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
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
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
Following are some key findings of the 2025 study:
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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.
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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.
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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:
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California :Kaiser Foundation Health Plan (648) (for an 18th 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 andBlue 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 16th 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.
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