A Look At The Typical State Employee Health Plan: Full Breakdown By State

Tyler Durden's picture

According to a new report by the Pew Trust, states in the US collectively spent $31 billion to insure 2.7 million employee households in 2013, an uptick in spending from 2011 and 2012 after adjusting for inflation. The average per-employee per-month premium for employees’ and dependents’ coverage was $963. States paid $808 (84 percent) of the total on average, and employees covered the remaining $155 (16 percent). However, this average masks sharp differences across the states, due to factors such as plan richness, average household size, provider price and physician practice patterns, as well as the age and health status of enrollees.

Some of the key findings:

  • Insutring Households: $31 billion was spent on state employee health plans by states in 2013
  • Premiums: 3/1 was the ratio between the highest and lowest per-employee state health plan premium in 2013
  • Actuarial Value: 92 percent was the average percentage of costs covered by state health plans in 2013
  • Deductibles: 76 percent of state employees enrolled in plans with an annual deductible of less than $500 in 2013
  • Early Retirees: 29 states enroll pre-65 retirees in health plans at the same premium rate as active employees

From the report:

In 2012, $865 billion was spent in the United States to insure 169 million people through employer-sponsored health insurance, which represented 31 percent of all health care spending. Public and private employers contributed $630 billion, or 73 percent, toward this total; employees picked up the difference. Employer-sponsored insurance is a vital element of the American health care landscape, and an important component of employee compensation. It helps provide people with access to affordable care, protects workers and their families from unaffordable medical costs, and serves as a critical funding source for virtually every medical institution.


The cost of health insurance has become a leading budget driver for employers of all sizes and in all sectors. From 1992 to 2012, the average cost of insuring each employee and dependent doubled, after adjusting for inflation. This increase has led many employers—including states—to review the benefits they provide, benchmark their offerings to comparable employers, and seek ways to control costs.


Health insurance costs have become a significant portion of states’ overall health care spending, second only to Medicaid. Nevertheless, little has been known about how states’ employee health plans and costs compare with one another and with those of large, private sector employers.


To provide policymakers and other stakeholders with information on state employee health care expenditures, as well as the factors underlying this spending, researchers from the State Health Care Spending Project—a collaboration between The Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation—worked with actuaries from Milliman Inc. to produce a first-of-its kind analysis of the costs and characteristics of state employee health plans.* Although meaningful state-to-state comparisons are complicated by a number of factors, including who is covered (i.e., the number, age, and health of enrollees) and differences in health plan benefit design, this analysis offers a nationwide benchmark against which states can be compared.

There is much more in the full report (link), but for those pressed for time here is the full breakdown of the average health plan by each state, showing plan premiums as well as average employer and employee contributions.

It's not exactly clear why the average employee contribution in OK and MT is negative, but something tells us those particular employees don't want too much attention being paid to the sign in front of the number.

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hedgeless_horseman's picture



Deductibles: 76 percent of state employees enrolled in plans with an annual deductible of less than $500 in 2013

Less than $500 means $0 deductlibles and most .gov employee plans also have no coinsurance (0%)...

...whereas most Obamacare deductibles are $5,000 plus 30% coinsurance after that.

Even Medicare has a $147 deductible and 20% coinsurance.


"Pay as we say, not as we pay...or else the IRS is going to fine your ass."
- Barry and Nancy


Coinsurance:  A cost-sharing requirement of some insurance plans where the patient assumes a percentage of the costs for covered services after the amount of the deductible has been met.  Coinsurance is described as a ratio, for example 30/70, meaning the patient is responsible for paying 30% and the insurance will pay 70% of the allowable.

Copayment (co-pay):  The amount to be paid to a physician by, or on behalf of, the patient in connection with the services rendered by the physician.  It is due at the time of service, is a fixed amount determined by the insurance company based on the level of benefit, and is usually found printed on the patient’s insurance card. 

Deductible:  The amount paid by the member before insurance will begin to reimburse services.  It is reset annually, and based on the level of benefits or amount of premium paid.  For example, with a $1,000 deductible the patient must pay medical providers for the first $1,000 of allowable expenses incurred by the patient each year, after which costs may be split according to a coinsurance arrangement, and/or may be limited to the patient’s out of pocket expenses.

Out of pocket expense:  The total of covered health care expenses that are paid for by the member or patient, not including any premium.  This is typically the total of the deductible and any coinsurance paid during a year.

Precertification:  The process of attempting to obtain approval from insurance, in advance, for a proposed treatment or diagnostic test.

Premium:  The monthly amount enrollees pay the insurance company to be covered.   

