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With trust low and costs high, do payers stand to lose members?

Healthcare payers might see fewer enrollments as members face higher prices for a product they don't trust or see as high value.

Sara Heath
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Published: 09 Oct 2025

Health insurance companies could be at risk of losing members in the near future -- especially those younger, healthier members who balance out their risk pools -- which could be a recipe for disaster as payers contend with mounting prices and consumer trust problems.

"Payers need to take a hard look in the mirror and think about what the future of their business truly looks like," according to Arielle Trzcinski, a principal analyst with Forrester.

"Doing the same thing over and over again, not looking different and not fixing the problem, is not going to be a winning strategy," she said in an interview.

It's clear that healthcare payers haven't had a winning strategy for some time. It's recently reached a boiling point as the health insurance industry sees dismal consumer trust numbers in Forrester's most recent report.

"The Trust Foundation Is Fractured for U.S. Health Insurers, 2025" report revealed that only about half (54%) of health plan customers view their insurer as trustworthy. Only a quarter of individuals who are not health plan customers say health insurers are trustworthy.

Meanwhile, commercial payers are anticipating record-high premium costs this year, driven in part by high healthcare spending and the threat of lapsing Affordable Care Act enhanced premium subsidies. Without enhanced subsidies, marketplace premiums are slated to more than double, according to estimates from KFF.

Premium increases for employer-sponsored plans will vary by employer and plan type, but estimates do say consumers should expect a spike. Mercer reported in September that the average premium increase will be about 9%, which is the highest increase in 15 years.

Charging consumers more for a product that they don't value and don't trust is going to be a hard sell, Trzcinski said, predicting that the U.S. might see a high uninsured rate in 2026. Low-income folks may see affordability barriers, but perhaps more threatening is a potential trend for younger, healthier members to decide they want an alternative to their health plan -- or no health plan at all.

Members see little value in health insurance

It's hard to sell a product consumers don't believe will bring value to their lives, but according to Forrester's report, of which Trzcinski is one of the authors, that's currently the case for health insurance.

Right now, only 48% of insured adults think their health plan is going to act in their best interest. That's on top of the growing number of adults who don't trust health insurance brands in general.

Those numbers are worse for Gen Z and Millennial members, who are arguably the most profitable generations health plans cover. Because these members tend to be younger, they also tend to be healthier and incur fewer high-cost health encounters.

But therein lies the rub, according to Trzcinski.

"These low trust folks are not going to consider that health plan the next time around for open enrollment," she explained. "If you have more folks that have more choice and are going out to the individual market, for instance, they're going to remember a bad experience and they're going to carry that into how they make that decision and what health plan they want to go with."

Low trust and high costs create a perfect storm for insurers

That's bad news for health plans that need to keep their risk pools balanced with younger, healthier members. With member pools mostly populated by high-cost individuals, payers might have to increase premiums. That's also bad news, Trzcinski said, considering the way high costs have soured members' perceptions of their payers.

 In a separate, yet-to-be-published report exploring the future of health insurance, Trzcinski and her colleagues at Forrester found that members aren't satisfied with their financial experience.

For example, 49% said their plan has competitive insurance premiums, co-insurance rates or deductible amounts. Another 49% said their plan offers a range of plan options that meet their budget. Meanwhile, only 50% said it's easy for them to anticipate their healthcare costs.

"We are at a point where less than half of customers are reporting a positive experience on cost. At the same time costs are going up," Trzcinski stated. "But we don't have more to show for it. We have a worse customer experience, less trust and now we're going to ask everybody to pay more. It's a recipe for someone to come in and truly disrupt this market and transform what this market looks like."

The proof is in the pudding, as consumers signal they're ready for a different type of health insurance.

In the report assessing the future of health insurance, 67% of respondents said they'd be interested in choosing their own health plan tailored to their own needs and preferences, as opposed to getting a more traditional plan selected by their employer. Among Gen Z respondents, 62% were not only interested in a customized plan, but were willing to pay a premium for it. Millennials weren't far behind, Trzcinski said.

Members -- especially profitable ones -- are craving a disrupted health insurance experience, and they're willing to put their money on the line to get it, so long as the plan offers value.

So, disrupt or be disrupted, Trzcinski challenged, indicating there are paths to success that payers can take to keep themselves from hemorrhaging members. In the next part of this two-part series, we'll discuss the need for a more personalized consumer experience and how to get the member data they need to build it.

Sara Heath has reported news related to patient engagement and health equity since 2015.

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