Health Plan Satisfaction with Benefits Coverage is Rising

Consumers’ overall satisfaction with their health plans is on the rise–but insurers continue to struggle with meeting key aspects of their customers’ financial and personal health expectations.

The J.D. Power 2019 Commercial Member Health Plan Study measured satisfaction among nearly 29,000 commercial members of 146 health plans across the U.S.

The good news: Overall health plan member satisfaction is up seven points during the past three years, to 713 out of a possible 1,000 points. One reason is broad-based satisfaction with health plans’ coverage and benefits offered–the most important driver of customer satisfaction, accounting for 25 percent of total health plan member satisfaction, according to the report.

But two factors are creating member satisfaction headwinds for insurers: cost and quality of mobile apps. In particular, high co-pays for office visits have pushed cost satisfaction scores lower in recent years.

The report highlights that overall satisfaction scores rose by 254 points when members perceived their plans to be working to keep out-of-pocket costs low, help coordinate care and offer enough coverage. The problem: 54 percent or fewer of health plan members say their plans deliver in those three areas.

One way to potentially boost cost satisfaction levels, according to the report authors, is to promote and help members navigate alternative treatment options–such as telehealth, urgent care and retail clinics–that can be less expensive than office visits. The report noted that 48 percent of members surveyed say they are either very or somewhat likely to consider telehealth options. In addition, 32 percent visited urgent care facilities.


The findings can potentially help health plans gain insights into members’ needs and expectations and incorporate best-in-class processes.

Health plans are doing a good job with benefits coverage, but are missing the mark when it comes to member expectations for getting their questions answered in a way they meets their experiences in other industries, according to J.D. Power.

Healthcare organizations as a whole have come up against the expectations of an Amazon-like experience.

Now in its 13th year, the J.D Power Commercial Member Health Plan Study examines six key factors to measure satisfaction — billing and payment, cost, coverage and benefits, customer service, information and communication, and provider choice — along with other key aspects of member experience and engagement.


Healthcare costs remain a key concern among the insured, and not just among commercial plan members. For example, four in ten workers with employee-sponsored health insurance say their family has had either problems paying medical bills or difficulty affording premiums or out-of-pocket medical costs, according to a recent Kaiser Family Foundation study. What’s more, half say someone in their household skipped or postponed some type of medical care or prescription drugs in the past year because of the cost.


“Health plans are doing a good job managing the operational aspects of their businesses, but they are having a harder time addressing the expectations members have based on their experiences in other industries where their service needs are more effectively addressed with better technology,” said James Beem, managing director of global healthcare intelligence at J.D. Power.  “Across the board, health plan members are satisfied with the coverage and benefits they have, but once they start looking to their health plans for guidance in areas like navigating issues related to cost or when to use primary care versus urgent care, many plans miss the mark on customer expectations.”

Mark Klimek is an independent writer and editor with 20 years’ experience covering financial issues, healthcare and more.