Getty Images
Member engagement leads to high health plan satisfaction
Commercial payers with better health plan satisfaction scores tended to have better member engagement and education, J.D. Power reported.
The difference between the top- and lowest-rated commercial health plans is growing starker, with new J.D. Power data showing significantly better health plan satisfaction is driven by clarity, communication and trust.
While the average member experience score for commercial health plans this year was 563 on a 1,000-point scale, there was a steep difference in the top and bottom performers. Average regional scores ranged from a high of 594 to a low of 523, meaning the typical health plan experience is vastly different based on location.
And that's not to mention the performance gap across all 147 health plans included in J.D. Power's study. The organization listed the top performers in each region, reporting a nationwide high of a 660 satisfaction score. Being that the nationwide average was 563, this indicates a significant gulf in performance.
"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 public statement.
Member education, engagement set health plans apart
The differentiating factor seems to be member education, the J.D. Power report continued.
For example, the report stressed that members who understand their financial responsibility, including out-of-pocket costs, and their in-network and out-of-network coverage were more likely to avoid dissatisfiers like claim denials and poor healthcare access.
Meanwhile, health plan members who don't completely understand their benefits were more likely to have a claim denied (48%) or say their choice of network doctors was not available (56%).
Poor member education could lead to lower member or employee satisfaction, the report continued, which could threaten health plan market share. A fifth of employers said they switched health plans because of low employee satisfaction.
Digital health remains a critical yet underutilized tool for improving member experience, the survey indicated. Virtual health options that support chronic disease management, remote patient monitoring and provider communication have proven to boost member satisfaction, but few health plans are utilizing them. In fact, a separate 2025 report from J.D. Power revealed middling scores for the digital member experience.
"Leading plans are setting themselves apart by delivering clarity, digital convenience and member-first communication," Moling said of this most recent survey. "Others are falling behind as trust erodes, digital tools go underutilized, and members struggle to understand their coverage."
Sara Heath has reported news related to patient engagement and health equity since 2015.
