Mistrust, Confusion in Medicare Advantage Plan Members, Survey Says

The overall satisfaction rate of Medicare Advantage plan members has dropped 29 points since last year, according to the recent J.D. Power 2025 U.S. Medicare Advantage Study.

The J.D. Power 2025 U.S. Medicare Advantage Study was based on the responses of 10,888 Medicare Advantage members across 10 regions, including California, Florida, Georgia, Illinois, Michigan, New York, North Carolina, Ohio, Pennsylvania and Texas. Responses were gathered from January through June 2025 and scored on a 1,000-point scale. Limited results were released on August 19, 2025.

Respondents rated their plan by:

1. The level of trust
2. Their ability to get services how and when they want
3. Their plan’s ability to save them time and money
4. The product/coverage offerings
5. Ease of doing business
6. The people, such as representatives or call center agents
7. The plan’s ability to resolve problems or complaints
8. Digital channels

For each region, the top-performing plans were:

• California – Kaiser Permanente (675)
• Florida – Freedom Health (670)
• Georgia – UnitedHealthcare (648)
• Illinois – Blue Cross Blue Shield of Illinois (654)
• Michigan – Blue Cross Blue Shield of Michigan (675)
• New York – Excellus Blue Cross Blue Shield (648)
• North Carolina – UnitedHealthcare (663)
• Ohio – Anthem Blue Cross Blue Shield (680)
• Pennsylvania – UPMC For Life (708)
• Texas – Blue Cross Blue Shield of Texas (639)

Decreases in satisfaction were seen across all dimensions, including a 39-point decrease in trust rating, a 33-point decrease in product coverage offerings and a 31-point decrease in the ease of doing business rate.

This overall dissatisfaction could be attributed to significant policy changes within the last year that have affected deductibles, out-of-pocket costs and prior authorization determinations.

One criterion that separated the highest-performing plans from the lowest-performing plans was the ability to engage members through digital channels. For example, digital satisfaction among top-performing plans is 98 points higher than low performers.Approximately 85% of members from higher-performing plans have used their member portal, compared with 76% of low-performing plans.

“Consumers are looking for digital tools that are easy to navigate, user-friendly, informative and helpful in managing their care and having line-of-sight to co-pays, deductibles, premiums, and out-of-network costs, and are ideally personalized, wherein most plans have a long way to go,” Christopher Lis, managing director of global healthcare intelligence at J.D. Power, said in an interview with Managed Healthcare Executive. “These are big opportunities to advance forward, and those organizations that leverage digital for these purposes in a highly customer-focused way will likely gain a competitive advantage in the long run.”

Members’ satisfaction during their first year often lags, with only 38% of members reporting their insurer fulfills their expectations during this time. The most common challenges listed were confusing explanations of benefits, how to find in-network providers and how to use their Health Savings Account (HSA)/Health Retirement Account (HRA).

As a potential solution, Lis suggests that plans could hold consumer focus groups that break down industry terms with the help of infographics, all made available in an appendix.

“Having the information available in multiple languages is beneficial,” Lis said. “Digital tools, if easy to use and with clear, simple language, could be helpful in these endeavors, as visuals, interactive tools, and short videos could be leveraged to improve clarity and understanding, as well as to help personalize information to member needs.”