Health insurers have their work cut out for them to regain consumer trust. Only 1 of 20 major U.S. health insurers earned a positive trust score from members in the latest Adoreboard Trust Index.

The findings from the predictive insights platform come as more than 20 million Americans face premium increases averaging 114%. The end of enhanced ACA subsidies also may cause almost five million Americans to lose coverage in 2026.

"Insurers risk sleepwalking into a financial crisis by neglecting customer trust," Adoreboard CEO Chris Johnston said. "We've now seen that price hikes don't create disloyalty; they reveal it. While market rates are beyond their control, insurers can address disputes and service failures that drive members away. Fixing these issues is key to protecting revenue and rebuilding trust."

The scores are based on an analysis of more than 17,000 online reviews. The trust index, which ranges from minus 100 (total distrust) to plus 100 (total trust), found that 19 of the 20 insurers scored between minus 42 and minus 54. Only one earned a positive score. Research also revealed a critical annual churn risk of nearly $800 million per insurer. Revenue impact is based on churn risk linked to the trust score, emotional intensity and customer lifetime value, assuming a $9,540 annual spend per policy.

Three persistent service failures account for much of this risk:

  • Insurance disputes and coverage denials account for $446 million in predicted churn. Addressing this issue could increase customer advocacy by up to 13%.
  • Frontline service failures and long wait times represent a potential $133.5 million bottom-line impact that, if fixed, could increase customer advocacy by up to 3%.
  • Prescription authorization struggles potentially represent $128 million in lost revenue that, if resolved, could increase customer advocacy by up to 4%.

"Insurers have a clear opportunity to reverse the negative trust spiral," the report concluded. "Insurers should act now by swiftly resolving the top service failures and prioritizing customer experience. Taking these steps will strengthen trust, protect revenue and help millions of Americans maintain health coverage before customer churn escalates."

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