Health care plan provisions for state and local government workers in the United States, 2021 : U.S. Bureau of Labor Statistics

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Health care plan provisions for state and local government workers in the United States, 2021

2021 Excel dataset (XLSX)

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Overview

The National Compensation Survey (NCS) provides features, costs, and limits of employer-sponsored benefits for private industry as well as state and local government workers. To produce estimates for benefits available to employees, Bureau of Labor Statistics field economists ask respondents to provide health care plan documentation. Summary Plan Descriptions (SPDs), Summary of Benefit Coverage (SBCs), or other documentation are obtained during initiation, which is the process of collecting data from newly sampled establishments. The information gathered from the plan documentation is paired with participation data collected for the NCS.

The BLS has provided detailed information on employer-sponsored benefits since the late 1970s. Estimates of detailed benefit provisions are available by worker and establishment characteristics and accessible in an Excel format (XLSX) and through the database. Estimates for prior years and other benefits publications are available from the Benefits publications page.

The following tabs summarize features, costs, and limits of health care plans available to state and local government workers.

Plan characteristics - Number of plan network available, non-emergency services outside of network, and eligibility requirements
Coinsurance & out-of-pocket - Coinsurance (fixed and variable) percentages and annual individual and family out-of-pocket maximums
Annual deductible - Individual and family plan deductibles including median dollar amount for in-network, out-of-network, and most generous coverage
High deductible - Annual individual deductible for high and nonhigh deductible health plans and tax-favored accounts
Services provided - Coverage and limits for hospital room and board, physician office visit, and specialist office visit benefits
Outpatient prescription drugs - Types of coverage and limits for generic and brand-name drugs

Medical care coverage

A plan network was available to 98 percent of state and local government union workers and 99 percent of nonunion workers participating in medical care plans. Plan administrators can contract specified rates with health care providers such as specialists, hospitals, and laboratories and are considered in-network. Plan participants usually receive a discount for using services in-network. Services provided outside of the network typically carry higher costs to plan participants. For union workers participating in medical care plans, 36 percent had one plan network and 54 percent had two networks available. For nonunion workers participating in medical care plans, 23 percent had one plan network and 68 percent had two networks available.

Non-emergency services outside the network were available to 63 percent of union workers and 76 percent of nonunion workers. For the remaining 37 percent of union workers and 24 percent of nonunion workers, non-emergency services were not available. That is, any non-emergency services received outside the network costs were the sole responsibility of plan participants.

Medical care eligibility

A service requirement existed for 40 percent of educational services workers participating in medical care plans. That is, before workers are eligible to participate in the plan, they need to complete a specified timeframe in the job. For 8 percent of educational services workers, the eligibility requirement was 2 months of service. Fifty-three percent of workers did not have a service eligibility requirement. For 7 percent of workers service eligibility requirements could not be determined from the collected documentation.

A service requirement existed for 35 percent of health care and social assistance industry workers participating in medical care plans. For 12 percent of these workers, 2 months of service were required for eligibility. A service eligibility requirement was not present for 59 percent of the workers. For the remaining 6 percent of workers service eligibility requirements could not be determined from the collected documentation.

Coinsurance requirement for medical services

A coinsurance is a requirement that plan participants pay a percentage of medical cost. In 2021, a coinsurance was required for 58 percent of state and local government workers participating in medical care plans. The percentage of workers with coinsurance ranged from 60 percent for service occupations to 55 percent for sales and office occupations. A variable coinsurance was present for 81 percent of workers participating in medical care plans with coinsurance requirements. The median coinsurance was 60 percent for out-of-network services and 80 percent for in-network services. For the most generous coverage⁽¹⁾, the median coinsurance percentage was 90 percent.

Out-of-pocket maximum for single coverage

An out-of-pocket maximum is the annual dollar amount limit that plan participants are required to pay out-of-pocket, in addition to the plan deductible. Ninety-eight percent of union workers and 99 percent of nonunion workers had an individual out-of-pocket maximum. The median amount was $2,000 for union and $3,000 for nonunion workers. The out-of-pocket maximum ranged from $900 at the 10th percentile to $6,840 at the 90th percentile for union workers and from $1,250 at the 10th percentile to $6,750 at the 90th percentile for nonunion workers.

Out-of-pocket maximum for family coverage

An out-of-pocket maximum was present for 97 percent for union and 99 percent for nonunion, and the median amount was $4,250 for union and $6,400 for nonunion workers. The out-of-pocket maximum ranged from $2,000 at the 10th percentile to $13,680 at the 90th percentile for union workers and from $2,800 at the 10th percentile to $13,500 at the 90th percentile for nonunion workers.

