Anthem Medicare Advantage 2023 Review

Anthem plans offer flexible options for care and extra benefits, but they have below-average ratings and a limited service area.
Kate Ashford, CSA®
Alex Rosenberg
By Alex Rosenberg and  Kate Ashford, CSA® 
Edited by Dawnielle Robinson-Walker

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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, with New York plans sold under the Empire Blue Cross Blue Shield name.

Anthem plans offer competitive premiums and plenty of $0-premium options, but their ratings for quality and member satisfaction 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: Many 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, help with housework 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. Most of Anthem's competitors have a larger footprint.

  • Middling star and satisfaction ratings: Anthem plans' average star rating from the Centers for Medicare & Medicaid Services, or CMS, weighted by enrollment is 3.72 stars (the national average for all providers is 4.15 stars), and Anthem's parent company, Elevance Health, came in seventh out of nine providers in J.D. Power’s latest member satisfaction study.

  • Fewer members in 4-star or better plans: Of Anthem’s plans with star ratings, 63% of members were in plans rated 4 stars or better as of October 2022. That’s a lower rate than most major Medicare Advantage providers.

Available Medicare Advantage plans

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:

Preferred provider organization, or 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.

Special needs plans, or 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 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

$67.60.

$60.20.

Annual deductible

$505.

None.

Drug copay, Tier 1*

$1.

$1.

Drug copay, Tier 2*

$2.

$4.

Drug copay, Tier 3*

$43.

$47.

*For a 30-day supply of a covered Part D prescription drug at a preferred retail pharmacy after meeting any applicable deductible.

Premiums, deductibles, covered drugs, costs for each tier and pharmacy arrangements all differ by plan. You can enter information about your prescriptions and choose your pharmacy on Anthem’s website to check how each available plan would cover your medications.

Additional benefits

Many Anthem Medicare Advantage plans include a variety of extras, some that are built into the plan and others that members select from a menu of “Essential Extras.” Here are some examples, although their availability varies by plan:

  • Home safety funds: Members can receive $500 per year for assistive devices or safety features like handrails or temporary ramps.

  • Flex account: Members can receive $500 per year to spend on dental, vision or hearing on top of the coverage included in their plan.

  • Food perks: Members can receive monthly funds to spend on healthy groceries.

  • Home help: Members can be visited in their homes for companionship, help with bathing or dressing, housework or other chores and errands.

  • Transportation: Members can receive rides to and from health appointments.

  • SilverSneakers: Members can visit gyms and access live and prerecorded online fitness classes tailored to older adults.

  • Utility help: Members can receive up to $50 per month that can be used toward household utility payments or for internet or cell phone bills.

Customer service

Here’s how Anthem members can contact customer service:

Anthem Medicare Advantage service area

Anthem offers Medicare Advantage plans in 14 states. The company also offers Medicare prescription drug plans in 12 states.

Anthem's parent company, Elevance Health, is the second-largest health insurer in the country by market share

. Anthem-brand plans covered more than 1.2 million Medicare Advantage beneficiaries as of October 2022.

Costs

Costs for Medicare Advantage plans depend on your plan, geographic location and health needs. One of the costs to consider is the plan’s premium. About 3 in 5 (58%) Anthem Medicare Advantage plans have $0 premiums

Centers for Medicare & Medicaid Services. 2023 MA Landscape Source File (v 10 14 2022) (ZIP). Accessed Nov 14, 2022.
.

For 2023 Medicare Advantage plans with a premium, the monthly consolidated premium (including Part C and Part D) ranges from $6.90 to $170. For special needs plans, or SNPs, with a premium, monthly premiums range from $4.70 to $59

Centers for Medicare & Medicaid Services. 2023 SNP Landscape Source File (v 10 14 2022) (ZIP). Accessed Nov 14, 2022.
.

Even as a Medicare Advantage user, you’ll still be responsible for paying your Medicare Part B premium, which is $164.90 per month in 2023, 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.)

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.

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. You can also shop directly from Anthem’s website by entering your ZIP code.

Medicare star ratings

Average star rating, weighted by enrollment: 3.72

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.

Based on the most recent year of data and weighted by enrollment, Anthem’s 2023 Medicare Advantage plans get average ratings of 3.72 stars

Centers for Medicare & Medicaid Services. 2023 Star Ratings Data Table (ZIP). Accessed Nov 14, 2022.
.

The average star rating for plans from all providers is 4.15

Centers for Medicare & Medicaid Services. 2023 Medicare Star Ratings Fact Sheet (PDF). Accessed Nov 14, 2022.
.

Of Anthem members in contracts with a Medicare star rating, 63% were in contracts rated 4.0 or above as of October 2022.

To get an overall star rating, CMS ranks contracts on 40 plan factors. (You can find definitions for each of these factors in the CMS Star Ratings Technical Notes.) Here are the measures for which Anthem plans scored an average of 4.5 (out of 5) and above:

  • Care for older adults — medication review.

  • Care for older adults — pain assessment.

  • Reviewing appeals decisions.

  • Health plan: Call center — foreign language interpreter and TTY availability.

  • Drug plan: Call center — foreign language interpreter and TTY availability.

Anthem plans averaged sub-3.0 scores in several categories. (You can find definitions for each of these factors in the CMS Star Ratings Technical Notes.)

  • Annual flu vaccine.

  • Monitoring physical activity.

  • Special needs plan care management.

  • Osteoporosis management in women who had a fracture.

  • Statin therapy for patients with cardiovascular disease.

  • Health plan: Customer service.

  • Rating of health plan.

  • Health plan quality improvement.

  • Drug plan quality improvement.

  • Rating of drug plan.

  • Getting needed prescription drugs.

  • Medication adherence for diabetes medications.

  • Medication adherence for cholesterol (statins).

  • Statin use in persons with diabetes.

You can find a plan’s rating with the Medicare plan-finding tool.

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 2021, AM Best affirmed its Financial Strength Rating of A for the core Blue Cross Blue Shield-branded insurance subsidiaries of parent company Anthem, which is now 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: 7th out of 9

In its 2022 U.S. Medicare Advantage Study — the eighth it has done — J.D. Power measured member satisfaction with Medicare Advantage plans based on six factors: coverage and benefits, provider choice, cost, customer service, information and communication, and billing and payment. On these measures, Anthem's parent company, Elevance Health, scored 791 points out of 1,000 and came in seventh out of the top nine Medicare Advantage providers

.

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.

About Elevance Health (formerly 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 from Anthem to Elevance Health but sells Medicare Advantage plans under several brands, including Anthem Blue Cross and Blue Shield.

Elevance Health offers commercial health insurance for individuals and employers; Medicare Advantage and Medicaid plans; life, disability, dental and vision insurance; and services for other government health insurance programs. In 2021, Elevance Health had $138.6 billion in annual revenue.

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, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).
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