Anthem Medicare Insurance Review

Who Is Anthem?

In 2004, WellPoint Health Networks and Anthem Inc. came together to create Anthem. 

Anthem currently has 2.3 million Medicare and Medicare Advantage members.

Anthem offers all three main types of Medicare insurance, which are;

 Medicare Advantage, Medicare Supplement, and Part D Prescription Drug plans (PDPs).

• Medicare: This is federal health insurance for people who are 65 or older. It covers medical costs for its members. You can pay a health insurance company for added benefits.

• Medicare Advantage: This is a health insurance plan with a private health insurer such as Anthem and covers medical costs that Original Medicare doesn’t cover. You will pay a monthly fee—known as a premium—to have this health insurance.

• Medicare Supplement or Medigap Plans: This is a health insurance plan that you can add to your current plan through a private health insurer to help cover your medical expenses if you are on Medicare or Medicare Advantage.

• Part D Prescription Drug Plan: This is a health insurance plan that covers your prescription drugs.

Anthem’s Medicare insurance plans are available in 14 states, including:

• California.

• Colorado.

• Connecticut.

• Georgia.

• Indiana.

• Kentucky.

• Maine.

• Missouri.

• Nevada.

• New Hampshire.

• New York.

• Ohio. 

• Virginia.

• Wisconsin.

Every year, Fortune magazine publishes a list of the 500 largest companies in America. Recently, Anthem ranked 33rd on this list. This makes it one of the biggest companies in the U.S. and one of the largest insurance providers. This is good news for members as they will have access to more doctors nationwide.

Pros and Cons

If you’re thinking about choosing an Anthem Medicare or Medicare Advantage Plan, you need to know the pros and cons first.

✅ Pro: Plenty of plans to choose from

Anthem has lots of Medicare and Medicare Advantage insurance plans, which makes them a great choice.

They offer:

• Anthem Medicare Advantage Health Maintenance Organization (HMO) plans.

• Anthem MedicareAdvantage Preferred Provider Organization (PPO) plans.

• Anthem MedicareAdvantage Special Needs Plans (SNPs) plans.

• Part D Prescription Drug Plans (PDPs).

• Medigap coverage.

They also offer Medicare Supplement Plans to help you pay for medical costs that government Medicare doesn’t cover.

Lots of insurance providers only give you Medicare Supplement Plans if you are on one of their Medicare Advantage Plans. But Anthem offers Supplement Plans even if you are only on Medicare.

The more options you can choose from, the better. You are more likely to find a plan that suits your needs well.

✅ Pro: Healthy living benefits

Anthem’s Medicare, or Medicare Advantage members, have access to extra healthy living benefits.

For example, Anthem Medicare Advantage members can receive $500 per year for safety features like handrails or wheelchair ramps. Also, members can get a fitness tracker to use when they exercise.

They have wellness tools to help you stay healthy, like weight management information and personalized coaching.

Anthem also gives members discounts when they buy healthy products or sign up for gym memberships. They offer maternity care and support for women who are pregnant. They can be paired with a nurse to be their pregnancy coach.

Anthem has a team of nurses called the ConditionCare team who can answer questions if you have a chronic medical condition.

✅ Pro: A useful mobile app

Anthem offers a useful mobile app that members can use to:

• Access a digital version of their membership ID card.

• Find health care professionals.

• Check on their specific plan benefits

• Monitor their costs.

• Ask questions.

• Sync their plan with their fitness tracker.

✅ Pro: Resources for caregivers

If you need help from a caregiver, Anthem Medicare or Medicare Advantage Plans may be a good choice for you.

This is because the insurance company helps your caregiver to do a better job.

They give caregivers access to your profile so that they can pay bills on your behalf, as well as review claims for you and manage your medications.

✅ Pro: More benefits

Anthem gives members extra free benefits like transport, help with housework, or money for health devices.

