Group health: What sets high-ranked plans apart?

What’s the difference between the highest- and lowest-performing employer-sponsored health plans? High-performing plans ranked high on their ability to deliver clear communication and meaningful member support. Meanwhile, bottom-ranked plans struggle to deliver a positive member experience.

Those were among the findings of the J.D. Power 2025 U.S. Commercial Member Health Plan Study.

Overall satisfaction with commercial health plans declined slightly year over year, but the study reveals widening performance gaps across brands, with the member experience a key competitive differentiator. The findings reflect broader industry pressures, as plans respond to rising expectations around cost transparency, digital access and personalized service.

“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, senior director of global healthcare intelligence at J.D. Power. “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 underused, and members struggle to understand their coverage.”

Following are some key findings of the 2025 study:

• Satisfaction varies widely across plans and regions. The national average satisfaction score for commercial health plans is 563 (on a 1,000-point scale), but regional scores range from a high of 594 to a low of 523. This indicates meaningful differences in how members experience service, communication and value across the country.
• Member experience drives loyalty and employer decisions. Low employee satisfaction was given as a top reason for switching health plans, 20% of employers said. Plans that invest in better engagement, education and service stand to gain both members and employer clients.
• Benefit understanding fuels better outcomes. Members who understand their out-of-pocket costs and out-of-network coverage have higher satisfaction and fewer issues such as denials and inaccessible care. Conversely, among members who say they do not completely understand their out-of-network benefits, 48% had a claim denied and 56% said their choice of network doctors was not available.
• Many high-impact digital tools remain underused. Tools such as chronic condition management programs, provider communication features and remote monitoring platforms deliver strong satisfaction gains but remain underused. This points to a critical disconnect between digital availability and member awareness.
• Deductibles hit small employers hardest. The average deductible paid by commercial health plan members working for small employers (those with 1 to 99 employees) is $2,847. This is 8% more than for those working for employers with 100-499 workers ($2,630) and 10% more than those working for employers with 500 workers or more. More than half (51%) of small-business employees met their deductibles, compared with 52% of midsize business employees and 53% of large business employees.

Study rankings for health plans

This is the 19^th year for the U.S. Commercial Member Health Plan Study, which measures satisfaction among members of 147 health plans in 22 regions throughout the United States.

The satisfaction rankings are based on performance in eight core dimensions, rated on a scale of poor to perfect. The dimensions that respondents were asked to rank are:

• Ability to get health services how and when I want.
• Availability of digital channels.
• Ease of doing business.
• Help in saving time and money.
• People
• Product and coverage offerings.
• Resolution of problems or complaints.

The study measures member satisfaction with commercial member health plans in 22 geographic regions. Highest-ranking health plans and scores are as follows:

• California: Kaiser Foundation Health Plan (648) (for an 18^th consecutive year)
• Colorado: Kaiser Foundation Health Plan (576)
• Delaware/West Virginia/Washington D.C.: Highmark Blue Cross Blue Shield West Virginia (592)
• East South Central: Blue Cross and Blue Shield of Louisiana (608)
• Florida: AvMed (638) (for a second consecutive year)
• Heartland: Arkansas Blue Cross and Blue Shield (586)
• Illinois/Indiana: Blue Cross and Blue Shield of Illinois (590) (for a second consecutive year)
• Maryland: Kaiser Foundation Health Plan (614) (for a fourth consecutive year)
• Massachusetts: Blue Cross Blue Shield of Massachusetts (565)
• Michigan: Blue Cross Blue Shield of Michigan (600) (for a second consecutive year)
• Minnesota/Wisconsin: Anthem Blue Cross and Blue Shield Wisconsin (561)
• Mountain: Regence BlueCross BlueShield of Utah (580)
• New Jersey: Horizon Blue Cross Blue Shield of New Jersey (578) (for a second consecutive year)
• New York: Capital District Physicians’ Health Plan, Inc. (CDPHP) (634) (for a fifth consecutive year)
• Northeast: Anthem Blue Cross and Blue Shield Connecticut (615) (for a third consecutive year)
• Northwest: Providence Health Plan (586)
• Ohio: Aetna (583) (for a second consecutive year)
• Pennsylvania: UPMC Health Plan (601) (for a second consecutive year)
• South Atlantic: Kaiser Foundation Health Plan (634) (for a 16^th consecutive year)
• Southwest: Aetna (579)
• Texas: Baylor Scott & White Health Plan (629)
• Virginia: Kaiser Foundation Health Plan (660) (for a second consecutive year)

See the rank chart for each region at http://www.jdpower.com/pr-id/2025052.

Low-ranked plans generally exhibit a few distinct patterns that contribute to consistently lower satisfaction, J.D. Power said. They include:

1. Inconsistent service across channels. Many low-performing plans have fragmented member experiences — information may be inconsistent between call centers, websites, and printed materials, making it difficult for members to get clear answers.
2. Reactive rather than proactive engagement. These plans often wait for members to call with problems rather than proactively guiding them through key touchpoints like plan onboarding, provider selection, or claim resolution. Conversely, health plans that rank highly on “care coordination” metrics, have substantially higher satisfaction scores.
3. Poorly aligned benefit design. Some underperformers offer benefit structures that are complex, unintuitive or mismatched to member needs — especially around cost sharing, out-of-network access or mental health coverage.
4. Lack of investment in member education. While top performers simplify complexity, lower-ranked plans often assume members understand the system—leading to high rates of confusion around coverage, billing and denials.

The survey also asked a few questions requiring “open-ended” responses from health plan members.

Below are two responses from members from a top-ranked plan. (In response to the survey question, “Why did you rate your health plan the way that you did?”)

• “Their customer service and coverage is outstanding. I also like their ads and member guides. It’s friendly and easy to understand.”
• “I am covered and good perks like cash back for gym, weight loss and other healthy living.”

Responses from one of the lower-ranked plans:

• “Difficult to get answers on the phone. Medications not on formulary.”
• “High premium, high out of pocket, low deductible. They denied a physical therapy claim recently saying it wasn’t medically necessary even though it was the only thing that helped my chronic pain.”

Susan Rupe is managing editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected].