What Drives Trust in Health Insurance? Secondary Analysis of a Nationally Representative U.S. Survey

Background Trust in health insurance plays a crucial role in shaping individuals’ engagement with healthcare services, particularly as insurers assume more proactive roles in care delivery. However, limited research has examined which factors influence trust in health insurance plans and companies at the national level. Methods We used data from 7,702 adults in the 2021 Health Reform Monitoring Survey (HRMS) to assess factors associated with trust in health insurance. The primary outcome was a binary indicator of trust, derived from agreement with the statement: “I trust my health insurance plan and company.” Weighted bivariate analyses were employed to assess the relationships between trust and sociodemographic, health-related, and insurance-related characteristics. Variables significantly associated with trust in bivariate analyses were included in a multivariate logistic regression model to assess their independent effects. All analyses accounted for the survey’s probability weights. Results Among the 7,702 respondents, 69.1% reported trusting their health insurance provider. In bivariate analyses, trust varied significantly by age, race, education, income, self-rated health, usual source of care, type of insurance, perceived respect from the insurer, and perceived affordability of care (all p  < 0.01). In the multivariate logistic regression model, individuals with better health status, lower income, lower education, a usual source of care, or non-private insurance had higher odds of trusting their insurance. Notably, respondents who felt respected by their insurer had substantially higher odds of reporting trust (adjusted odds ratio (OR) = 67.41; 95% confidence interval (CI): 52.25–86.97). Perceived affordability of care was also positively associated with trust (adjusted OR = 1.21 per unit increase in score; 95% CI: 1.11–1.31). Race and age were not independently associated with trust after adjusting for other variables. Conclusions Both access-related experiences and perceived interpersonal respect from insurers shape conclusions about trust in health insurance. These findings underscore the importance of fostering dignity and responsiveness in insurance interactions, as well as addressing affordability barriers to strengthen beneficiaries’ trust, particularly as insurers assume a greater role in population health and care coordination.