Commercial health plan satisfaction stalls as trust erodes and costs keep climbing

For three consecutive years, member satisfaction with commercial health plans has barely budged. According to the J.D. Power 2026 U.S. Commercial Member Health Plan Study released in May, the national average overall satisfaction score for commercial health plans stands at 562 on a 1,000-point scale — down just one point from 2025 and three points from 2024. The findings, drawn from responses of 37,768 commercial health plan members surveyed between September 2025 and March 2026, suggest that despite significant investment in digital tools and customer engagement initiatives, health plans have largely failed to build meaningful relationships with the people they cover.

The picture emerging from this data is one of a transaction-based relationship, not a partnership — and the consequences of that dynamic are showing up not just in survey scores, but in physician offices and emergency rooms across the country.

Trust deficit at the center

One finding in the J.D. Power study is how rarely members feel their health plan is actually on their side. Only 30% of commercial health plan members said their plan is a trusted partner in their health and wellness. The remaining 70% described experiences that, in the language of the study, "appear more focused on cost management than on helping them navigate their health care."

"By and large, health plans are delivering on the basics, but many are failing to deliver more meaningful emotional connections with their members," said Meaghan Hafner, senior director of healthcare solutions at J.D. Power. "Health plan members want to feel like their insurer is a trusted partner in their health and wellness. Accordingly, those that clearly communicate how their services work and deliver consistently positive experiences stand to set themselves apart from the pack."

That trust gap is not happening in a vacuum. It is unfolding against a backdrop of rising premiums, growing deductibles and an increasingly adversarial claims environment that is leaving millions of Americans caught between their doctors' recommendations and their insurer's decisions.

The cost pressure spiral

The J.D. Power data makes the financial connection explicit and stark. More than half of commercial health plan members — 53% — experienced a monthly premium increase in the past year. For those members, overall satisfaction dropped by 116 points. Another 34% experienced an annual deductible increase, which drove a 111-point decline in satisfaction. These are not marginal changes; they represent a dramatic collapse in member confidence tied directly to out-of-pocket exposure.

That pattern aligns closely with what researchers at the Employee Benefit Research Institute have been documenting. The EBRI says that six in 10 patients now face rising health care costs and deductibles, and cost has overtaken all other barriers as the most frequently cited reason Americans delay or avoid needed care.

Paul Fronstin, Ph.D., Director of Health Benefits Research at EBRI, told Medical Economics that the data reveals a troubling pattern of strategic, often risky, delay. "The survey found that cost was the most commonly cited reason individuals delayed or avoided needed care," Fronstin said. "Among those who needed care in the past year, delays were most common for services such as physical therapy and mental health care, followed by outpatient or specialty visits and diagnostic testing. Prescription drugs and primary care visits were less frequently delayed but still affected for a notable share of respondents."

What EBRI's research also found — and what the J.D. Power data reinforces from a different angle — is that patients are not passively accepting these trade-offs. They are making calculated decisions under financial duress, often without fully understanding what their plans actually cover. "When plan decisions are made quickly or passively, misunderstandings about coverage details, deductibles, and cost-sharing are inevitable," Fronstin said.

Claims resolution: The fastest path to winning back members

Among the J.D. Power findings, for health plans, claims resolution is the single fastest way to improve member satisfaction. Yet right now, only 30% of members describe their claims resolution experience as excellent or perfect.

The satisfaction gap between claims outcomes is enormous. Members who give their claims resolution an excellent rating score 734 overall — 120 points higher than those who rate it as "great" (614) and a full 330 points higher than those who describe it as merely good, just OK or poor (404). In other words, going from a mediocre claims experience to an excellent one is worth more, in satisfaction terms, than almost any other intervention a health plan could make.

That data point becomes more urgent in the context of research on how claims and coverage denials are affecting patients today. A June 2026 report from the Commonwealth Fund, covered by Medical Economics, found that more than 20% of Americans with private health insurance had treatments delayed or denied in the past year due to coverage disputes. Prior authorization denials alone affected 13% of privately insured adults, with 41% of those patients reporting care delays and 28% saying their health actually worsened as a result.

"The complexity of the U.S. health care system is leaving many patients and their families caught between their providers and their insurance companies," said Sara R. Collins, Commonwealth Fund Senior Scholar for Expanding Coverage and Access, in a statement. "When an insurer denies coverage for care their doctor recommends, patients are frequently unsure of how to appeal decisions or even if they have a right to appeal."

Commonwealth Fund President Joseph R. Betancourt, M.D., framed the issue with clinical directness. "As a primary care physician, I've seen firsthand how challenging it is for patients trying to manage the complexity of the prior authorization process. It is difficult, time-consuming, and frustrating for all involved," Betancourt told Medical Economics. "In many cases, it leads to delayed care or no care at all; in the worst cases, it puts patients' lives at risk. When oversight overrides clinical judgment without good reason, quality of care and patient safety suffer, and that demands a policy response."

Regional variation reveals what's possible

While the national average satisfaction score has flat-lined, the J.D. Power study reveals that some health plans and regions are achieving dramatically better results — a sign that the trust gap is not an inescapable feature of the industry, but a solvable problem.

Regional scores range from a high of 592 to a low of 527, reflecting meaningful differences in how members experience service, communication, and value across the country. At the top of the regional rankings, Kaiser Foundation Health Plan earned the highest score in California (640, for the 19th consecutive year), Maryland (660, for the fifth consecutive year), and Virginia (682, for the third consecutive year) — the latter being the top score nationally. In Michigan, Blue Cross Blue Shield of Michigan scored 614 for the third consecutive year. In Texas, Baylor Scott & White Health Plan earned 604. These consistent, high-performing plans share a common thread: they tend to operate in markets where members report clearer communication, more reliable network access, and faster resolution of problems.

The study, now in its 20th year, measures satisfaction across 148 health plans in 22 regions based on eight dimensions: the ability to get health services how and when members want them; level of trust; whether product and coverage offerings meet members' needs; helping to save time or money; ease of doing business; people; digital channels; and resolving problems or complaints.

The spread between top and bottom performers on these dimensions suggests that health plans with clear, consistent communication — particularly around costs and coverage — are the ones retaining member trust even in an environment of rising premiums.

What members are actually looking for

The EBRI data reveals what patients say they value most when choosing a health plan. Despite all of the focus on premiums and deductibles, access to a preferred provider network ranked as the single most important factor in plan selection.

That finding maps directly onto the J.D. Power framework, which identifies the ability to get health services how and when members want them as a core satisfaction dimension. When plans restrict that access through narrow networks, opaque prior authorization requirements, or slow claims resolution, satisfaction plummets — and trust, already fragile, erodes further.

The road forward

The J.D. Power study arrives at a moment when public, legislative, and clinical pressure on health plans is intensifying. Lawmakers at the state and federal level are debating requirements to standardize prior authorization workflows, expand patients' appeal rights and mandate plain-language explanations of coverage denials. The Commonwealth Fund and other researchers are pushing for more transparency in how insurers report claim denial rates and outcomes.

For health plans, the J.D. Power data offers a clear diagnostic: the gap between what members need and what they experience is not primarily about benefits design. It is about communication, trust and consistency. Plans that invest in timely claims resolution, proactive cost transparency and genuine member-facing communication are the ones showing up at the top of regional rankings — year after year. Those that don't are watching their members grow more transactional, more skeptical, and less likely to describe their insurer as anything close to a partner.

The score may have only dropped one point in a year. But the trust it represents has been eroding for much longer, according to the data.