Table 1. Annual out-of-pocket maximum, state and local government workers, 2021
Medical care benefits	Union	Nonunion
Individual out-of-pocket maximum
With out-of-pocket maximum	98%	99%
Without out-of-pocket maximum	2%	-
Amount of out-of-pocket maximum ($)
10th percentile	$900	$1,250
25th percentile	$1,500	$2,000
50th percentile (median)	$2,000	$3,000
75th percentile	$4,500	$4,500
90th percentile	$6,840	$6,750
Family out-of-pocket maximum
With out-of-pocket maximum	97%	99%
Without out-of-pocket maximum	2%	-
Amount of out-of-pocket maximum ($)
10th percentile	$2,000	$2,800
25th percentile	$3,000	$4,000
50th percentile (median)	$4,250	$6,400
75th percentile	$9,000	$10,920
90th percentile	$13,680	$13,500
Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

End note

⁽¹⁾ In instances where more than two tiers of benefits (networks) exist, which provide participants with options when selecting services, the most generous coverage refers to the network that provides the lowest out of pocket cost for services (deductible, copayment, or coinsurance) rendered.

Annual deductible

Many health care plans have a deductible. A deductible is a dollar amount that plan participants pay during the benefit period, usually a year, before the insurer starts to make payments for covered medical services. Plans may have individual and family deductibles.

In 2021, 83 percent of state and local government workers participating in medical care plans had an annual deductible. Across industries, the percentage of workers with an annual deductible ranged from 80 percent in public administration to 88 percent in elementary and secondary schools.

Individual deductible

Most (over 80 percent) of workers participating in medical care plans have either individual or family deductibles. In the case of individual deductibles, once plan participants meet the deductible amount, covered medical benefits begin.

The median individual deductible amount in 2021 was $1,000 for state and local government workers. Amongst occupations, the individual deductible amount was $750 for protective service occupations and $1,050 for primary, secondary, and special education school teachers.

Some medical care plans have fixed deductibles while others have variable deductibles. In 2021, 33 percent of workers participating in medical care plans had fixed deductible amounts and 48 percent of workers had variable deductibles. In the case of variable deductibles, insurers may offer tiered networks and provide the insured participants with the lowest costs for using preferred provider(s). The insured participants may also receive services from the other in-network providers.

In 2021, the most generous coverage⁽¹⁾ median deductible amount for state and local government workers was $400, the median in-network amount was $1,050, and the median out-of-network amount was $1,500. For union and nonunion workers, the most generous coverage median deductible amount was $400. The in-network deductible was $600 for union workers and $1,250 for nonunion workers. The out-of-network amount was even higher for both groups: $800 for union workers and $2,500 for nonunion workers. The median in-network deductible was $500 for state government workers and $1,250 for local government workers. The out-of-network median deductible amount was $800 for state government workers and $2,000 for local government workers.

Family deductible

In 2021, 82 percent of state and local government workers participated in medical plans with a family deductible.

For state and local government workers, 32 percent had a fixed deductible for family coverage and the median amount was $1,400. A variable deductible for family coverage was required for 47 percent of workers and the most generous coverage median amount was $1,200. The in-network median family deductible for union workers was $1,500 and $3,000 for nonunion workers. The out-of-network median family deductible was $1,600 and $6,000, respectively. Amongst wage categories, the most generous coverage median family deductible was $3,000 for workers in the lowest 10 percent wage category and $1,050 for workers in the highest 10 percent wage category. The out-of-network median family deductible was $6,000 and $1,500, respectively.

Table 1. Percentage of state and local government workers participating in medical care plans with an annual deductible and associated dollar amounts, 2021
Medical care benefits	Individual deductible	Family deductible
With deductible	83%	82%
Amount of deductible ($)
10th percentile	$250	$500
25th percentile	$400	$980
50th percentile (median)	$1,000	$2,000
75th percentile	$1,500	$3,750
90th percentile	$2,500	$5,200
With fixed deductible	33%	32%
Median deductible amount ($)	$500	$1,400
With variable deductible	48%	47%
Median most generous amount ($)	$400	$1,200
Median in-network amount ($)	$1,050	$2,800
Median out-of-network amount ($)	$1,500	$4,000
Without deductible	16%	17%
Source: Bureau of Labor Statistics, National Compensation Survey.

