific census divisions paid lower than average co-pays of $10.16, 

$11.96, $13.91, and $12.37, respectively. 

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

government enrollees in 2005, the average coinsurance percentage for an office visit for those enrollees 

who paid a coinsurance percentage was 17.7 percent (figure 6). Enrollees from governments in the 

Pacific census division who had a coinsurance, paid a lower than average rate of 14.6 percent, while 

those from the Middle Atlantic, West North Central, West South Central, and Mountain census divisions 

paid higher than average coinsurance rates of 19.6, 22.4, 19.5, and 20.3 percent, respectively. 

Data Source 

This Statistical Brief summarizes data from the 2005 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 

Employer 

An employer is defined as either a private sector firm or a state or local government. A private sector firm 

is defined as a business entity that controls one or more business establishments or locations. 

Consequently, an employer can have multiple work locations. 

 

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 

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). The yearly response rate has averaged 78 

percent for in-scope sample units. Approximately 4 percent of the original sample has been out-of-scope 

in a typical year. A total sample of 42,000 establishments was selected for the 2005 survey, prior to 

accounting for losses due to nonresponse and out-of-scope cases. 

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. Co-pays, Deductibles, and Coinsurance Percentages for Employer-Sponsored Health 

Insurance in the State and Local Government Workforce, by Census Division, 2007. Statistical Brief #185. 

September 2007. Agency for Healthcare Research and Quality, Rockville, Md. http://www.meps.ahrq. 

gov/mepsweb/data_files/publications/st185/stat185.pdf 
∗ ∗ ∗

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, 2005

57.1

50.6

34.9

47.1

74.9

60.2

56.2

50.4

28.0

12.7

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

Percent

Figure 1. Percentage of state and local government enrollees

in a plan with a deductible, by census division, 2005

Source: Center for Financing, Access, and Cost Trends, AHRQ, Insurance Component of the Medical Expenditure Panel Survey, 2005

647

456

345

430

367

587

379

321

209

318

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

D

ollars

Figure 2. Average single deductible for state and local

government employees enrolled in a plan with a deductible,

by census division, 2005

Statistical Brief #185: Co-pays, Deductibles, and Coinsurance for Employer-Sponsored Health Insurance in the State 

and Local Government Workforce, by Census Division, 2005 
Source: Center for Financing, Access, and Cost Trends, AHRQ, Insurance Component of the Medical Expenditure Panel Survey, 2005

1,581

1,007

724

899 885

1,042

892

676

542

692

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

D

ollars

Figure 3. Average family deductible for state and local

government employees enrolled in a plan with a deductible,

by census division, 2005

Source: Center for Financing, Access, and Cost Trends, AHRQ, Insurance Component of the Medical Expenditure Panel Survey, 2005

85.9

77.8

72.9

78.2

71.4 69.0

89.3

65.4

80.5

86.5

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

Percent

Figure 4. Percentage of state and local government enrollees

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

by census division, 2005

Statistical Brief #185: Co-pays, Deductibles, and Coinsurance for Employer-Sponsored Health Insurance in the State 

and Local Government Workforce, by Census Division, 2005 
Source: Center for Financing, Access, and Cost Trends, AHRQ, Insurance Component of the Medical Expenditure Panel Survey, 2005

21.87

18.53

12.37

15.59

18.12 17.98

16.42

13.91

11.96

10.16

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

D

ollars

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, 2005

Source: Center for Financing, Access, and Cost Trends, AHRQ, Insurance Component of the Medical Expenditure Panel Survey, 2005

19.5 20.3

14.6

17.7 17.2

22.4

18.6

14.9

19.6

16.8

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

Percent

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, 2005

Statistical Brief #185: Co-pays, Deductibles, and Coinsurance for Employer-Sponsored Health Insurance in the State 

and Local Government Workforce, by Census Division, 2005