Employer Health Plan Performance Gap Expands, Says J.D. Power

The good get better while the bad get worse as overall member satisfaction declines slightly.

J.D. Power has released the results of its 2025 U.S. Commercial Member Health Plan Study. This year’s study, now in its 19th year, highlight notable and growing gaps in member satisfaction among the nation’s health insurers.

“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, J.D. Power senior director of global healthcare intelligence in the study press 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.”

Moling’s observations highlight the key takeaways of the report — which included 147 health plans in 22 regions throughout the United States and also assessed member satisfaction impact on employers.

Key takeaways

The J.D. Power study was based on responses from 39,797 commercial health plan members surveyed from September 2024 to March 2025. It found:

• Member satisfaction with health plans was lower and varied. While the national average was 563 on a scale of 1,000, regional scores ranged from 523 to 594. These results created a drag on overall satisfaction, which declined slightly from 2024.
   
• Members who understand their out-of-pocket costs and out-of-network coverage have higher satisfaction, fewer denials, and better access to care. Conversely — among members who were not clear on out-of-network benefits — 48% had a claim denied and 56% reported that they lacked access to their doctor of choice.
   

• Digital tools go unused. When members do take advantage of these tools — in such areas as chronic condition management, provider communication, and remote monitoring — satisfaction is generally high.

This last finding “points to a critical disconnect between digital availability and member awareness,” notes the press release.

Member satisfaction favors regional, Blues and provider-led plans

The J.D. Power study measures member satisfaction based on based on performance (poor-to-perfect) across eight core dimensions:

1. able to get health services how/when I want
2. digital channels
3. ease of doing business
4. helps save time and money
5. people
6. product/coverage offerings
7. resolving problems or complaints
8. trust
    

Across these metrics, 2025 health plan performance mirrors past years with many carriers repeating their top rankings — some for decades.

The leader here is Kaiser Foundation Health Plan, the insurance arm of one of the nation’s leading integrated health systems, Kaiser Permanente. In multiple states or regions where Kaiser operates — California, Colorado, Maryland, Virginia and the South Atlantic — members ranked its health plan first in satisfaction. This was for the 18^th consecutive year in California and the 16^th consecutive year in the study’s South Atlantic region.

Kaiser was followed closely by Blue Cross Blue Shield plans, which were top ranked in nine states, some also for consecutive years.

In addition to Kaiser, four other provider-operated plans were ranked first in their geographies:

• Capital District Physicians’ Health Plan (New York for the fifth year)
   
• Providence Health Plan (Northwest region)
   
• UPMC Health Plan (Pennsylvania for a second year)
   
• Baylor Scott & White Health Plan (Texas)

Aetna was the lone national plan to earn top rankings in the study and in two states: Ohio and Southwest region.

Of the 22 states and/or regions that J.D. Power defines, UnitedHealthcare — the largest national commercial insurer — ranked last in member satisfaction in 11.

Performance impacts employer decision-making

Member experience has become a competitive differentiator for health plans. The J.D. Power study notes that 20% of employers “cite low employee satisfaction as a top reason for switching health plans.”

The study also called out the role of deductibles, an out-of-pocket cost that affects such member satisfaction metrics as access, cost and trust.

The J.D. Power results shows that higher deductibles hit small employers harder. While more than half of employees meet their deductibles, regardless of employer size — 51% small, 52% midsize, 53% large — average deductibles are still high across the board:

• $2,847 for small employers
• $2,630 for midsize employers

The press release concludes: “Plans that invest in better engagement, education and service stand to gain both members and employer clients.”