✅ Pro: Virtual health care

Perhaps one thing the pandemic has taught us all is that it’s not always possible to receive health care services in person.

Anthem’s Medicare Advantage Plans give members free online health care visits with LifeHealth Online.

They also have a 24/7 nurse service, meaning you can speak to a health professional whenever you need to. 

They also offer a pharmacy support service where you can call a pharmacist at any time. This saves you a trip to the emergency room or to the pharmacy.

❌ Con: Geographical restrictions

Anthem’s Medicare insurance plans are only available in 14 U.S. states. This means that you may not be able to access their services if you live in any of the other states.

It’s worth noting that their Blue Cross Shield plans are offered in 23 states.

❌Con: Denied claims

Compared to all other health insurance providers in the U.S., Anthem denies claims twice as often as the industry average.

In 2019, Anthem denied 36% of member claims, whereas the average rate of denied claims across the industry was 17%.

Anthem says they usually deny claims because a deadline was missed or because the medical treatment was not necessary.

❌ Con: Customer complaints

In the past, Anthem has gotten into trouble for not giving coverage and canceling plans for members who need more expensive medical care.

They have also been fined for not resolving member complaints within a reasonable time.

Anthem’s Medicare Star Rating ⭐️⭐️⭐️⭐️

Health insurance companies get a star rating for their Medicare insurance plans from the Centers for Medicare and Medicaid Services (CMS).

CMS is a government agency in the Department of Health and Human Services (HHS) that runs the federal Medicare program. It works in partnership with state governments to provide medical coverage for elderly citizens. 

Here’s what the different star ratings mean:

(No stars): New Plan

⭐: Poor

⭐⭐: Below average

⭐⭐⭐: Average

⭐⭐⭐⭐: Good

⭐⭐⭐⭐⭐: Excellent

The star ratings are released every October, and every star represents the quality and level of service the insurance company provides.

An insurance company’s star rating can help you decide if they are a good option for you. You’d want to choose an insurance provider with a good star rating.

The rating insurance companies can receive is between zero and five stars.

CMS rates health plans based on various factors such as member rating and the insurer's ability to:

• Ensure policyholders stay healthy.

• Assist members in managing their chronic conditions.

• Make sure their members have a positive experience while being enrolled in one of the provider’s plans through effective customer service.

The national average for most insurance companies is over four stars. Anthem’s Medicare Advantage Plans only received three-and-a-half stars from CMS up to 2020.

In 2021, Anthem achieved a four-star rating, which is the highest they’ve ever received.

Anthem says their improved rating is because they are giving members high-quality and affordable services.

Other Third-Party Ratings

Besides their CMS rating, Anthem’s Medicare Plans are reviewed by other organizations. These are called third-party reviewers. In other words, Anthem is reviewed by companies and members who are not employed by Anthem.

These ratings are to help people choose the right health insurance provider for them. If an insurance provider has bad third-party reviews, you’ll not it’s not the right choice for you.

You want to choose a health insurance provider with good reviews so that you have a good experience.

Consumer affairs

There are over 400 reviews about Anthem on Consumer Affairs, and their rating is under two stars. However, there are many insurance plans who have two stars or lower on Consumer Affairs.

They have two stars because they have received lots of negative reviews on the Consumer Affairs website. Most of these reviews are about poor service or denied claims.

It’s worth noting that these reviews cover all Anthem’s health insurance products, not only their Medicare offering.

Considering the insurance company is so large, the volume of complaints is not all that high.

Most of these reviews are complaints about denied claims and bad customer service.

Here is an example of a Consumer Affairs review for Anthem Medicare:

source: consumeraffairs

JD Power

A company called JD power does research about Medicare Advantage Plans. They are a third-party company, which means that they are not part of Anthem.

JD Power reviews Medicare and Medicare Advantage providers based on:

• Member satisfaction with coverage and benefits.

• The choice of doctors and pharmacies they offer.

• The cost of their health insurance plans.

• How they communicate information to their policyholders.

