The bottom line: Anthem sells Medicare Advantage plans in 13 states. Its plans can be cost-effective, especially if you take mostly generic prescription drugs or you’re concerned about copays for hospital stays. But weak government ratings for quality and measures of member experience would have me thinking twice.
Compare Medicare Advantage plans carefully when you’re shopping for 2027. You might be able to find alternatives with higher quality and happier members while still keeping costs under control. Humana is our pick among the big national companies this year, but you could also consider smaller high-performers like Kaiser Permanente or SCAN Health Plan, if they sell plans in your area.
Pros: The vast majority of Anthem plans have $0 out-of-pocket costs for generic prescription drugs. That’s not just the $0-copay “preferred generics” that many plans offer — it extends to other generics at Tier 2, too. And its copays for hospital stays are cheaper than average.
Cons: Anthem gets below-average quality ratings for 2027 from the Centers for Medicare & Medicaid Services (CMS). It particularly underperformed on CMS’ measures of member experience. And if your Anthem plan doesn’t offer $0 out-of-pocket costs for prescription drugs, your copays and/or coinsurance might be higher than average.
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NerdWallet’s Medicare content, including articles, reviews and recommendations, is produced by a team of writers and editors who specialize in Medicare. Their work has appeared in The Associated Press, Washington Post, Nasdaq, MSN, MarketWatch, Yahoo! Finance and other national and regional media outlets. They have been cited in publications including Healthline, and appeared on NerdWallet's "Smart Money" podcast.
NerdWallet star rating for Anthem Medicare Advantage
Anthem earned 3.5 out of 5 stars in our analysis. It performed best on our measures of cost, with lots of $0-copay prescription drugs and inexpensive hospital copays. But subpar government ratings on measures of quality and member experience hold Anthem back from a higher score.
How we score companies
NerdWallet's editorial team uses huge quantities of data to score Medicare Advantage companies. Unlike the government's quality ratings, we include costs as a factor in our scoring. And compared with review sites across the web, NerdWallet's editorial assessments are more comprehensive in a range of areas:
More data: Our analysis includes hundreds of thousands of rows of data. We incorporate data from all 45 Centers for Medicare & Medicaid Services (CMS) quality measures — and that’s just the start. We’ve also built and analyzed our own measures for customer service, premiums, prescription drug costs, and out-of-pocket costs for emergency visits, ambulance rides and hospital stays to provide a more well-rounded picture of plans’ performance.
More plans and companies: We don’t just stick to a few big names. We've analyzed and assigned scores to every single one of over 5,000 commercial Medicare Advantage plan offerings, down to individual plans offered state-by-state. Our reviews span 23 companies covering about 31.5 million enrollees. That’s about 87% of all Medicare Advantage members.
More timely updates: You don’t want to rely on out-of-date reviews when shopping for your coverage. Our team grabs the new year’s data as soon as it’s released in September and October, delivering the freshest updates for open enrollment season.
More detail: We’re not just providing surface-level summaries. We publish multiple roundups of the best plans, individual deep-dive reviews of nearly two dozen Medicare Advantage companies, 50 state roundups with information specific to the best plans available in each state, and data-driven head-to-head comparisons for many of the big companies you might be choosing between.
CMS quality measures
C01: Breast Cancer Screening.
C02: Colorectal Cancer Screening.
C03: Annual Flu Vaccine.
C04: Improving or Maintaining Physical Health.
C05: Improving or Maintaining Mental Health.
C06: Monitoring Physical Activity.
C07: Special Needs Plan (SNP) Care Management.
C08: Care for Older Adults – Medication Review.
C09: Care for Older Adults - Functional Status Assessment.
C10: Osteoporosis Management in Women who had a Fracture.
C11: Diabetes Care – Eye Exam.
C12: Diabetes Care – Blood Sugar Controlled.
C13: Kidney Health Evaluation for Patients with Diabetes.
C14: Controlling High Blood Pressure.
C15: Reducing the Risk of Falling.
C16: Improving Bladder Control.
C17: Plan All-Cause Readmissions.
C18: Statin Therapy for Patients with Cardiovascular Disease.
C19: Transitions of Care.
C20: Follow-up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions.
