3.6 CMS Star Rating Anthem's plans offer a range of benefits and flexible care, but plans are available in only 14 states and receive below-average star ratings. (855) 608-4561 / TTY 711 8am - 11pm EST, 7 days a week Speak to a licensed insurance agent on MedicareEnrollment.com from MedicareEnrollment.com States available 14 states Members in high-rated plans Low (49% or less) Member experience 2.98 (Average) States available 14 states Members in high-rated plans Low (49% or less) Member experience 2.98 (Average) Pros Cons
Anthem
Anthem is one of the brands of parent company Elevance Health. Anthem-branded Medicare Advantage plans are available in 14 states as part of the Blue Cross Blue Shield collective .
Anthem plans offer competitive premiums and plenty of $0-premium options, but their ratings for quality and member experience are below average.
Here’s what you should know about Anthem Medicare Advantage.
Anthem Medicare Advantage pros and cons
Anthem’s offerings have advantages and disadvantages.
Pros
Wide-ranging benefits: Most Anthem plans cover prescription drugs and have dental, vision, hearing and wellness benefits beyond what’s included in Original Medicare.
Flexibility for additional benefits: Anthem plans let some members choose from a menu of benefits and services — like transportation, money toward household utilities or an allowance to spend on assistive devices — to add to their plan at no extra cost.
Flexible care options: Anthem members may have access to a 24/7 nurse line and 24/7 online appointments for virtual care.
Cons
Available in relatively few states: Anthem offers Medicare Advantage plans in only 14 states.
Below-average ratings: Anthem plans' average star rating from CMS, weighted by enrollment, is 3.6 stars (the national average for all providers is 4.04 stars).
Fewer members in 4-star or better plans: Of Anthem’s plans with star ratings, 40% of members were in plans rated 4 stars or better as of March 2024. That’s a lower rate than most major Medicare Advantage providers.
» MORE: Best Medicare Advantage plans
Anthem Medicare Advantage star ratings
Average star rating, weighted by enrollment: 3.6
CMS maintains star ratings for Medicare Advantage and Medicare Part D plans on a 5-point scale, ranking plans from best (5 stars) to worst (1 star). The agency bases these ratings on plans’ quality of care and measurements of customer satisfaction, and ratings may change from year to year.
All Medicare Advantage plans are evaluated on health plan measures, and Medicare Advantage plans that include prescription drug coverage are also evaluated on drug plan measures. Based on the most recent year of data and weighted by enrollment, Anthem’s 2024 Medicare Advantage plans get an average rating of 3.6 stars.
For comparison, the average star rating for plans from all providers in 2024 is 4.04.
Of Anthem members in contracts with a Medicare star rating, 40% were in contracts rated 4.0 or above as of March 2024.
You can find a plan’s rating with the Medicare plan-finding tool.
Still deciding on the right carrier? Compare Medicare Advantage plans
What does Anthem Medicare Advantage cost?
Costs for Medicare Advantage plans depend on your plan, geographic location and health needs.
Premiums
One of the costs to consider is the plan’s premium. About 3 in 5 (59%) Anthem Medicare Advantage plans have $0 premiums.
Even as a Medicare Advantage user, you’ll still be responsible for paying your Medicare Part B premium, which is $174.70 per month in 2024, although some plans cover part or all of this cost. (Most people pay this standard amount, but if your income is above a certain threshold, you'll pay more.)
Copays, coinsurance and deductibles
Requirements for copays, coinsurance and deductibles vary depending on your plan, location and the services you use. Other out-of-pocket costs to consider include:
Whether the plan covers any part of your monthly Medicare Part B premium.
The plan’s yearly deductibles and other deductibles, such as a drug deductible.
Copayments and/or coinsurance for each visit or service. For instance, there may be a $10 copay for seeing your primary doctor and a $45 copay for seeing a specialist.
The plan’s in-network and out-of-network out-of-pocket maximums.
Whether your medical providers are in-network or out-of-network or how often you may go out-of-network for care.
Whether you require extra benefits and whether the plan charges for them.
