Background <p>This study examined the serial mediating roles of perceived quality and customer satisfaction in the relationship between trust and repurchase intentions among private health insurance owners.</p> Methods <p>This cross-sectional study included 525 private health insurance owners. The data were collected between 15.12.2023 and 15.03.2024, and SPSS AMOS was used to analyze the direct and indirect estimates. The study utilized structural equation modeling (SEM) to examine the relationships among the constructs. The proposed model was tested using maximum likelihood estimation. Model fit indices and statistical significance levels were reported to ensure the robustness of the findings. Using an online survey, the participants completed self-reported measures of perceived quality, customer satisfaction, trust, and repurchase intention.</p> Results <p>Trust significantly affected perceived quality, customer satisfaction and repurchase intention. Furthermore, perceived quality acted as a mediator in the relationship between trust and customer satisfaction. Additionally, customer satisfaction played a partial mediating role in the relationship between trust and repurchase intention. Both perceived quality and customer satisfaction play a serial mediating role in the relationship between trust and repurchase intention.</p> Conclusions <p>This study highlighted the significance of perceived quality and customer satisfaction in the relationship between trust and repurchase intention. Private health insurance agencies both alleviate the burden on public health services and operate as profit-driven entities. Considering their indirect benefits to healthcare services, maintaining existing customer portfolios and acquiring new customers are important for both the health system and the profitability of insurance businesses.</p>