The latest J.D. Power 2025 U.S. Commercial Member Health Plan Study reveals a troubling — and growing — divide in health plan performance. Top-performing regional, Blue Cross Blue Shield, and provider-led plans are pulling further ahead, while large national carriers are slipping further behind, with member satisfaction hitting new lows in many markets.
A Clear Message: Member Experience Now Drives Market Share
J.D. Power surveyed nearly 40,000 commercial health plan members across 22 regions. The findings are clear:
- National average satisfaction score dropped to 563 (out of 1,000)
- Performance varied widely by region (scores ranged from 523 to 594)
- Understanding out-of-pocket costs is a top predictor of satisfaction
- Digital tools are available—but often underused due to poor awareness
- Employer decisions are being shaped by employee experience metrics
“Brand performance gaps are no longer subtle,” said Caitlin Moling, J.D. Power’s Senior Director of Global Healthcare Intelligence. “They’re directly impacting satisfaction, retention, and competitive strength.”
Who’s Leading—and Who’s Losing?
Top-Ranked Plans:
- Kaiser Foundation Health Plan – #1 in multiple regions, including California and the South Atlantic (for the 18th and 16th years respectively)
- Blue Cross Blue Shield plans – Top in nine states
- Provider-led plans like UPMC (PA), Baylor Scott & White (TX), Providence (NW), and CDPHP (NY)
National Plans Falling Behind:
- UnitedHealthcare ranked last in 11 out of 22 markets
- Aetna was the only national carrier to top rankings in any region (Ohio and Southwest)
What’s Driving Satisfaction?
The study evaluated plans across eight dimensions:
- Access to care
- Digital experience
- Ease of doing business
- Time and cost savings
- Customer service
- Coverage and products
- Problem resolution
- Trust
Top-performing plans earned high marks for communication, clarity, and convenience. Members who clearly understand out-of-network coverage and out-of-pocket costs experienced fewer claim denials and better access to preferred providers. On the flip side, confusion about benefits often led to care disruptions and dissatisfaction.
What Employers Need to Know
According to J.D. Power, 1 in 5 employers switch plans due to low employee satisfaction. And higher deductibles are hitting small employers hardest, with average employee deductibles exceeding $2,800 in many cases. These cost pressures and poor member experiences are shaping retention, recruitment, and benefit value perception.
Solidarity Health Network’s Take
At SHN, we believe member experience is no longer just a service metric — it’s a business metric. As the gap between top and bottom performers grows, employer groups need more than just competitive rates. They need data-driven, member-first solutions that align with trust, access, and transparency.
We partner with labor unions and employer groups to:
- Identify high-performing, value-based health plan partners
- Monitor member satisfaction trends and feedback
- Enhance access and clarity through better engagement and advocacy
If your members aren’t getting the experience they deserve — or your current plan isn’t delivering — it’s time to talk.
Let’s design a benefit strategy that puts members first — and brings value back to your plan.