End note

High deductible health plans

Twenty-four percent of state and local government workers participated in high deductible health plans and 73 percent were enrolled in nonhigh deductible health plans in 2021. High deductible health plans (HDHP) typically feature a higher deductible and lower insurance premiums than those of traditional (nonhigh deductible) health plans. Normally HDHPs include catastrophic coverage to protect against large medical expenses, but the insured participants are responsible for routine out-of-pocket expenses up to the plan deductible.

In the education and health services industry, 26 percent of state and local government workers participated in HDHPs in 2021. Within education and health services, participation in HDHPs ranged from 15 percent for workers in junior colleges, colleges, and universities to 30 percent for workers in elementary and secondary schools. Twenty-six percent and 28 percent of workers in the health care and social assistance, and hospitals industries participated in HDHPs, respectively.

HDHPs allow workers to establish Health Savings Accounts (HSA)⁽¹⁾, which are employee-owned and used to pay for medical expenses with pretax contributions. Additionally, HSAs may earn tax-free interest and unused contributions rollover from year to year. In 2021, 48 percent of state and local government workers with high deductible health plans had HSAs available to them as did 72 percent of hospital workers.

Health reimbursement arrangements (HRA), also known as "health reimbursement accounts" or "personal care accounts," reimburse participants for qualified medical expenses. Health reimbursement arrangements consist of funds set aside by employers to reimburse employees for qualified medical expenses, just as an insurance plan will reimburse participants for the cost of services incurred⁽²⁾. In 2021, 12 percent of state and local government workers in HDHPs had an HRA available and 2 percent of workers in traditional (nonhigh deductible) health plans had one available.

Table 1: Percentage of state and local government workers participating in high deductible health plans and deductible dollar amounts, 2021
Medical care benefits	High deductible health plan	Nonhigh deductible health plans
Percentage of workers participating	24%	73%
With an annual individual deductible	100%	77%
Amount of annual individual deductible ($)
10th percentile	$1,500	$225
25th percentile	$1,500	$300
50th percentile (median)	$2,000	$500
75th percentile	$2,750	$850
90th percentile	$3,600	$1,250
Selected tax-favored accounts
With health savings account	48%	-
With health reimbursement arrangement	12%	2%
Source: Bureau of Labor Statistics, National Compensation Survey.

End notes

⁽¹⁾ Health savings accounts (HSAs) are used in combination with high deductible health plans to pay for current and future medical expenses. HSAs are controlled by the employee, although both employees and employers may contribute to the account. Accounts can accumulate tax-deferred interest. For more information see the Health Savings Accounts factsheet.

⁽²⁾ The Health Spending Accounts article provides a summary on accounts available to fund health care expenses.

Services provided

Two types of limits on coverage are copayments and coinsurance. Copayments are a predetermined dollar amounts that plan participants must pay when services are received before any remaining charges are paid by insurers when the deductible has been met. For hospital room and board benefits, the copayment may vary based on salary or length of stay. Coinsurance is a form of medical cost sharing that requires a participant to pay a stated percentage of medical expenses after the deductible amount, if any, has been paid. After the deductible and coinsurance are paid, insurers are responsible for costs up to the allowable charges. Participants may be responsible for any charges in excess of what insurers determine to be "usual, customary, and reasonable." Coinsurance rates may differ between services received from an approved provider and those received from providers not on the approved list. In addition to overall coinsurance rates, rates may also differ for different types of services.

Hospital room and board

In 2021, 97 percent of state and local government workers participating in medical care plans had coverage for hospital room and board. For workers in the Middle Atlantic division 81 percent were covered. Eighty-two percent of workers had coverage with limits for hospital room and board and 15 percent had full coverage. Twenty-six percent of union workers were covered in full whereas 4 percent of nonunion workers had full coverage. Three percent of workers in the lowest 10 percent wage category and 25 percent of workers in the highest 10 percent wage category had full coverage. Sixty-eight percent of union workers and 95 percent of nonunion workers were covered with some type of limit. Limits were present for 97 percent and 67 percent of the workers in the lowest and highest 10 percent wage category, respectively.

Hospital room and board visits

In 2021, 52 percent of workers had limits on coverage via coinsurance only and 15 percent had copayment and coinsurance. Fifty-six percent of nonunion workers had coinsurance only, more than the 46 percent of union workers. Seventeen percent of nonunion workers and 32 percent of union workers had copayment only. Nonunion workers had a 20 percent copayment and coinsurance coverage limit compared to 6 percent for union workers. Twenty-three percent of workers had copayment only for hospital room and board benefits, compared to 53 percent of workers in the Northeast, 32 percent in the West and 14 percent in the Midwest census regions.