Here are examples of Anthem Medicare Advantage costs for the most popular plans in a mid-range city:
Anthem Medicare Advantage plan | Pricing |
|---|---|
Anthem Medicare Advantage (PPO) | Monthly premium: $0. Out-of-pocket max: $7,550. Copays:
|
Anthem Grocery (HMO) | Monthly premium: $0. Out-of-pocket max: $4,900. Copays:
|
Anthem I Carelon Medicare Advantage (HMO) | Monthly premium: $0. Out-of-pocket max: $3,850. Copays:
|
Selected plans are available in ZIP code 23173. | |
Sources: Anthem Healthkeepers. Summary of Benefits — Anthem Grocery (HMO). Anthem Healthkeepers. Summary of Benefits — Anthem I Carelon Medicare Advantage (HMO). | |
To get a sense of costs, use Medicare’s plan-finding tool to compare information among available plans in your area. You can select by insurance carrier to see only Anthem plans or compare across carriers.
Anthem Medicare Advantage plan types
There are several kinds of Anthem Medicare Advantage plans, and they vary in terms of structure, costs and benefits. Anthem offers Medicare Advantage prescription drug plans, or MAPDs, as well as stand-alone prescription drug plans and Medicare Advantage plans without drug coverage.
Plan offerings include the following types:
HMO plans
A health maintenance organization (HMO) generally requires that you use a specific network of doctors and hospitals. You may need a referral from your primary doctor in order to see a specialist, and out-of-network benefits are usually very limited.
HMO-POS plans
HMO point-of-service (POS) plans are HMO plans that allow members to get some out-of-network services, but you’ll pay more for those services.
PPO plans
Preferred provider organization (PPO) plans provide the most freedom, allowing you to see any provider that accepts the insurance. You may not need to choose a primary doctor, and you don’t need referrals to see specialists. You can seek out-of-network care, although it may cost more than seeing an in-network doctor.
SNPs
Special needs plans (SNPs) restrict membership to people with certain diseases or characteristics. Hence, the benefits, network and drug formularies are tailored to the needs of those members. Anthem offers three types of SNPs:
Chronic Condition SNP: Designed to meet the needs of members with certain chronic conditions, such as diabetes, congestive heart failure and cardiovascular disease.
Dual-Eligible SNP: For people who are entitled to Medicare and who also qualify for assistance from a state Medicaid program.
Institutional SNP: For people living in an Anthem network nursing home or assisted living community or another plan-approved spot.
Available Anthem Part D prescription drug plans
Most of Anthem’s Medicare Advantage plans include Part D drug coverage, but the company also sells stand-alone Part D prescription drug plans, or PDPs, in 12 states. These plans provide drug coverage for people enrolled in Medicare Part A and Part B, so they don’t provide medical coverage.
Anthem offers two plan options in each state where it sells stand-alone prescription drug plans: a standard option and a “plus” option with enhanced coverage. For example, if you live in Madison, Wisconsin, you have these two options from Blue Cross Blue Shield of Wisconsin:
Anthem MediBlue Rx Standard.
Anthem MediBlue Rx Plus.
Here’s how those plans compare:
Plan feature | Anthem MediBlue Rx Standard | Anthem MediBlue Rx Plus |
|---|---|---|
Monthly premium | $83.60. | $89.50. |
Annual deductible | $545. | None. |
Drug copay, Tier 1* | $1. | $1. |
Drug copay, Tier 2* | $2. | $4. |
Drug copay, Tier 3* | 20%. | $47. |
*For a 30-day supply of a covered Part D prescription drug at a preferred retail pharmacy after meeting any applicable deductible. | ||
Source: Anthem. Compare Part D Plans. | ||
Premiums, deductibles, covered drugs, costs for each tier and pharmacy arrangements all differ by plan.
Anthem Medicare Advantage third-party ratings
A few companies weigh in on health plans or on the strength of the company in question, and we’ve included two:
AM Best Financial Strength Rating: A (Excellent)
AM Best is a credit rating agency that specializes in the insurance industry. In December 2023, AM Best affirmed its Financial Strength Rating of A for the core Blue Cross Blue Shield-branded insurance subsidiaries of parent company Elevance Health. An A rating in this category indicates that AM Best believes the company has an excellent ability to meet its ongoing insurance obligations.