Liberal's picture

And we as liberals will not rest until our way of life is entirely covered by your tax dollars!

max2205's picture

Deductibles: 76 percent of state employees enrolled in plans with an annual deductible of less than $500 in 2013

This has to stop

NoDebt's picture

Just check out Oklahoma.  Average employee contribution -25% (negative).  They're MAKING money on their health insurance.

Seasmoke's picture

Fucking PUBLIC Pigs !!!!!

takeaction's picture

Look at Oregon...We win Bitchez...   Again...the leeches of society will collapse this nation.  How long till we are done,  months, years, decades...What a shit show.

sessinpo's picture

Worked for Robin Williams too.

Kirk2NCC1701's picture

So, "Keep Portland Weird" has morphed into "Salem is Nuts"?

souljaboy's picture

Multiply those numbers by 2 and you've got the 2014 numbers.

MachoMan's picture

Pretty much.  However, the trend will be for state sponsored insurance to reimburse less and demand more paperwork/compliance.  I believe some people have grossly overestimated our unfunded liabilities considering no medical professionals will be accepting state sponsored insurance.  If no one uses the insurance, then the insurance company (government) doesn't have to pay.  They're trying this out on the private side now to see what happens and gauge elasticity.  I'm not sure why you would need to experiment though, the answer is obvious...  no one can afford medical care at present price levels.  Margin compression -> bankruptcy.

suteibu's picture

The bureaucracy can be very, very powerful.  Most politicians would rather suck their asses and disregard the public than turn career bureaucrats against them.

Catullus's picture

Yep. I've got the kids on my insurance because once you start putting dependent on to a state insurance, you start racking it up.

Hint: those hospital workers who basically walk around all day doing nothing are all there for the health insurance. They make $12/hour, but get insurance for like nothing. It's like 30% of their pay. And they take all sick days every year. All 19-21 of them. Including the 2 weeks of paid vacation.

Oh university medical systems... The secondary welfare system.

GubbermintWorker's picture

Wow, you're sure talking out of your arse. Hospital workers just walking around? The hospitals in my area are laying off all kinds of people and the nurses are pulling double shifts. These big business hospitals are concerned about the bottom line and with employees being a big expense they're cutting back. My wife is a nurse who works for a group of general practitioners. They got bought out by a big business hospital because they could no longer afford malpractice insurance. Her pay and benefits have been cut back every fucking year now that they got bought out. Oh, that health insurance she gets? It aint free and you pay through the nose unless you go to one of the doctors that have "privliledges"  at their facilities.

MachoMan's picture

and they want immunity from lawsuit when they injure patients...  can't eat your cake and have it too.

Catullus's picture

Am I talking out of my arse? Try a university hospital system. Those people doing nothing are orderlies. And then the levels of administration?


But yeah, tell me what a nurse has to say please. I'm dying to hear it.

Uber Vandal's picture

I presume you are not referring to a privately run hospital, for the experience may differ greatly from what is presented.

Having to work double shifts, being called up while on vacation and asked to come in to work, having to request your vacation about 3 months in advance is no picnic.

But, my friends can still do the "glad I went to school for this $12 per hour job" happy dance.

NOTaREALmerican's picture

Just a reminder that anybody making $12 / hour is officially in the Trash Class (bottom 60 or 70%), which makes them worthless losers who should be glad they are allowed to exist and aren't killed for being a burden on society.

WillyGroper's picture


Their medical plan sucks way worse than the private sector.

Their only saving grace is there are doctors right there that will look at them & write a script if needed for free to keep them at work bypassing the system.

It's all cost shifting now for maximun extraction & the corporate/insurance bottom line.

Avoid the whole complex if you can. They'll kill ya.

GubbermintWorker's picture

Absolutely! Fucking thing is designed to maximize profits from the surgeon all the way down, including maximum profits for the big pharmas.  I finally got my shit together and got fit. The only medication I take now is an occasional puff of  medicinal herbs. Blood pressure is normal, healthy heart, lungs, and can still do 75 straight pushups. Can do five one handed ones. Not bad for 62.

Apocalicious's picture

Ah, public servants, the "Hey, get out of bed, put on some clothes, and at least act like you're productive" version of welfare. 



still kicking's picture

Do the ones in your state act productive?  Here in Oklahoma they just blatantly don't give a shit.

GubbermintWorker's picture

I ain't gonna be your fucking servant much longer. Come and have my job as working in sewage for 37 years is enough!

RET's picture

How will you support yourself after you quit?

