Just Over Half of U.S. Health Plan Members Satisfied With Plan, Study Shows

Only 56% of health plan members in the United States are satisfied with their coverage, according to the results of the recent 2025 U.S. Commercial Member Health Plan Study from J.D. Power.

“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,” Caitlin Moling, senior director of global healthcare intelligence at J.D. Power, said in a news release. “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 survey asked approximately 39,797 members from 147 health plans living in 22 states and regions to grade their plan satisfaction in eight areas concerning service, communication and value. Results were scored using a 1,000-point scale. This year’s study is based on responses from 39,797 commercial health plan members and was conducted from September 2024 through March 2025.

The health plans with the most member satisfaction were

• California: Kaiser Foundation Health Plan (648 points) (for an 18^th consecutive year)
• Virginia: Kaiser Foundation Health Plan (660 points) (for a second consecutive year)

And a tie between

• South Atlantic Region: Kaiser Foundation Health Plan (634 points) (for a 16^th consecutive year)
• New York: Capital District Physicians’ Health Plan, Inc. (CDPHP) (634 points) (for a fifth consecutive year)

Benefit understanding was tied to patient satisfaction. Of those members who did not understand their plan, 48% had a claim denied and 56% reported their chosen doctor was not in network.

Small employers (1-99 employees) were also the most affected by deductibles when compared with midsize (100-499) and large employers (500+ employees). Members working for small employers paid an average deductible of $2,847—8% more than those working for midsized employers ($2,630) and 10% more than large employers.

In addition, 51% of employees at small companies met their deductible, whereas 52% met it at midsized companies and 53% at large companies. Employer satisfaction does have some sway on brand loyalty at companies, with one-fifth of employers citing low employee satisfaction as the top reason they switched plans, the release states.

This lack of understanding can be attributed to the underutilization of digital tools such as chronic condition management programs, provider communication features and remote monitoring platforms, the release says.

Just 10% of respondents reported using a chronic condition monitoring program, 11% have used a remote monitoring platform and 12% have used digital provider communication tools, Moling said in an email interview with Managed Healthcare Executive.

"Cost estimation tools are similarly underused but highly impactful,” Moling said. “Members who use a digital cost estimator report satisfaction scores that are +86 points higher than those who wait for a bill, +41 points higher than those who call their provider and +22 points higher than those who contact their insurer for cost information. These findings emphasize the critical importance of driving adoption of digital tools that improve clarity, confidence and convenience in the healthcare journey.”