BURLINGTON, Mass. – HealthEdge® has released its fifth annual Healthcare Consumer Report, revealing evolving consumer attitudes toward health insurance and the increasing role technology—especially AI—could play in transforming the member experience. Based on a survey of over 4,500 U.S. health plan members, the report highlights rising expectations for affordability, transparency, personalization, and digital engagement.
One of the most striking findings is that 51% of respondents now view their health plan as a “partner” in their care rather than merely a “payer” of medical bills. This distinction significantly affects consumer satisfaction. Those who see their insurer as a partner report higher levels of engagement, loyalty, and overall satisfaction compared to those who view their plan as a transactional service provider.
“Consumers want more choice in their health coverage—and they’re getting it,” said Alan Stein, Chief Product & Strategy Officer at HealthEdge. “As the market shifts toward more flexible options like Medicare Advantage, ACA exchanges, and employer reimbursement plans, payers are being forced to adopt more retail-like, personalized experiences. AI and digital tools will be essential in making this shift meaningful.”
The report found a sharp increase in digital engagement, with 78% of respondents saying they have used or plan to use their health plan’s mobile app, up from 64% the previous year. However, despite this digital uptick, AI tools remain underused. Nearly 80% of respondents said they either have not used or are unsure if they’ve used AI-powered features through their health plan.
Even with this limited adoption, the appetite for AI is growing. About 64% of consumers said they would be open to using AI-based services such as chatbots or personalized cost-saving tools. Yet concerns persist. The top apprehensions cited include quality and accuracy of AI tools (26%), privacy (20%), and data security (20%). Nearly a third of respondents said that better communication about when and how AI is used would help increase their trust.
The survey also examined the impact of consumer perceptions on loyalty. Among those who view their insurer as a partner, 78% reported satisfaction with the level of personalized service they receive, compared to only 49% among those who see their insurer as a payer. Cost continues to be a key factor influencing loyalty. While 42% of all respondents said premiums or out-of-pocket costs were reasons to stay with a plan, 43% said the same factors could drive them to switch. Interestingly, consumers who view their plan as a partner are less cost-sensitive than those who see it as a payer.
Trust remains elusive for insurers. Seventeen percent of consumers said they would not trust their health plan no matter what efforts are made. However, 42% identified transparent communication about benefits as the best way to build trust.
Flexibility is also becoming a central demand. Sixty percent of those with employer-provided insurance said they would likely participate in an Individual Coverage Health Reimbursement Arrangement (ICHRA), which allows employees to choose their own insurance if offered.
The report also noted a concerning trend: for the third year in a row, consumers are reporting decreasing satisfaction with the support care managers provide for social determinants of health (SDOH). Only 33% of those assigned a care manager said they were fully satisfied with help on economic concerns, housing, food, and utilities—down steadily from previous years.
When asked about the root of inefficiencies in the U.S. healthcare system, respondents divided blame between government (36%) and health insurers (32%).
The survey, conducted in May 2025, included a broad cross-section of consumers across age, health status, and insurance types, offering a comprehensive look at how Americans perceive and interact with their health plans in an increasingly digital healthcare environment.