GubbermintWorker's picture

My needs are few. My house is paid off, cars too. No CC debt whatsoever. Have a small govt pension, a 401K, and metals. Have a 5acre mini farm with fruit trees, garden, and berry bushes.


I've been seeing this shit storm coming for awhile.

GubbermintWorker's picture

TPTB are doing a very nice job of pitting you against them, eh?

NOTaREALmerican's picture

Don't forget the official ZH hate priority:


1)  Jews
2)  Muslums (Unless killing #1)
3)  "those people" 
4)  spicks, dagos, micks, polocks, and lugans
5)  anybody making miniumum wage

I think government workers fall into #3.


Kirk2NCC1701's picture

Do you or CAN you differentiate between Hate, Righteous Indignation and plain "Fed up"?

p.s. It's Muslims, not Muslums. Although many Israelis call them that: Muh-slums. You didn't know that? You need to get out more. ;-)

Syrin's picture

Gov't workers are at the top of the list here.   Especially those in any three letter gov't agency.     I'm willing to bet you're pretty high on the shit list too.

GubbermintWorker's picture

They make your spidey sense tingle, eh? You know what day I'm waiting for? The day when those over militarized local police forces figure out their bosses lied to them and they won't be getting that pension.

Blood Spattered Banner's picture

Yes, that is when the shit gets real.  This will happen when the middle class is finally disembowled, and Wall Street, corporations, the MIC & bureaucrats start to eat each other.

It's almost certain to happen if the wealth inequality continues to increase.  Historically proven.

Not My Real Name's picture

A friend of mine told me his brother recently retired from a local police force (town population ~75,000) a couple of years ago. The guy is 52 years old, with a pension that pays him $106,000 a year, PLUS cost of living adjustments, and full medical benefits. How on earth can anybody think this is economically sustainable? (That's a rhetorical question.)




GubbermintWorker's picture

Yeah, that's a fact. I can't believe the pension benefits afforded the police, fire, and then especially, the judges on the gov't dole. And, if they're unionized, they also get medical benefits for....life.

I see that is not sustainable. I get it. But quit bashing the whole public sector because of it.

tawdzilla's picture

"TPTB are doing a very nice job of pitting you against them, eh?"

You mean the SEIU?  Yes, they are great at that.

GubbermintWorker's picture

Were you aware that 60% of public sector workers are NOT members of a union?

walküre's picture

There's a FED building in St. Louis....

koaj's picture

i should link what i pay as a small business owner to insure myself and 3 young kids per month in NJ for my "catastrophic" plan. FU government workers


mind you...i am healthy as a horse. i go to the chiropractor for a tune up every few weeks. kids healthy also.

GubbermintWorker's picture

FU too. It's attitudes like yours that makes me happy  to retire from being a public servant. Makes me want to go and turn the fucking pumps off tonight so you can drown in your own sewage.

EBT excepted's picture

i see wut you mean, serve yo'self at da public feedin' trough...da new defnishun of public servant...just keep da recharge on my EBT...

GubbermintWorker's picture

The public feeding trough? Go ahead! Go and hire a fucking high school dropout to trouble shoot and repair the fucking sewage pumping station that serves your fucking house, in the fucking neighborhood that requires you to pay a homeowner's association fee, to make sure all your needs are met. From water and sewer to making sure your asshole neighbor cuts his lawn.


Just wait until we say enough is enough.

Not My Real Name's picture

Yep. You're a government worker alright.

Tapeworm's picture

I can see how some sets of goomint employees do work for their dough. Yours is one among some of the legitimate jobs. There have been many layers of worthless jobs added in the past fifty years and some such as education have devolved to the point where the public schools need to be sold off to those that can do the job.

 I am against wholesale privitization because the taxcows have already paid up for systems such as sewage and do not need to have the assets sold off for a pittance to a crony connected racket that will raise prices instantly.

 Would you ask the water works people to stop adding the damned poisons of fluorides to our drinking water?

Fuku Ben's picture

Wow, look at how much the blood sucking leeches are draining the carcass of America!

You'll be able to laugh at them soon enough. They'll all be getting haircuts just like Cyprus.

Syrin's picture

They'll do a bail in from us to save their lifestyle before they get a haircut.

Caveman93's picture

Jesus, I wish the dollar would vaporize!

Dr. Richard Head's picture

I wake up with that thought daily.  I grab my phone to turn off my alarm, I use the phone so the NSA knows my sleeping patterns and all, brew my coffee, grab a smoke, and then open up ZH just hoping to see that article "US Dollar Implodes Overnight.".  Alas, I brew another cup of coffee, smoke another cigarette, get into the shower...