Anthem offers a wide range of plan options and covers a fairly wide geography with extra benefits and customer service options that are competitive. These plans earn average quality ratings from CMS, with a few standouts. Anthem plans aren’t rated by NCQA, one of the main health insurance accrediting bodies, so it is hard to compare them to other national competitors. Its plans are worth reviewing and considering; there are no red flags even as there are few superlatives.
- Pros & Cons
- Key Takeaways
- Company Overview
Lots of Medicare plan options
Free virtual visits for Medicare Advantage members
Not available in every state
- Wide range of comprehensive and standalone supplemental plans available
- Competitive extra benefits and support options
- History—and current operations—as Blue Cross Blue Shield plans
Headquartered in Indianapolis, Indiana, Anthem is the result of the 2004 merger between WellPoint Health Networks, which originated in California, and Anthem, Inc. Anthem is an independent Blue Cross and Blue Shield Association licensee and offers commercial, Medicaid, Medicare, and individual insurance products. Anthem operates through subsidiaries including America’s 1st Choice, Amerigroup, Aspire Health, CareMore, Freedom Health, HealthLink, HealthSun, Optimum HealthCare, Simply Healthcare, and/or UniCare. Anthem serves more than 42 million health plan members, including 2.3 million Medicare enrollees. Prospective members can explore plans online, over the phone with a licensed agent, or at a live webinar.
Anthem operates Blue Cross Blue Shield plans in 14 states, including California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia, and Wisconsin. Anthem offers Medicaid and Medicare in 23 states each.
- Year Founded 2004
- Kinds of Plans Medicare Advantage HMO and PPO plans, Medicare Advantage Dual-eligible Special Needs Plans, Medicare Advantage Chronic Condition Special Needs Plans, Prescription Drug Plans, Medicare Supplement Insurance (Medigap), Medicare Dental and Vision Plans
- Number of Plans 8
- Payment Options Pay by mail, phone, online, or through automatic bank withdrawals or credit/debit card charges
- Customer Service Telephone, online, live chat
- Phone Number 855-949-3321
- Official Website www.anthem.com/medicare
- Lots of Medicare plan options: Anthem offers several Medicare Advantage plans plus supplemental plans, including standalone dental and vision plans which some insurers only offer as part of Medicare Advantage plans.
- Caregiver resources: Anthem supports caregivers of Anthem Medicare members with access to the member’s account so the caregiver can pay bills, review claims, and manage the member’s medications.
- Remote care: Anthem offers free virtual visits for Medicare Advantage members via LiveHealth Online and a 24/7 Nurse Line and pharmacy support.
- Not available in every state: Anthem is a large plan with a fairly broad geographic footprint, but it only offers Medicare plans in 23 states and operates Blue Cross Blue Shield plans in 14 states.
- Average quality: Anthem plans score an average of 3.59 Stars in the CMS Five-Star Rating system, which is not bad, but it’s not outstanding. Just one Anthem plan earned 5 Stars in 2021.
Medicare Advantage Plans
Anthem offers HMO and PPO plans—with and without prescription drug coverage—and two types of Special Needs Plans. These all-in-one plans typically also include extra benefits such as fitness, dental, vision, and hearing aid benefits.
Anthem’s Medicare Advantage HMO is called Anthem MediBlue HMO. Members need to choose a primary care provider (PCP) who provides most of their care and serves as a gatekeeper to specialists. These plans typically have lower monthly premiums than PPOs. In 2021, Anthem offers 1,829 HMO plans with prescription drug coverage and 84 plans without.
Anthem’s PPO plans, called Anthem MediBlue PPO, offer more flexibility in accessing providers than the HMO plans. Though PPO members still choose a PCP, you don’t need to go through your PCP to get a referral to a different doctor or specialist. On the PPO plan, members can see doctors outside the Anthem network though you may pay more. For 2021, Anthem offers 1,214 local PPO plans with prescription drug coverage and 233 without.
Special Needs Plans (SNP)
Anthem offers two types of Special Needs Plans (SNP): Dual-Eligible Special Needs Plans (D-SNP) for Medicare enrollees who also qualify for Medicaid, and Chronic Condition Special Needs Plans (C-SNP) for people with specific conditions or needs. These plans include the benefits of Medicare Advantage plus additional services and programs or providers for members with special needs.
Stand-Alone Prescription Drug Plans
Anthem offers stand-alone Prescription Drug Plans (PDP) that cover medications that fall into the Medicare coverage gap. These plans work alongside Original Medicare Parts A and B, and Medicare Supplement Insurance (Medigap) plans. Anthem contracts with 68,000 pharmacies.
Anthem offers three types of PDPs, including:
- MediBlue Rx Enhanced Part D Plan: Offers the lowest premiums of the Anthem PDPs, with savings on prescriptions at preferred pharmacies.
- MediBlue Rx Plus Part D Plan: Offers the largest drug list of all the Anthem PDPs. These plans have no deductibles and savings at preferred pharmacies.
