Consumers Split on Health Insurance as ‘Partner’ or ‘Payer’ According to HealthEdge Research

Business Wire

Survey of 4,500+ Consumers Measures Public Perception of Health Insurance and Reveals Gaps and Opportunities for AI to Transform Member Experience

BURLINGTON, Mass.--(BUSINESS WIRE)--
HealthEdge^® today released its fifth annual Healthcare Consumer Report, unveiling key insights into consumer sentiment about their health insurance plans. This year’s findings highlight the growing importance of affordability, transparency, member engagement, and the role of emerging technologies like artificial intelligence (AI) in shaping consumer expectations.

Notably, more than half of respondents (51%) now view their health plan as a partner in their care rather than just a payer of medical bills. This shift in perception matters because those who see their plan as a partner report significantly higher levels of satisfaction, loyalty, and engagement.

“Consumers want more choice in their health coverage – and they’re getting it as the market shifts towards Medicare Advantage, ACA exchanges, employer reimbursement and other flexible arrangements. This demand for choice is forcing payers to reinvent themselves with retail-like experiences that position them as a true partner in care,” said Alan Stein, Chief Product & Strategy Officer at HealthEdge. “Technology will play a vital role in this evolution as consumers embrace and ask for digital tools that enable better communication and more personalized experiences. As AI proliferates through all areas of life and business, health plans have a massive opportunity to exceed member expectations if they can introduce AI-powered innovations to scale the more personalized and proactive services that members expect.”

Research Highlights Increasing Digital Engagement and AI Growth Potential

This year’s Healthcare Consumer Study identified a surge in digital engagement among healthcare consumers. For example, 78% of respondents said they have used or plan to use their health plan’s mobile app, compared to 64% a year ago. However, as healthcare organizations focus on strategies for implementing AI, consumers have not been quick to adopt the technology – or they don’t realize they’re using it. A large majority (79%) of consumers say they either haven’t used (58%) or don’t know if they’ve used (21%) AI-powered tools provided by their health plan.

Despite slower adoption, a significant number of consumers — 64% — are open to trying healthcare AI tools like chatbots and personalized cost-saving features. Still, concerns linger. When asked about their primary apprehensions regarding AI, respondents cited quality and accuracy (26%), privacy (20%), and data security (20%) as top issues. Nearly one-third (30%) of respondents stated that clearly communicating when and how AI is used would improve their confidence in their health plan using AI technology.

Other key findings of the research include:

78% of people who view their health plan as a partner are satisfied with the level of personalized experience, compared to only 49% of people who view their plan as a payer.
Cost is the biggest factor influencing consumers’ loyalty to their health plan. 42% cited monthly premiums or out-of-pocket costs as reasons they would stay with a health plan, while 43% cited these as reasons they would leave.
However, consumers that view their health plan as a partner versus a payer are less cost-driven with fewer citing monthly premiums (16% vs. 25%) and out-of-pocket costs (19% vs. 28%) as criteria that would influence them to switch plans.
Trust is difficult for health plans to earn, with nearly one in five consumers (17%) saying they would remain skeptical and unwilling to trust their health plan—no matter what it does. Providing clear and transparent communication about benefits is the best way to earn trust, according to 42% of respondents.
A majority (60%) of consumers with employer-provided coverage said they would be likely to participate in an individual coverage Health Reimbursement Arrangement (ICHRA), which would allow them to shop for their own insurance, if it were offered by their employer.
For the third consecutive year, consumers have voiced a decline in satisfaction with the tailored support their care managers provide to address their social determinants of health (SDOH) needs. For example, among consumers assigned a care manager, 33% are fully satisfied with resources to address economic conditions, compared to 36% in 2024, and 38% in 2023. Similarly, 33% are fully satisfied about resources to access essentials including housing, food and utilities, down from 38% in 2024, and 42% in 2023.
When asked who is to blame for inefficiencies in the U.S. healthcare system, responsibility is almost evenly directed towards the government and health insurers, cited by 36% and 32% of respondents respectively.

This research was conducted through a survey of more than 4,500 health plan members in the U.S. in May 2025. Respondents include members with diverse age ranges, health statuses, and health insurance coverage types.

The complete report, “From Payers of Claims to Partners in Care, the 2025 Healthcare Consumer Study” can be downloaded at https://learn.healthedge.com/page/healthcare-consumer-survey-2025.

About HealthEdge:

HealthEdge® is building a future without limits for health plans, where they can deliver better service and care, make more informed decisions and streamline operations. Through an integrated platform of solutions for core administration (HealthEdge HealthRules® Payer), payment accuracy (HealthEdge Source™), provider network management (HealthEdge Provider Data Management), care management (HealthEdge GuidingCare®) and member experience (HealthEdge Wellframe™), health plans can converge their data and harness automation to drive more informed decisions, improve touchless transaction processing and payment accuracy, foster meaningful collaboration and enhance service and care delivery. HealthEdge is trusted by 116+ health plans, covering more than 110 million lives across 48 states. See what it means to converge without limits at HealthEdge.com and follow us on LinkedIn.

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