What You Should Know:
– A new class of health plan leaders is setting itself apart by excelling in clear communication, digital convenience, and meaningful member support, according to the J.D. Power 2025 U.S. Commercial Member Health Plan Study,℠ released.
– While overall member satisfaction with commercial health plans saw a slight decline year over year, the study reveals widening performance gaps between brands, underscoring member experience as a critical competitive differentiator in a landscape facing rising expectations around cost transparency, digital access, and personalized service.
Widening Performance Gaps Highlight Member Experience as Key Differentiator
The 19th annual study indicates that the differences in how health plans perform are becoming more pronounced, directly impacting member satisfaction, retention, and overall competitive strength.
“Brand performance gaps in the commercial health insurance market are no longer subtle—they’re widening in ways that directly affect satisfaction, retention and competitive strength,” said Caitlin Moling, senior director of global healthcare intelligence at J.D. Power. “Leading plans are setting themselves apart by delivering clarity, digital convenience and member-first communication. Others are falling behind as trust erodes, digital tools go underutilized, and members struggle to understand their coverage”.
The 2025 study, based on responses from 39,797 commercial health plan members, highlights several critical trends:
- Satisfaction Varies Widely Across Plans and Regions: The national average satisfaction score for commercial health plans stands at 563 on a 1,000-point scale. However, this masks significant regional variations, with scores ranging from a high of 594 to a low of 523, indicating meaningful differences in member experiences across the country.
- Member Experience Drives Loyalty and Employer Decisions: The quality of member experience has a direct impact on loyalty. Notably, 20% of employers cite low employee satisfaction as a top reason for switching health plans. This suggests that plans investing in better engagement, education, and service are better positioned to retain members and attract employer clients.
- Benefit Understanding Fuels Better Outcomes: Members who clearly understand their out-of-pocket costs and out-of-network coverage report higher satisfaction and encounter fewer issues like claim denials or inaccessible care. Conversely, among members who do not completely understand their out-of-network benefits, 48% had a claim denied, and 56% stated their choice of network doctors was not available.
- High-Impact Digital Tools Remain Largely Underutilized: Digital tools such as chronic condition management programs, provider communication features, and remote monitoring platforms show strong potential for satisfaction gains but are currently underused by members. This points to a critical disconnect between the availability of digital resources and member awareness or engagement with them.
- Deductibles Hit Small Employers Hardest: The average deductible paid by commercial health plan members working for small employers ($2,847) is 8% higher than for those with midsized employers ($2,630) and 10% higher than for those with large employers. The percentage of employees meeting their deductibles was similar across business sizes (51% small, 52% midsize, 53% large).
Top-Ranking Health Plans by Region
The study measures member satisfaction across 22 geographic regions. Kaiser Foundation Health Plan continues its long-standing leadership, ranking highest in California (648) for the 18th consecutive year, Colorado (576), Maryland (614) for the fourth consecutive year, the South Atlantic region (634) for the 16th consecutive year, and Virginia (660) for the second consecutive year.
Other notable highest-ranking plans include:
- Delaware/West Virginia/Washington D.C.: Highmark Blue Cross Blue Shield West Virginia (592)
- East South Central: Blue Cross and Blue Shield of Louisiana (608)
- Florida: AvMed (638) (for a second consecutive year)
- New York: Capital District Physicians’ Health Plan, Inc. (CDPHP) (634) (for a fifth consecutive year)
- Texas: Baylor Scott & White Health Plan (629)
(A full list of regional winners is available in the J.D. Power report.)
Study Background/Methodology
The U.S. Commercial Member Health Plan Study, now in its 19th year, measures satisfaction among members of 147 health plans based on performance in eight core dimensions: able to get health services how/when I want; digital channels; ease of doing business; helps save time and money; people; product/coverage offerings; resolving problems or complaints; and trust. This year’s study is based on responses fielded from September 2024 through March 2025.