• How they handle billing and payments.

In their 2021 US Medicare Advantage Study, JD Power awarded Anthem 791 points out of 1,000.

Anthem’s JD Power rating isn’t something to worry about. This is because the industry average is 806 out of 1,000 points, and Anthem’s rating is close to that.

In JD Power’s study, Anthem ranked eighth out of the top 10 health insurance providers for Medicare Advantage Plans.

This graph indicates the customer satisfaction ranking in JD Power’s study:

Source: JD Power

AM Best

AM Best is a credit rating agency that rates the financial security of insurance companies.

You would want to choose a Medicare or Medicare Advantage insurance provider that is financially stable.

AM Best has given Anthem a rating of A—excellent—for their Blue Cross Blue Shield insurance subsidiaries.

This rating shows that AM Best believes Anthem is a good insurance company.

How Does Anthem Medicare Insurance Compare to Other Medicare Providers?

You need to compare Medicare health insurance companies to decide which one is right for you. 

Comparing providers gives you a better idea of what you can expect from Anthem if you choose them and when you’re weighing up the pricing of their plans.

Anthem Medicare vs. UnitedHealthcare 

UnitedHealthcare has the largest footprint of all the Medicare providers in America. In other words, United Healthcare covers almost every state, while Anthem only offers plans in 14 states.

• They have 4.4 million Medicare members. Anthem has 2.3 million Medicare members.

• Anthem has more Medicare and Medicare Advantage Plan options to choose from compared to United Healthcare.

• United Healthcare’s average Medicare star rating is over three and a half stars, while Anthem is now at four stars, as mentioned above.

Anthem Medicare vs. Aetna

Aetna Medicare Advantage is available in 46 states with a Medicare star rating of over three and a half stars.

It has around 9.2 million Medicare members across the U.S.

Anthem Medicare vs. Humana

Founded in 1961, Humana health insurance is available in 14 of the 50 U.S. states and currently serves over 20 million people.

Humana health insurance plans are available in Alabama, Arizona, Florida, Georgia, Kentucky, Louisiana, Michigan, Mississippi, North Carolina, Tennessee, Texas, Utah, and Virginia.

It has a Medicare star rating of three out of five stars, which is where Anthem outperforms them.

The biggest difference between these companies is that Humana doesn’t offer individual and family health plans anymore.

Medicare Advantage Plans Offered by Anthem 

Anthem offers both health maintenance organization (HMO) and preferred provider organization (PPO) plans.

Medicare Advantage Plans are health insurance plans for people who want or need more medical coverage than what they can get from Original Medicare. Medicare Advantage is provided by a private insurance company and not the government.

If you are an Anthem Medicare Advantage member, you will get extra benefits like fitness, dental, vision, and hearing aid benefits.

HMO plans

Anthem’s Medicare Advantage HMO plan is called Anthem MediBlue HMO. 

Members are required to choose a primary care provider (PCP) who would oversee most of their care. This PCP is a gatekeeper to seeing specialists.

Anthem’s HMO plans have lower monthly premiums than its other plans.

PPO plans

Anthem’s preferred provider organization (PPO) plans are called Anthem MediBlue PPO. They offer flexibility, because accessing providers is easier than it would be on an HMO plan since you have more doctors and pharmacies to choose from.

Members will still need to choose a PCP, but won’t need referrals to see a specialist or a different doctor.

Also, members can see health care providers outside of the Anthem-approved network, but this may cost more than seeing your PCP. Many other Medicare providers don’t cover visits to doctors outside their approved network.

Special needs plans

Anthem offers two different types of Special Needs Plans (SNPs). 

An SNP is a Medicare Advantage Plan for people with special needs, like disabilities or chronic conditions that stop them from living a normal life.

1. The first is a Dual-Eligible Special Needs Plan (D-SNP) for Medicare enrollees who also have Medicaid. 

D-SNPs are for people who should be getting Medicare and Medicaid help.

