Recent changes in Medicare Advantage have led to increased confusion, lower member satisfaction, and a widespread lack of trust among plan members, according to the J.D. Power 2025 U.S. Medicare Advantage Study.
The annual study, now in its 11th year, is based on the responses of 10,888 members of Medicare Advantage plans in 10 market-based U.S. regions: California, Florida, Georgia, Illinois, Michigan, New York, North Carolina, Ohio, Pennsylvania, and Texas.
The research was conducted from January through June 2005 and measured member satisfaction with Medicare Advantage plans based on several factors: level of trust; ability to get health services how/when I want; helping to save me time or money; product/coverage offerings meeting my needs; ease of doing business; people—representatives, call center agents; resolving problems or complaints; and digital channels.
“With so much rumbling in the marketplace right now about increased government oversight, policy changes, and profitability challenges confronting Medicare Advantage plans, it can be misleading for plans to conclude that the significant decline in member satisfaction is a byproduct of changes that are outside their control,” said Christopher Lis, managing director of global healthcare intelligence at J.D. Power, in a study announcement.
Lis said that plans that invest in robust new-member onboarding, increased transparency, new digital tools, broader networks, and social support services are better equipped to maintain member trust and satisfaction—even in a volatile environment. These digital tools, he said, can help drive increased personalization, automated and more consistent onboarding, and increased transparency with real-time updates that members need.
Here are three key findings from the report:
- Members' lack of trust in their Medicare Advantage plans has led to a steep drop in satisfaction: Overall customer satisfaction with Medicare Advantage plans is 623 (on a 1,000-point scale), down 29 points from a year ago. Researchers said the primary reason for the decline is a 39-point drop in members’ overall level of trust in their Medicare Advantage plan. Other factors showing significant declines in this year’s study are product/coverage offerings that meet needs and ease of doing business.
- New members are dissatisfied with their plans: When new members join a Medicare Advantage plan, their first year often comes with confusion, unmet expectations, and administrative challenges, researchers noted. However, only 38 percent of first-year members surveyed say their insurer fulfills their service expectations. That number rises to 45 percent among established members, or those who have been with the same plan for more than one year. Common challenges cited by new members include explanation of benefits, how to find in-network doctors, deductibles, prior authorizations, and usage of their Health Savings Account (HSA)/Health Retirement Account (HRA).
- Digital channels may help with satisfaction: The study found one factor that separates the highest-performing Medicare Advantage plans from the lowest-performing plans is the ability to engage with members via digital channels. Digital satisfaction among members of the highest-performing plans is 98 points higher, on average, than among those of the lowest-performing health plans. Indeed, 85 percent of members of high-performing plans have used their member portal (vs. 76 percent of low-performing plans), and 52 percent of members of high-performing plans find the features or tools offered on their plan’s website very easy to use (vs. 40 percent of low-performing plans).