- MediBlue Rx Standard Part D Plan: Savings on prescriptions at preferred pharmacies and a high level of coverage with higher monthly premiums, low out-of-pocket costs, and more comprehensive drug coverage.
Medicare Supplement Insurance (Medigap) Plans
Medicare Supplement Insurance plans, also called Medigap, cover some costs that Original Medicare doesn’t cover. There are 10 different types of Medigap plan, each with set benefits and coverage, spelled out on Medicare.gov. Within each plan type, insurers must offer the same benefits, though costs and extra benefits can vary.
Anthem offers Medigap plans in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, New Hampshire, Nevada, New York, Ohio, Virginia, and Wisconsin. Anthem directs consumers in other states to look for options on the Blue Cross Blue Shield site. It offers most Medigap members extra benefits such as fitness benefits through SilverSneakers.
Dental and Vision Plans
Many Anthem plans include dental and vision benefits, but Anthem also offers supplemental dental insurance and supplemental vision coverage in some states. These supplements can be combined with some Anthem Medicare Advantage or Medicare Supplement Insurance (Medigap) plans, and some of these supplemental plans bundle both dental and vision together.
Members who opt for dental supplement plans can get coverage for routine dental care and help to pay for procedures such as fillings, root canals, crowns, extractions, bridges, dentures, and periodontal services. Supplemental vision plans may include zero or low copayments for vision exams, eyeglasses, lenses, contact lenses, or help to pay for other Medicare-related vision services.
Not all Medicare insurers offer standalone supplemental coverage other than for prescriptions. Anthem’s dental and vision plans offer members flexible, add-on coverage.
Most Medicare plans offer extra benefits such as dental, vision, hearing, fitness, and other benefits. Anthem is no exception. Depending on the type of plan, extra benefits vary, but may include:
- Extra coverage including prescriptions and dental, vision, and hearing benefits
- Transportation: Up to 30 rides to health appointments per year
- Personal Home Helper: Home health aide support for housework and help with activities of daily living
- Fitness: Fitness tracking device plus memory and attention support via an online brain exercise program
- Meal Delivery: Healthy food delivery
- Telehealth Visits: Free virtual visits for Medicare Advantage members via LiveHealth Online
Prospective members can speak with licensed sales agents at 855-949-3319, seven days a week between 8 a.m. and 8 p.m.
Anthem offers support for caregivers who may be caring for an Anthem Medicare member. Caregivers can create a caregiver account to access information about the member’s doctors and hospitals, medications, claims, and bills. Anthem also offers caregiver resources.
Caregiving can take its toll; Anthem offers support for people who are caring for its Medicare members
The National Association of Insurance Commissioners (NAIC) calculates the ratio of complaints an insurance company receives compared to its share of premiums. A complaint index score less than 1.0 indicates the company received fewer than expected complaints; a score greater than 1.0 means it received more complaints than expected based on its market share.
Overall, the complaint index for Anthem Insurance Company was below 1.0 for 2017 (0.79), 2018 (0.46), and 2019 (0.75). For Medicare Supplement insurance specifically, the complaint index is higher: 7.07 in 2017, 2.49 in 2018, and 1.86 in 2019—so it is moving in the right direction. A closer look shows the number of complaints against Anthem for its Medicare Supplement plans is low: 16 in 2017 and 4 in both 2018 and 2019.
AM Best, the credit rating agency that assesses insurance companies’ financial strength, affirmed its A (Excellent) Financial Strength Rating of Anthem’s Blue Cross Blue Shield subsidiaries, effective December 3, 2020. AM Best also affirmed its A- (Excellent) rating of Anthem subsidiaries Amerigroup and UniCare, which offer Medicare and Medicaid products.
Most health plans are accredited through the National Committee for Quality Assurance (NCQA), which reviews and rates health plans. Though many Medicare plans are rated in the 2019-2020 ratings, Anthem plans are not NCQA accredited, and therefore not rated.
Anthem Medicare plans are not accredited by NCQA, one of the leading accrediting agencies, making it difficult to compare Anthem plans to others.
In its 2020 U.S. Medicare Advantage Study, J.D. Power rated Medicare Advantage plans based on member satisfaction with the plans’ coverage and benefits, choice of health care providers, cost, customer service, information and communications, and billing and payment. In the overall J.D. Power customer satisfaction index, Anthem earned 779 points out of 1,000, compared to the industry average of 800. Anthem ranked seventh out of the top 10.
Medicare Star Ratings
One of the main ways to evaluate the quality of Medicare Advantage plans is the Medicare Star Rating, issued by the Centers for Medicare and Medicaid Services (CMS). Based on a five-star rating system, Star Ratings reflect how well plans help members stay healthy and manage chronic conditions, and how members rate their experience with the plan and its customer service. CMS also considers member complaints into the overall rating. Different plans under a corporate umbrella might be reviewed and rated separately.
In the 2021 Star Ratings, Anthem and affiliated plans earned between 3.0 and 5.0 out of 5.0 Stars. The average Star Rating for Anthem plans is 3.56 overall. Medicare Advantage Part C ratings average 3.59 and Part D ratings average 3.58. Anthem’s best-performing plan is HealthSun Health Plans, which earned a perfect 5 Stars.