2. The second is a Chronic Condition Special Needs Plan (C-SNP) which is for members with specific conditions and medical needs.

C-SNPs are for people who have special needs such as disabilities. 

These SNPs give you all the benefits of a Medicare Advantage Plan, but with extra services, programs, and providers for people with special needs, including:

• Extra support from care providers.

• Prescription drug coverage.

• Rides to health care appointments.

• Free healthy meals.

How Much Do Anthem Medicare Advantage Plans Cost?

The cost of your Anthem Medicare Advantage Plan will depend on your monthly premium and other expenses. The cost also depends on where you live and your health needs.

Your monthly premium

Of course, one big cost to think about is the monthly premium you will pay to be an enrolled member.

Your premium is affected by which plan you choose and the type of Medicare plan you need.

Three in every five Anthem Medicare Advantage Plans have $0 premiums. This means you won’t pay a monthly fee to be a member. 

Instead, you will only pay for the health care services you receive.

The premiums for Anthem Medicare Advantage Plans range from $2.10 to $172 per month, including Medicare Part C and Part D coverage.

For SNPs, the monthly premium can be anything from $1.70 to $59. 

Medicare Part B premiums

Remember that even though you are a Medicare Advantage member, you will still need to pay your premium for your Medicare.

In 2022, this premium is $170.10. Some of Anthem’s plans will cover a part of your Part B premium.

Deductibles and out-of-pocket maximums

Deductibles are what you pay for health care services before your Medicare Advantage insurance starts to pay. Deductibles on Anthem Medicare Advantage Plans can be from $0 to $445 per month.

Some of Anthem’s HMO plans have no deductibles. 

Your Medicare Advantage Plan will also have an out-of-pocket maximum. This is the limit on the amount of money you pay when you visit doctors that Anthem doesn’t cover.

In other words, you will need to contribute money out of your own pocket to your medical costs. But the amount of money you will have to pay is limited to a certain amount. The limit is called an out-of-pocket maximum.

From Anthem’s HMO plans, the out-of-pocket maximum for in-network providers can range from $900 to $7,550 per year.

For their PPO plans, Anthem’s out-of-pocket maximums are anything from $4,900 to $5,500 per year.

Co-payments and coinsurance

Co-payments and coinsurance are costs you will need to pay for your medical treatment. Anthem doesn’t pay for your doctor’s visit in full. You will need to pay some of the cost.

If you were to visit a PCP, the average co-payment would be around $60 and $150 to get urgent care.

Co-payments and coinsurance with Anthem Medicare will depend on the plan you choose.

• Gold Plan: Covers 80% of your medical bill.

• Silver Plan: Covers 70% of your medical bill.

• Bronze Plan: Covers 60% of your medical bill.

If you are on their Gold Plan, you could have a co-payment of up to $30 for a PCP visit.

A Bronze Plan could have a co-payment of $75 for the same service. 

The higher your monthly premium, the lower your co-payments and coinsurance will be.

Anthem Medicare Part D Plans

Also known as a prescription drug plan (PDP), Medicare Part D helps members pay for self-administered prescription medication.

Anthem offers three Part D plans, which work with your coverage for Parts A and B. Currently, Anthem covers over 66,000 pharmacies nationwide.

• Their first Part D plan, MediBlue RX Enhanced Part D Plan, has the lowest premium but has a deductible of $300. 

This means you won’t pay much for your premium, but you will pay a lot for your prescription drugs. This is the right plan for you if you don’t take much medication.

• Their second, the MediBlue Rx Plus Part D Plan, includes the largest medication list of all their PDPs and has no pharmacy deductibles. They also offer further savings at certain pharmacies. This plan is right for you if you take a lot of medication.

For MediBlue Rx Plus, tier one drugs start at $1.00, and tier two drugs start at $3.00. 

Any tier three or four medications have a coinsurance percentage of 38% and 33%, respectively.