Physician office visits

In 2021, 99 percent of state and local government workers participating in medical care plans had coverage for physician office visits and 93 percent had coverage with limits. The Middle Atlantic census division had fewer workers with coverage with limits than other divisions at 74 percent.

Specialist office visits

In 2021, 97 percent of state and local government workers participating in medical care plans had coverage for specialist office visits and 70 percent had copayment only. Ninety three percent of workers had coverage with limits and 80 percent of workers in the Northeast had coverage with limits for specialist office visits. Among the census regions, workers with copayment only ranged from 59 percent in the Midwest to 77 percent in the West region.

Outpatient prescription drugs

In 2021, 88 percent of state and local government workers participating in prescription drug plans had coverage for brand-name drugs not on formulary and 41 percent of workers were subject to an annual deductible. Eighty percent of union workers had coverage for brand-name drugs not on formulary, compared to 94 percent of nonunion workers. Outpatient prescription drugs were subject to a deductible for 30 percent of union workers and 50 percent of nonunion workers. Eighty-six percent of union workers and 77 percent of nonunion workers were subject to a copayment for generic drug coverage. Eighty-four percent of union workers and 66 percent of nonunion workers were subject to a copayment for brand-name drugs on formulary, and 81 percent of union workers and 56 percent of nonunion workers were subject to a copayment for brand-name drugs not on formulary.

Table 1. Outpatient prescription drug benefits: Coverage and limits for state and local government workers, 2021
Coverage and limits	All workers	Union	Nonunion
Coverage availability
Brand-name drugs not on formulary	88%	80%	94%
Mail-order drugs	86%	90%	82%
Subject to an annual deductible	41%	30%	50%
Generic drug limits
Subject to copayment	81%	86%	77%
Subject to coinsurance	14%	9%	19%
Brand-name drugs on formulary limits
Subject to copayment	74%	84%	66%
Subject to coinsurance	22%	13%	31%
Brand-name drugs not on formulary limits
Subject to copayment	66%	81%	56%
Subject to coinsurance	32%	17%	42%
Source: Bureau of Labor Statistics, National Compensation Survey.

Generic drug limits

A copayment for generic drugs was required for 81 percent of workers and 94 percent of workers in the Middle Atlantic census division. Fourteen percent of state and local government workers had coinsurance limits as did 4 percent of workers in the Northeast, 20 percent in the South, 14 percent in the Midwest, and 10 percent in the West.

Brand-name drugs on formulary

Formulary drugs are defined as both brand-name and generic drugs that are approved by the healthcare provider. In 2021, 74 percent of state and government workers with prescription drug coverage were subject to copayment and 22 percent were subject to coinsurance. Nonunion workers were more likely to be subject to coinsurance for brand-name drugs on formulary than union workers, at 31 percent for nonunion workers and 13 percent for union workers. Thirty-four percent of state and local government workers with an average wage in the lowest 10 percent wage category were subject to coinsurance. Among workers in the hospital industry, 56 percent were subject to copayments and 44 percent were subject to coinsurance. In the Northeast census region, 94 percent of workers were subject to a copayment and 5 percent were subject to coinsurance for brand-name drugs on formulary.

Brand name drugs not on formulary

Nonformulary drugs are those that are not approved by the healthcare provider, where participants receive less generous benefits, such as higher copayment amounts per prescription. In 2021, 66 percent of state and government workers had prescription not on formulary drug coverage subject to copayment and 32 percent were subject to coinsurance. A copayment was required for 81 percent of union workers and 56 percent of nonunion workers. Coinsurance was required for 17 percent of union workers and 42 percent of nonunion workers. A copayment was required for 55 percent of workers in the South and 94 percent for workers in the Northeast.

Technical note

Data are from the National Compensation Survey (NCS), which is conducted by the U.S. Bureau of Labor Statistics (BLS). The summary contains 2021 data on detailed employer-provided health benefit plan provisions for state and local government workers in the United States. Federal government workers are excluded from the survey. Previous publications containing information on employee benefits for civilian, private industry, and state and local government workers are available on the National Compensation Survey - Benefits page.

The survey could not have been conducted without the cooperation of the many private businesses and state and local government agencies and jurisdictions that provided benefits data. BLS thanks these respondents for their cooperation. Additional information for survey respondents is available on the National Compensation Survey (NCS) Respondents page.

Most estimates of detailed benefit provisions are expressed in terms of the percentage of workers participating in a particular benefit plan or the percentage covered by a specific provision. Some estimates, however, provide values other than percentages of workers, such as the median eligibility service requirement, percentiles of annual individual deductible amount, percentiles of annual individual out-of-pocket maximum, or median copayment amounts.

