Objective Loyalty is important for hospitals because it not only enhances the quality of care and outcomes for individual patients but also contributes to the overall success, reputation, and sustainability of the healthcare institution. Based on the Theory of Planned Behavior developed by Icek Ajzen, this study aims to examine the mediating role of social media usage and behavioral intention in the impact of trust on loyalty. Methods Data were collected from 387 individuals through Web 2.0. The study was designed considering the most recent hospital experience (public-private). Variables predicting loyalty were identified using Partial Least Squares Structural Equation Modeling. For the model, the SRMR value was calculated as 0.045, NFI value as 0.872, and GoF value as 0.52, determining a good fit of the model. Results The study revealed that the patient’s trust directly influences loyalty. Additionally, it was determined that social media usage (excluding patient satisfaction) and behavioral intention mediate between trust and loyalty. Conclusion In an ever-changing healthcare landscape, loyalty is of significant importance for enhancing the competitive edge and improving both the financial and non-financial performance of hospitals. This study provides a model highlighting the critical roles of trust, social media and behavioral intention elevating loyalty.”