Anthem Medicare Insurance Review

Pros Explained

• Additional drug coverage in the Medicare donut hole: Most Medicare Advantage plans with prescription drug coverage offer additional coverage in the Medicare donut hole or coverage gap. This is a valuable feature if you have or expect to pay a lot for prescription drugs.
• Reasonably priced premiums: The average premium across all 2023 Anthem Medicare Advantage plans is $17.47 per month. This is lower than the industry average and better than major competitors like Cigna and Kaiser Permanente.
• Well-rated Part D drug plans: Anthem’s Part D prescription drug plans (PDP) have a 4.0 Medicare star rating, on average, from the Centers for Medicare and Medicaid Services (CMS). That’s higher than any other major provider, though Humana is a close second.

Cons Explained

• Limited state availability: Anthem’s Medicare Advantage plans are only available in 12 states: Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, Ohio, Virginia, Wisconsin.
• Below average customer satisfaction score: Anthem is rated below average for overall customer satisfaction in the J.D. Power 2022 Medicare Advantage Study.
• High limits on maximum out-of-pocket expenses: Medicare Advantage plans cap your annual expenses, but some have higher caps than others. The maximum you’re liable to spend with an Anthem Medicare Advantage plan is higher compared to any of the major Medicare players, on average.

Third-Party Ratings

Anthem has very good third-party ratings in some categories. The company’s Medicare Advantage plans have an average Medicare star rating of 3.9. Its Part D prescription drug plans get 4.0 stars on average, which is the highest Medicare star rating for PDP plans of all major Medicare providers. 

However, the National Committee for Quality Assurance (NCQA), which ranks MA plans based on member experience and plan performance, gives a lower average rating—3.52 stars, putting it below competitors like Aetna and UnitedHealthcare. 

Anthem also has excellent financial strength, according to AM Best. The independent ratings agency gives Anthem an A (Excellent) grade, which indicates Anthem can easily cover financial obligations like paying claims. 

But the company didn’t fare so well in J.D. Power’s 2022 U.S. Medicare Advantage Study. Anthem received a score of 791 out of 1,000, which is below the industry average score of 809. Anthem was ranked seventh out of nine Medicare Advantage providers. 

Policies Available

Medicare Advantage (Part C) Plans

Medicare Advantage Plans, also called Medicare Part C, provide Part A (hospital Insurance) and Part B (medical insurance) coverage. Most of Anthem’s Part C plans also include coverage for prescriptions. And many offer vision, dental, hearing, telehealth, fitness, and non-emergency transportation benefits. 

Some Anthem plans are available with $0 physician copays. And most plans with drug coverage provide additional coverage in the Medicare donut hole or coverage gap. 

Anthem sells Medicare Advantage PPO and HMO plans, both called MediBlue. 

Part D Prescription Drug Plans

Anthem offers several ways to get Medicare Part D (prescription drug coverage). You can purchase a standalone Plan D to supplement Original Medicare, or you can select an Anthem Medicare Advantage HMO or PPO plan with drug coverage. Note that most of Anthem’s standalone Part D plans don’t provide additional drug coverage during the gap period. This means that you’ll pay 25% for brand name and generic drugs once you and your plan spend $4,660 on prescriptions in 2023. You leave the gap (which means much lower copays) once you spend $7,400 out-of-pocket on medications.

There are two Part D plans available—MediBlue Rx Standard and MediBlue Rx Plus. MediBlue Rx Standard has a $350 deductible and Rx Plus has a $0 deductible. Both plans have $1 to $5 copays for most generic drugs (outside of the gap phase).  But the Rx Plus plan has a bigger list of drugs that are covered.

Medicare Supplement Plans (Medigap)

Anthem offers a few Medicare supplement plans, including Medigap Plans A, F, G, and N. Medigap plans pay for a portion of the out-of-pocket costs that Original Medicare doesn’t cover, like deductibles and copays. Note that you’re only eligible for Plan F if you became eligible for Medicare before Jan. 1, 2020.