In detailed provisions of employer - sponsored health plans, the "not determinable" classification is used when no information on a particular plan feature is available from the Summary Plan Description (SPD). The SPD is used as a primary source of information on the provisions of health plans. Additionally, the Summary of Benefits and Coverage (SBC) can be used to supplement information in the SPD. The SBC is a summary document that explains a plan's health benefits in a structured format to facilitate easy comparison between plans and they are typically less detailed than SPDs.

Average hourly wage percentiles

Estimates by worker average wage are grouped into six wage categories - the lowest 10 percent, the lowest 25 percent, the second 25 percent, the third 25 percent, the highest 25 percent, and the highest 10 percent. The categories use percentile values based on unpublished March 2021 wages and salaries from the BLS Employer Costs for Employee Compensation publication.

The percentiles are computed using hourly wages and salaries along with scheduled hours of work reported for individual workers in sampled establishments. Establishments in the survey are asked to report only individual worker wages and salaries for each sampled job. For the calculation of the percentile values, the individual worker hourly wages and salaries are weighted and arrayed from lowest to highest. The values corresponding to the percentiles are:

Ownership	Average hourly wage percentiles
	10^th	25^th	50^th (median)	75^th	90^th
	10^th	25^th	State and local government workers	75^th	90^th	$14.73	$19.48	$28.99	$41.01	$56.26

The lowest 10- and 25-percent wage categories include those occupations with an average hourly rate less than the 10^th percentile value and 25^th percentile value, respectively. The second 25-percent category includes those occupations with rates at or above the 25^th percentile value but less than the 50^th percentile value. The third 25-percent category includes those occupations with rates at or above the 50^th percentile value but less than the 75^th percentile value. Finally, the highest 25- and 10-percent wage categories include those occupations with an average hourly wage greater than or equal to the 75^th percentile value and 90^th percentile value, respectively.

Individual workers can fall into a wage category different from the average for the occupation into which they are classified because average hourly wages for the occupation are used to produce the benefit estimates.

Survey Methods

For technical information on survey methods, see the Handbook of Methods: National Compensation Measures. The Concepts section provides definitions for worker and establishment characteristics, including geographic areas.

Appendix table 1. Survey establishment response, state and local government, 2021
Establishments	Number of establishments(1)
Total in sampling frame(2)	230,410
Total in sample	1,600
Responding(3)	1,430
Refused(4)	140
Out of business or not in survey scope	30
Footnotes: (1) The number of establishments are rounded to the nearest 10. (2) The sampling frame was developed from state unemployment insurance reports and is based on the 2017 North American Industry Classification System (NAICS). With some minor exceptions, an establishment is a single economic unit that engages in one, or predominantly one, type of economic activity. For state and local government, an establishment can include more than one physical location, such as a school district or a police department. (3) Establishments that provided data at the initial interview. (4) Establishments that did not provide data at the initial interview. Data for establishments not responding at the time of update interviews are imputed. For information on nonresponse adjustment and imputation, see National Compensation Measures in the BLS Handbook of Methods.
Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

Appendix table 2. Number of workers represented, state and local government, 2021
Occupational group(1)	Number of workers(2)
All workers	18,389,200
Management, professional, and related	10,435,500
Professional and related	8,949,200
Teachers	4,796,700
Primary, secondary, and special education school teachers	3,689,600
Service	3,849,400
Protective service	1,884,200
Sales and office	2,555,900
Office and administrative support	2,481,200
Natural resources, construction, and maintenance	786,400
Production, transportation, and material moving	762,000
Footnotes: (1) The 2018 Standard Occupational Classification system is used to classify workers. (2) The number of workers represented by the survey are rounded to the nearest 100. Estimates of the number of workers provide a description of the size and composition of the labor force included in the survey. Estimates are not intended, however, for comparison to other statistical series to measure employment trends or levels.
Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

Additional Information

For articles on employee benefits, see the Monthly Labor Review benefits section and Beyond the Numbers: Pay and Benefits, and The Economics Daily. Benefit publications from 1980 to the present are available through the publications archive. In addition, the benefits database may also be used to obtain data from 1985 to 2006 and 2010 to the present.

Contact information

For more information on benefits estimates, contact National Compensation Survey staff by:

Email: Online form
Telephone: (202) 691-6199 (Monday-Friday, 8:30 a.m. - 4:30 p.m. Eastern Time)
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Mail:
Bureau of Labor Statistics
National Compensation Survey - Benefits
2 Massachusetts Ave., N.E. - Suite 4160
Washington, D.C. 20212-0001

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Last Modified Date: April 14, 2022