Gap Widens between Highest- and Lowest-Performing Employer-Sponsored Health Plans, J.D. Power Finds

High-Performing Plans Improve Clarity, Communication and Trust Scores While Bottom-Ranked Plans Struggle to Deliver Positive Member Experience

TROY, Mich.--(BUSINESS WIRE)--
A new class of health plan leaders is emerging, distinguished by their ability to deliver clear communication, digital convenience and meaningful member support, according to the J.D. Power 2025 U.S. Commercial Member Health Plan Study,℠ released today.

While overall satisfaction with commercial health plans declined slightly year over year, the study reveals widening performance gaps across brands, making 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 underutilized, 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: A notable 20% of employers cite low employee satisfaction as a top reason for switching health plans. 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 underutilized: Tools like 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 employers¹ is $2,847, which is 8% more than for those working for midsized employers ($2,630) and 10% more than those working for large employers. 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

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.

The U.S. Commercial Member Health Plan Study, now in its 19^th year, measures satisfaction among members of 147 health plans in 22 regions throughout the United States based on performance in eight core dimensions on a poor-to-perfect rating scale. The dimensions are (in alphabetical order): able to get health services how/when I want; digital channels; ease of doing business; helps save time and money; people; product/coverage offerings; resolving problems or complaints; and trust. This year’s study is based on responses from 39,797 commercial health plan members and was fielded from September 2024 through March 2025.

For more information about the U.S. Commercial Member Health Plan Study, visit https://www.jdpower.com/business/resource/commercial-member-health-plan-study.

About J.D. Power

J.D. Power is a global leader in consumer insights, advisory services, and data and analytics. A pioneer in the use of big data, artificial intelligence (AI) and algorithmic modeling capabilities to understand consumer behavior, J.D. Power has been delivering incisive industry intelligence on customer interactions with brands and products for more than 55 years. The world's leading businesses across major industries rely on J.D. Power to guide their customer-facing strategies.

J.D. Power has offices in North America, Europe and Asia Pacific. To learn more about the company's business offerings, visit JDPower.com/business. The J.D. Power auto-shopping tool can be found at JDPower.com.

About J.D. Power and Advertising/Promotional Rules: www.jdpower.com/business/about-us/press-release-info

View source version on businesswire.com: https://www.businesswire.com/news/home/20250528344385/en/

Media Relations Contacts

Geno Effler, J.D. Power; West Coast; 714-621-6224; [email protected]

John Roderick; East Coast; 631-584-2200; [email protected]

Source: J.D. Power