Special Needs Plans

There are three Special Needs Plans (SNPs) that Anthem sells. The Dual-Eligible SNP (D-SNP) is available to people who qualify for Medicare and Medicaid. It provides coverage for vision, dental, hearing, and prescription drugs.

The Chronic Condition SNP (C-SNP) offers coverage for people with more serious medical conditions. Most C-SNP plans also have $0 or low monthly premiums, $0 deductibles, and other benefits. 

If you currently need or are expected to need long-term care for more than 90 days in a skilled nursing facility, you can also qualify for the Institutional SNP (I-SNP) plan.

Dental and Vision Insurance

Anthem sells standalone dental and vision insurance through the Anthem Extras package, which can supplement your Original Medicare, Medicare Part D, or Medigap plan. There are several tiers of coverage you can choose from, which differ in terms of cost and annual benefits.

Cost

The cost of Anthem’s Medicare Advantage plans depends, in part, on how much you use it. Premiums are well-priced, relative to major competitors. But Anthem doesn’t do nearly as good a job at limiting your out-of-pocket costs. 

Below are the average premium, average prescription drug deductible, and average out-of-pocket maximum for the company’s Medicare Advantage plans for 2023:

• Average premium: $17.47 (better than average)
• Average drug deductible: $101.31 (about average) 
• Average out-of-pocket maximum: $5,710.90 (much higher than average)

For comparison, Humana’s average premium is $22.40 per month, while Cigna’s is $5.23. Each company’s maximum out-of-pocket limits average $5,463.88 and $5,245.96, respectively.

Customer Service

Anthem has good customer service options. To purchase a new Medicare plan, you can call the company at (855) 949-3319 between 8 a.m. and 8 p.m. ET, seven days per week. Current customers can use the Sydney Health app to view benefits and claim information, manage prescriptions, view ID cards and chat with a live Anthem representative.

Methodology

Literature Review

We identified top companies by market share within the industry offering Medicare plans from various business and market insight databases including Statista, Plunkett, and Gale. We also considered user-generated data from Google to determine public interest and trends in Medicare plans. 

Data Collection and Verification

Our data was collected through third-party rating agencies, official government websites and databases, and directly from companies via websites, media contacts, and existing partnerships. Our sources include: AM Best, the National Committee for Quality Assurance (NCQA), J.D. Power, and the Centers for Medicaid and Medicare Services (CMS).

Data was verified to ensure data integrity and accuracy by cross-referencing the records and citation corresponding to each data point with our primary sources.

Ratings Methodology

We calculated star ratings for the quality of each company’s plan types. Factors considered for companies offering Medicare plans were: 

• Plan quality and customer satisfaction: CMS and NCQA ratings were considered to measure these criteria. Each organization independently rates the quality of Medicare plans on a one-to-five scale to help people compare plans during open enrollment. 
• Cost to value: This is a measure of plan value based on plan premiums, deductibles, maximum out-of-pocket amounts, whether additional drug coverage is offered in the Medicare gap, and star ratings.
• Additional coverage offered in the Medicare gap: The coverage gap or "donut hole" refers to a period when there is a limit on drug coverage. During this time, members are responsible for up to 25% of brand name and generic drugs. You may spend less on prescription drugs if your plan provides additional coverage during the gap.
• State availability: This measure indicates how widely available plans are across the U.S.
• Additional plan benefits: This measure concerns additional benefits available, including vision, dental, hearing, non-emergency transportation, worldwide emergencies, gym memberships, and telehealth. 
• Types of plans available: Insurance companies offer Medicare Advantage plans through managed care organizations, including HMOs and PPOs. This measure concerns the number of managed care options available.
• Special needs plans: This is a measure of whether the company offers plans designed for those with specific diseases.
• Financial strength: This measure accounts for each company’s AM Best financial strength rating to understand how well it’s positioned to pay insurance claims. 

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