• Lastly, their MediBlue Rx Standard Part DPlan offers savings on prescriptions at preferred pharmacies and includes more extensive coverage. 

This plan’s monthly premium is higher, but this is contrasted with low out-of-pocket costs and more full-scale drug coverage. If you visit more than one pharmacy to get your medication, this may be the right option for you.

Medicare Supplement Plans Anthem Offers

The Supplement Insurance Plans that Anthem Medicare has will cover some of the costs that Original Medicare won’t cover. This is also called Medigap.

Medicare Supplement Insurance helps cover the costs that the government version of Medicare won’t pay.

There are different kinds of Medicare Supplement Plans. Some will cover things like dental and vision insurance, and others will cover hospital visits. 

You need Medicare Supplement Insurance if your medical needs are more than what the government Medicare will cover.

Anthem’s Supplement Insurance Plans usually offer most Medigap members additional benefits, including fitness benefits.

Tips for Finding the Right Anthem Medicare Advantage Plan

There are a few things you need to think about before you decide on the right Anthem Medicare or Medicare Advantage Plan. You would need to:

• Understand the costs of the plan, like your monthly premiums, deductibles, co-payments, and coinsurance. 

• Check that the plan covers the health care providers you visit.

• Check that the plan covers the prescription drugs you take.

• Understand what the plan does and doesn’t cover. If you have certain medical needs, you’ll want to ensure the plan you choose will cover them.

• Choose a plan that offers extra benefits like discounted gym memberships if this is  important to you.

Where Can I Learn More about Medicare Advantage Plans?

You can visit Anthem’s website to find out more about their Medicare Advantage Plans and everything that is covered by each plan. 

To learn more about Medicare Advantage Plans in general, check out the various insights we have on our website. 

Final Thoughts on Anthem Medicare

One thing that makes Anthem Medicare different from its competitors is that they have a lot more Medicare, Medicare Advantage, PDP, and Supplement plans.

Although their CMS ratings haven’t been very good in the past, their most recent improved four-star rating indicates that the insurance company takes the services they provide seriously.

Many health insurance companies don’t have plans that come without a premium or deductibles. 

Anthem offers several HMO and PPO plans without any premiums or deductibles, which makes them a good choice if you’re on a budget.

Based on their extensive coverage, additional benefits, and their range of plans, Anthem Medicare is an excellent choice when it comes to Medicare insurance.

Our goal at PolicyScout is to make Medicare easy to understand and help you make the best choice.

If you need more help, take a look at our Medicare hub. You can also call us at 1-844-569-0988 or send an email to help@PolicyScout.com.

Frequently Asked Questions (FAQs) about Anthem Medicare 

Is Anthem a good Medicare Advantage Plan?

For many, Anthem Medicare Advantage is the right choice when it comes to health insurance. 

The insurance company has a big network of doctors and wide many plans to choose from—which means there’s something for everyone.

It’s worth keeping in mind that Anthem Medicare isn’t available in all U.S. states and that some reviews mention denied claims.

If you review the details of the plan you choose carefully, you should avoid running into issues with denied claims.

Anthem Medicare offers eight Medicare payment options. This makes it easier for you to pay for your health insurance. 

You can pay via phone call or mail. You can also set up an automatic bank withdrawal or a credit/debit card charge.

What type of insurance is Anthem?

Anthem offers various different types of medical insurance, including HMO, PPO, and SNPs. 

They also offer PDP coverage, supplemental plans, and short-term insurance.

Anthem’s insurance is available to individuals and families. Senior citizens can sign up for Medicare and Medicare Advantage Plans. 

Those with a low income can receive Medicaid coverage underwritten by Anthem.

Who has the best-rated Medicare plan?

There is no single ‘best plan’ when it comes to Medicare. Your needs and preferences will determine what the best Medicare option is for you.

Blue Cross Blue Shield, Humana, and United Healthcare have the highest ratings for health insurance providers in many states.