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3 Reasons Why Beneficiaries Switch Health Plans

Analysis  |  By Jay Asser  
   October 26, 2022

A new report reveals the top factors members care about when evaluating payers.

Beneficiaries are holding health insurers more accountable and weighing experience factors when considering a switch in plans, according to a report by Accenture.

The benchmark survey compiles responses from almost 11,000 adults between March and May to examine how their insurers perform across nine healthcare consumer touchpoints.

Results show that younger generations are less likely than older adults to consider price, medical benefits, and network coverage to be primary factors when choosing a health plan. Instead, younger generations value experience factors like customer service, convenience, and trust.

The survey finds the top three reasons why beneficiaries leave their payers to be:

  1. Ease of navigation (49%) — Respondents identified issues such as inconsistent or inaccurate information, unanswered questions, poor experiences using digital tools, poor customer service, and discomfort with how payers used their personal data.
  2. Clinical experience/expertise (35%) — Switching factors included prescription drug benefits not meeting needs or expectations, condition management programs not being robust enough to meet needs, and the wellness or supplemental benefits not being strong enough.
  3. Access/network (32%) — Preferred providers not being in the prior plan network and lack of convenient options were cited as deterrents.

To retain members and deliver the experience that is expected, the report highlights four factors payers should focus on: access, ease of doing business, digital engagement, and trust.

For access, more than two-thirds of respondents (69%) strongly agree that insurers that make it easy to find necessary information to select new providers deserve a positive healthcare rating.

"One of payers' primary roles is enabling people to access the quality care they need," the authors of the report state. "People want that to happen with the right information, minimal hassle and flexibility. Payers' effectiveness across these factors has a significant impact on people's perception of their health experiences, and as such, on their likelihood of staying."

Ease of doing business is similarly held in high regard, with respondents being four times more likely to stay with insurers they find are easy to work with compared to those that find their payer difficult.

Digital engagement, meanwhile, is another indicator of loyalty to insurers. The survey finds highly digitally engaged people are more likely to stay (64%) than the national average (55%) and more likely to consider their payer very easy to do business with (74% versus 50%).

Building trust with beneficiaries is essential, which means providing consistent information, helping members understand their coverage, and minimizing hassles. Based on respondents' answers, those who are trusting of their payers are four times more likely to stay than those that are distrusting and almost twice as likely as those who remain neutral.

"Healthcare organizations want to make meaningful progress in responding to people's rapidly evolving health experience expectations," the report states. "After all, loyalty and engagement hang in the balance."

Jay Asser is the contributing editor for strategy at HealthLeaders. 


Ease of navigation, or lack thereof, is the biggest reason why members ditch their insurer.

Younger adults care more about experience factors like customer service than they do price.

Payers should focus on access, ease of doing business, digital engagement, and trust to retain beneficiaries.

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