HealthEdge’s fifth annual Healthcare Consumer Report indicates a significant shift in consumer perception, with over half of respondents now viewing their health plans as active partners in care rather than merely payers of medical bills, signaling increased demand for digital engagement and personalized experiences facilitated by emerging technologies.
The 2025 Healthcare Consumer Study found that 51% of consumers consider their health plan a partner in their care. This shift is notable because individuals who view their plan as a partner report higher levels of satisfaction, loyalty, and engagement compared to those who see it only as a payer of medical bills. According to Alan Stein, Chief Product & Strategy Officer at HealthEdge, this change reflects a market shift towards greater choice in health coverage, including Medicare Advantage, ACA exchanges, and employer reimbursement models. Stein emphasized that this demand is prompting payers to evolve, offering retail-like experiences that position them as true partners. He added that technology, particularly AI, will be crucial in this evolution as consumers increasingly expect and embrace digital tools for improved communication and personalized experiences.
The research highlights a surge in digital engagement, with 78% of respondents reporting they have used or plan to use their health plan’s mobile app, an increase from 64% a year prior. Despite this, consumer adoption of AI-powered tools from their health plans has been slower, with 79% stating they either have not used (58%) or are unaware if they have used (21%) such tools. However, 64% of consumers express openness to trying healthcare AI tools like chatbots and personalized cost-saving features. Lingering concerns about AI include quality and accuracy (26%), privacy (20%), and data security (20%). Nearly one-third (30%) of respondents indicated that transparent communication regarding the use of AI would enhance their confidence in their health plan.
Additional findings from the report include: 78% of consumers who view their health plan as a partner are satisfied with personalized experiences, compared to 49% of those who view it as a payer. Cost remains a primary factor influencing loyalty; 42% cited monthly premiums or out-of-pocket costs as reasons to stay with a plan, while 43% cited them as reasons to leave. However, consumers who perceive their health plan as a partner are less driven by cost. Trust in health plans remains a challenge, with 17% of consumers expressing persistent skepticism. Providing clear and transparent communication about benefits was cited by 42% of respondents as the most effective way to build trust. Furthermore, 60% of consumers with employer-provided coverage stated they would likely participate in an individual coverage Health Reimbursement Arrangement (ICHRA) if offered.
The study also noted a third consecutive year of declining satisfaction among consumers regarding tailored support for their social determinants of health (SDOH) needs. For instance, among those assigned a care manager, satisfaction with resources for economic conditions dropped to 33% (from 36% in 2024 and 38% in 2023), and satisfaction with resources for essentials like housing and food decreased to 33% (from 38% in 2024 and 42% in 2023). When asked about inefficiencies in the U.S. healthcare system, 36% of respondents attributed blame to the government, and 32% to health insurers.
The research was conducted through a survey of more than 4,500 U.S. health plan members in May 2025, encompassing diverse age ranges, health statuses, and health insurance coverage types. The complete report, “From Payers of Claims to Partners in Care, the 2025 Healthcare Consumer Study,” is available for download at https://learn.healthedge.com/page/healthcare-consumer-survey-2025.
HealthEdge provides an integrated platform of solutions including HealthRules® Payer for core administration, HealthEdge Source™ for payment accuracy, HealthEdge Provider Data Management for provider network management, HealthEdge GuidingCare® for care management, and HealthEdge Wellframe™ for member experience. The company’s solutions aim to enable health plans to consolidate data, automate processes, and enhance decision-making and service delivery. HealthEdge serves over 116 health plans, covering more than 110 million lives across 48 states.
