Anthem Medicare Advantage Review

Kat Casna
Licensed Insurance Agent and Medicare Expert Writer
August 26, 2019

Anthem is part of the nationwide Blue Cross Blue Shield (BCBS) network of health insurers. This company offers plans in 14 states and made the U.S. News list of “Best Insurance Companies for Medicare Advantage 2019” in three of those states.1

If you’re looking for HMO or PPO plan options that include Part D drug coverage, Anthem Blue Cross Blue Shield could be the right choice for you.

States Anthem serves

  • California*
  • Colorado
  • Connecticut
  • Georgia
  • Indiana
  • Kentucky
  • Maine
  • Missouri*
  • New Hampshire
  • Nevada
  • New York
  • Ohio
  • Wisconsin
  • Virginia*

*Listed in “U.S. News Best Insurance Companies for Medicare Advantage 2019”

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Is an Anthem Medicare Advantage plan right for you?

While Anthem plans are making headlines in some states, that doesn’t mean they’re the right choice for everyone. People in the following groups may find that Anthem’s Medicare Advantage plans meet their needs:

  • People looking for a network: Most Anthem plans (HMOs and PPOs) require or prefer that you stay in a provider network.
  • People who need drug coverage too: Many Anthem plans come with drug coverage already included.
  • Dual eligible: Anthem has plans that cater to people who qualify for both Medicare and Medicaid.

Anthem Medicare Advantage coverage

Blue Cross Blue Shield is the third-largest Medicare Advantage health care provider in the nation.3 While Anthem is just one of 36 BCBS companies, it serves over 1.1 million Medicare Advantage beneficiaries across 14 states.4 Many BCBS companies serve just one or a handful of states.5

Anthem offers several types of Medicare Advantage plans. Plans vary by location, so contact our licensed sales agents today to find out what’s available in your area.

Anthem HMO plans

Anthem Medicare Advantage HMOs are managed care networks that require beneficiaries to use in-network doctors and hospitals to get coverage (except in an emergency, of course). You’ll also need to declare a primary physician and obtain a referral to see a specialist.

These plans can cover prescription drugs, hearing care, and the SilverSneakers fitness program. Some plans include vision and dental coverage at no additional cost, while others allow you to add these coverage options for an additional premium.

HMO plans could be a good choice if you don’t mind staying in network when receiving non-emergency medical care. Anthem’s variety of HMO options means you may find one that fits your needs.

Not sure if you want an HMO? Read our page on understanding HMO Advantage plans.

Anthem HMO-POS plans

Health Maintenance Organizations with a point-of-sale option (HMO-POS) are less common than straight HMOs, but they allow more freedom for the beneficiary to choose providers. With this option, you can go out of network to receive care, but it’ll cost you more. And you may still need to work with your primary care physician to obtain prior authorization for some services.

While out-of-network costs can add up quickly, an HMO-POS could be the right choice if you’re not satisfied with your local in-network provider options.

Anthem PPO plans

If you choose a Preferred Provider Organization (PPO), you won’t have to stay in a network to receive care. Some insurers, like Anthem, still create a network because it allows these companies to negotiate lower costs with some care providers.

In short, you may have lower healthcare costs if you stay in network, but you might avoid declaring a primary physician or get a referral to see a specialist.

If you want the freedom to receive care without a primary physician’s permission but to still have the option to save money if you stay in Anthem’s network, this plan could be a good choice for you.

Anthem HMO SNP plans

Special Needs Plans (SNPs) cater to beneficiaries in specific situations. In the case of the Anthem SNPs we sampled, these health plans help coordinate care for dual eligible—people who have both Medicare and Medicaid.

If you’re a dual-eligible beneficiary, Anthem HMO SNP plans may offer lower out-of-pocket costs.

Bottom line

If you live in an Anthem state, this insurer could have plan options that will work for you

Anthem has Medicare Advantage health plans with $0 deductibles and drug coverage.

If you want a Medicare Advantage plan that also covers your medications, Anthem could be the right choice for you . If you don’t live in one of the 14 states this insurer serves, however, you’ll need to find this combination of coverage elsewhere.

A licensed Medicare sales agent can help you find the right plan in your location and start your application.

Want to learn more?

Want to learn more about Anthem or Medicare? Check out these other pages:

Anthem FAQ

When can I apply for Medicare Advantage Anthem health plans?

The best time to enroll in Medicare Advantage is during your Initial Enrollment Period (IEP), which starts three months before you become eligible for Medicare and runs for seven months. If you miss that period, you can switch to a Medicare Advantage plan during the Fall Annual Enrollment Period (AEP) October 15 through December 7.

If you want to change Medicare Advantage plans or switch from Medicare Advantage to Original, you can do that during the Medicare Advantage Open Enrollment Period (MAOEP)


Sources

1.  U.S. News & World Report, “Best Insurance Companies for Medicare Advantage 2019
2. Centers for Medicare and Medicaid Services, “2018 Star Ratings and Display Measures
3.  Kaiser Family Foundation, “A Dozen Facts About Medicare Advantage
4.  Centers for Medicare and Medicaid Services, “Monthly Enrollment by Contract
5.  Blue Cross Blue Shield, “BCBS Companies and Licensees

Content on this site has not been reviewed or endorsed by the Centers for Medicare & Medicaid Services, the United States Government, any state Medicare agency, or any private insurance agency (collectively "Medicare System Providers"). Eligibility.com is a DBA of Clear Link Technologies, LLC and is not affiliated with any Medicare System Providers.

Kat Casna
Written by
Kat Casna
Kathryn is a Medicare and geriatric specialist who has appeared on Baby Boomers, OppLoans, and Best Company. Her readers don’t need a degree in government-speak to get the right coverage because Kathryn sifts through Medicare’s parts, plans, and premiums to distill only the most useful information. Her favorite place in the world is a hammock that swings peacefully between two crabapple trees somewhere in New Mexico’s Gila National Forest.
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