J.D. Power Ranking
In its 2023 U.S. Medicare Advantage Study — the ninth it’s done so far — J.D. Power measured member satisfaction with Medicare Advantage plans based on eight factors ranging from level of trust to how well a provider resolves problems or complaints. The study was fielded in the five biggest Medicare markets, and here’s how Elevance Health, Anthem’s parent company, ranked out of all major providers. (Elevance Health sells plans in three of the five markets.)
California: 6th out of 7.
Florida: 4th out of 6.
New York: 5th out of 8.
Anthem Medicare Advantage service area
Anthem offers Medicare Advantage plans in 14 states.
Anthem's parent company, Elevance Health, is the fourth-largest for-profit Medicare Advantage provider. Elevance plans cover nearly 2 million Medicare Advantage beneficiaries, but the company lost 25,000 members for the 2024 plan year.
About Anthem
Anthem's parent company, Elevance Health, is headquartered in Indianapolis and was formed in 2004 out of a merger between WellPoint Health Networks and Anthem. In 2022, the company changed its name to Elevance Health, but it continues to sell Medicare products under the Anthem brand.
Elevance Health offers commercial health insurance for individuals and employers; Medicare Advantage, Medicare Supplement Insurance and Medicaid plans; life, disability, dental and vision insurance; and services for other government health insurance programs.
» MORE: Read our review of Anthem Medicare Supplement Insurance
Anthem Medicare Advantage customer service number
Here’s how Anthem members can contact customer service:
Call a state-specific phone number. Log in or select your state on Anthem’s Contact Us page to find the number and hours.
Chat on anthem.com or in Anthem’s Sydney Health app for Android or iOS.
Email [emailprotected].
Compare Medicare Advantage providers
Get more information below about some of the major Medicare Advantage providers. These insurers offer plans in most states. The plans you can choose from will depend on your ZIP code and county.
AARP Medicare Advantage plans.
Aetna Medicare Advantage plans.
Anthem Medicare Advantage plans.
Blue Cross Blue Shield Medicare Advantage plans.
Cigna Medicare Advantage plans.
Humana Medicare Advantage plans.
Kaiser Permanente Medicare Advantage plans.
UnitedHealthcare Medicare Advantage plans.
Wellcare Medicare Advantage plans.
Find the right Medicare Advantage plan
It’s important to do your research before selecting a Medicare Advantage plan for yourself. Here are some questions to consider asking:
What are the plan’s costs? Do you understand what the plan’s premium, deductibles, copays and/or coinsurance will be? Can you afford them?
Is your doctor in-network? If you have a preferred medical provider or providers, make sure they participate in the plan’s network.
Are your prescriptions covered? If you’re on medication, it’s crucial to understand how the plan covers it. What tier are your prescription drugs on, and are there any coverage rules that apply to them?
Is there dental coverage? Does the plan offer routine coverage for vision, dental and hearing needs?
Are there extras? Does the plan offer any extra benefits, such as fitness memberships, transportation benefits or meal delivery?
If you have additional questions about Medicare, visitMedicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).
Medicare Advantage review methodology
The Medicare Advantage marketplace is concentrated among just a handful of companies; in many places, one insurer serves more than half of the market. NerdWallet reviewed 26 Medicare Advantage brands, with some insurers having more than one brand under their umbrella. (For example, Blue Cross Blue Shield includes the brands Anthem and Highmark.) At the national level, these reviews include nine of the 10 largest brands by enrollment. At the state level, our research includes at least one major insurer in 47 of the 49 states that offer Medicare Advantage plans, and includes the top two insurers in 35 of those states. (Alaska doesn't offer Medicare Advantage plans.) We also look at online search volume to identify regional and other notable players in the space.
NerdWallet’s Medicare Advantage reviews are based on ratings data from the Centers for Medicare & Medicaid Services, as well as pricing, plan availability by state, plan types available, consumer experience, extra benefits offered and more. These reviews are a guide, but we encourage you to shop around and compare several plans to find the best coverage and rate for you. NerdWallet does not receive compensation for any reviews. Read our editorial guidelines for additional information.