Costs vary by state and type of insurance product; details are available on Anthem’s website. Medicare Advantage 2021 price ranges for Anthem and its affiliates include:
HMO plans with prescription drug coverage
- Monthly premiums range from $0 to $105, averaging $11.53; 62% of these plans have no monthly premium.
- Deductibles range from $0 to $445, averaging $175.25; nearly half (47%) the available plans have no deductible.
- Annual out-of-pocket maximums for in-network services range from $900 to $7,550, averaging $5,556.
HMO plans without prescription drug coverage
- Anthem HMO plans without prescription drug coverage have no monthly premiums or deductibles.
- Annual out-of-pocket maximums for in-network services range between $6,700 and $7,550, averaging $7,452.
Local and regional PPO plans with prescription drug coverage
- Monthly premiums range from $0 to $172, averaging $44.68; just 16% of plans have no premium.
- Deductibles range from $0 to $370, averaging $97.24; 19% of plans have no deductible.
- Annual out-of-pocket maximums for in-network services range from $4,300 to $7,550, averaging $6,067.
Local and regional PPO plans without prescription drug coverage
- PPO plans without prescription drug coverage have no monthly premiums or deductibles.
- Annual out of pocket maximums range from $4,900 to $5,500, averaging $5,021.
Anthem PDPs range in costs depending on the plan:
- MediBlue Rx Enhanced Part D Plan: Premiums start at $18.90 and deductibles start at $275, with no deductible on Tiers 1 and 2. These plans include $1 to $2 copayments for most generic drugs at preferred pharmacies.
- MediBlue Rx Plus Part D Plan: Premiums costs more because it covers more with no deductible. These plans include $1 to $3 copayments for most generic drugs at preferred pharmacies.
- MediBlue Rx Standard Part D Plan: Monthly premiums range from $46.50 to $77.80; deductibles start at $250, though Tier 1 drugs are waived from the deductible at preferred pharmacies. These plans include $1 to $3 copayments for most generic drugs at preferred pharmacies.
Rates may vary by location.
Competition: Anthem vs. UnitedHealthcare
Anthem competes on the national stage given its fairly wide footprint. Head-to-head with the nation’s largest insurer, UnitedHealthcare, Anthem has some disadvantages. UnitedHealthcare covers nearly every state. UnitedHealthcare’s average Star Rating is somewhat higher, though in the general range of Anthem. Anthem offers more plan options, including standalone and bundled dental and vision supplemental coverage, which may give it the edge with consumers looking for specific add-on coverage.
|Number of States Available||23||47|
|Customer Service Options||Telephone, online, live chat||Telephone, online, in-person, chat|
|AM Best Rating||A (Excellent)||A- (Excellent)|
|Average CMS Star Rating||3.56||3.78|
Anthem offers more types of Medicare plans than many competitors, from comprehensive Medicare Advantage plans to supplemental dental and vision coverage. Anthem plans don’t stand out for quality in CMS Star Ratings, and they aren’t rated by NCQA, one of the main accrediting bodies for health plans. Given a choice, higher-quality ratings usually indicate a better plan. But, many of Anthem’s plans are attractive based on price, with many HMO and PPO plans without premiums or deductibles. Though quality is something of a question given the lack of NCQA ratings and average Star Ratings, for the range of plan types and price points, Anthem offers good choices.
How We Reviewed Medicare Providers
Even Medicare health plans with a national presence can vary locally in their cost, quality, and customer satisfaction. To evaluate Medicare plans, we looked at health insurance industry ratings from the primary accrediting agency for health plans, NCQA, and the Medicare Star Ratings from CMS, the regulatory agency that oversees Medicare. We included the National Association of Insurance Commissioners’ complaint index, and AM Best’s financial stability ratings. We also considered information from the companies on their programs and strategies.
Center for Medicare & Medicaid Services. “Part C and D Performance Data, 2021 Star Ratings Data Table.” Accessed Feb. 16, 2021.
Centers for Medicare and Medicaid Services. “2021 MA Landscape Source Files.” Accessed Feb. 16, 2021.
Medicare.gov. “What’s Medicare Supplement Insurance (Medigap)?” Accessed Feb. 16, 2021.
Kaiser Family Foundation. “Medicare Advantage 2021 Spotlight: First Look.” Accessed Feb. 16, 2021.
National Association of Insurance Commissioners. “Anthem Ins Co Inc National Complaint Index Report.” Accessed Feb. 16, 2021.
AM Best. “AM Best Affirms Credit Ratings of Anthem, Inc. and Its Subsidiaries.” Accessed Feb. 16, 2021.
NCQA. “NCQA Health Insurance Plan Ratings 2019-2020 – Summary Report (Medicare).” Accessed Feb. 16, 2021.
J.D. Power. “Medicare Advantage Plans Struggle to Communicate Effectively with Members, J.D. Power Finds.” Accessed Feb. 16, 2021.