C21: Getting Needed Care.*
C22: Getting Appointments and Care Quickly.*
C23: Customer Service.*
C24: Rating of Health Care Quality.*
C25: Rating of Health Plan.*
C26: Care Coordination.*
C27: Complaints about the Health Plan.
C28: Members Choosing to Leave the Plan.
C29: Health Plan Quality Improvement.
C30: Plan Makes Timely Decisions about Appeals.
C31: Reviewing Appeals Decisions.
C32: Call Center – Foreign Language Interpreter and TTY Availability.
D01: Call Center – Foreign Language Interpreter and TTY Availability.
D02: Complaints about the Drug Plan.
D03: Members Choosing to Leave the Plan.
D04: Drug Plan Quality Improvement.
D05: Rating of Drug Plan.
D06: Getting Needed Prescription Drugs.
D07: MPF Price Accuracy.
D08: Medication Adherence for Diabetes Medications.
D09: Medication Adherence for Hypertension (RAS antagonists).
D10: Medication Adherence for Cholesterol (Statins).
D11: Statin Use in Persons with Diabetes (SUPD).
D12: Concurrent Use of Opioids and Benzodiazepines (COB).
D13: Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH).
* Also used to calculate NerdWallet's Member Experience sub-score for Medicare Advantage plans.
NerdWallet's unique measures
Percentage of plans with $0 premiums.
Percentage of members in plans with $0 premiums.
Average non-$0 premium.
Average maximum out-of-pocket cost.
Percentage of plans offering prescription drug coverage. Percentage of plans with no deductible for Tier 1 prescription drugs.
Percentage of plans with no deductible for Tier 2 prescription drugs.
Percentage of plans with no deductible for Tier 3 prescription drugs.
Average non-$0 deductible for Tier 1 prescription drugs.
Average non-$0 deductible for Tier 2 prescription drugs.
Average non-$0 deductible for Tier 3 prescription drugs.
Average cost of a typical emergency department visit.
Average cost of a typical ambulance ride.
Average cost of a typical hospital stay.
Plan disenrollment reasons index.
Percentage of plans rated 4 stars or higher.
Percentage of members in plans rated 4 stars or higher.
Prevalence of "Giveback" plans.
Government quality ratings for Anthem Medicare Advantage
Average CMS star rating, weighted by enrollment: 3.33
Anthem Medicare Advantage plans are rated below the industry average, receiving an average rating of 3.33 stars out of 5 from the Centers for Medicare & Medicaid Services (CMS), weighted by enrollment for plans available in 2027. For comparison, the weighted average for all 2027 plans is 3.92 out of 5.
Of Anthem members in plans with a Medicare star rating, 6% are in plans rated 4 stars or better for the 2027 plan year.
CMS maintains its own database of star ratings, which rank each plan 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.
You can find a plan’s rating with Medicare's plan finding tool.
NerdWallet star ratings are different from CMS ratings for Medicare plans.
Our data-driven, consumer-first scoring rubric for Medicare Advantage plans includes crucial metrics like cost and a wider range of data sources for quality and customer satisfaction in addition to the information incorporated into CMS ratings.
About 70% of Anthem Medicare Advantage plans have a $0 premium.
Anthem plans with a premium cost about $38.92 per month on average, weighted by enrollment. The weighted average among all Medicare Advantage plans is $49.28 for 2027.
With any Medicare Advantage plan, you'll still be responsible for paying your Medicare Part B premium, which is $202.90 per month in 2026.
Most people pay this standard Part B amount, but if your income is above a certain threshold, you'll pay the income-related monthly adjustment amount (IRMAA). Some Medicare Advantage plans cover part or all of your Part B premium.
Prescription drug costs for Anthem Medicare Advantage
About 92% of Anthem Medicare Advantage plans include prescription drug coverage.
Here’s what you might pay for prescription drugs at some common price points.
Tier 1 (Preferred generics) 99.3% of Anthem's Medicare Advantage plans have $0 copays/coinsurance.
$3.75: Average out-of-pocket cost for a drug with a $15 retail price, among Anthem plans with copays or coinsurance.
Tier 2 (Most generics) 83.6% of Anthem's Medicare Advantage plans have $0 copays/coinsurance.
$10.51: Average out-of-pocket cost for a drug with a $50 retail price, among Anthem plans with copays or coinsurance.
Tier 3 (Preferred brands) 7.9% of Anthem's Medicare Advantage plans have $0 copays/coinsurance.
$49.18: Average out-of-pocket cost for a drug with a $200 retail price, among Anthem plans with copays or coinsurance.
Formulary tiers
We evaluate Medicare Advantage plans based on their prices for the first three tiers on their formulary, the list of covered drugs. Many plans have five-tier formularies:
Tier 1: Preferred generic drugs.
Tier 2: Most generic drugs.
Tier 3: Preferred brand-name drugs.
Tier 4: Non-preferred brand-name drugs.
Tier 5: Specialty drugs.
We evaluate Tiers 1–3 individually based on their out-of-pocket costs and whether a prescription drug deductible applies.
We don't compare plans based on higher tiers because there are fewer significant differences in plan design. Nearly all plans charge coinsurance for Tier 4 and Tier 5 drugs, so what you'll pay depends mostly on the retail price of the drug.
Scoring
Plans get the highest scores for offering the lowest out-of-pocket costs. Plans get a perfect score for the tier if they offer $0 copays.
We evaluate plans that do charge copays or coinsurance based on reference prices:
Tier 1: $15.
Tier 2: $50.
Tier 3: $200.
Using reference prices lets us compare plans with copays and coinsurance. For example, with a copay, you might owe a flat $40 for a Tier 3 drug. An 18% coinsurance could work out slightly cheaper, at $36 for a $200 drug. But a plan with a 25% coinsurance would cost you $50 — and we'd score it lower.
Plans also earn points based on whether a prescription drug deductible applies at each of the first three tiers. We prefer plans that start covering your medications immediately, rather than after you've met a deductible.
Plan details
We give two numbers in the boxes above. First, the percentage of the company's plans with $0 copays for the tier. These percentages are often pretty high for Tier 1, but can drop off sharply afterward. Second, we list averages of what plans that do charge copays or coinsurance would cost. We don't include the plans with $0 copays in these averages because we want to give a realistic sense of what you might actually pay. The averages are estimates based on our reference prices, after you've met your prescription drug deductible, if any.
Medicare Advantage plans that don't include prescription drug coverage don't get scored on these measures. They're not penalized for the lack of coverage, but their scores for other cost factors like premiums and out-of-pocket costs for medical care get higher weight in their overall ratings.
Medical costs with Anthem Medicare Advantage
While many Medicare Advantage plans have $0 or low premiums, you should also keep an eye on out-of-pocket costs when comparing plans. We calculated average potential out-of-pocket costs for a few kinds of unexpected medical care: emergency department visits, ambulance rides and hospital stays.
🏥 Emergency department
$125: Average out-of-pocket cost for a typical emergency visit.
The weighted average among all 2027 plans is about $124.
🚑 Ambulance
$258: Average out-of-pocket cost for a typical ambulance ride.
The weighted average among all 2027 plans is about $278.
🛌🏽 Hospital stay
$1,346: Average out-of-pocket costs for a 7-day hospitalization.
The weighted average among all 2027 plans is about $1,801.
Services
We evaluate Medicare Advantage plans based on the out-of-pocket costs they charge for three services: a visit to the emergency department, an ambulance ride and a seven-day hospital stay.
We chose these services for several reasons:
They’re all reasonably common.
They could result in unexpected healthcare costs.
Plans can differ significantly in terms of their out-of-pocket costs for these services.
Emergency and ambulance charges
We extracted plan-level cost information from CMS’ “MPF Benefit Summary,” a giant spreadsheet that lays out whether and how plans cover an array of healthcare services.
Emergency visits and ambulance rides often have coinsurance, which means you owe a percentage of Medicare’s allowed cost. To put plans on a level playing field, we used reference prices for these services. We used $1,200 as a round reference price for an ambulance ride, based on numbers from MedPAC’s June 2026 report to Congress.
For an emergency department visit, we used $800 to represent the allowed amounts for a high-severity visit that doesn’t result in an admission to the hospital for inpatient care. That’s based on the sum of Medicare’s physician payment rate for CPT 99285 and facility fee for APC 5025.
We used these reference prices to calculate out-of-pocket costs for plans that charge coinsurance for either of the services above. That allows us to compare plans with copays against plans with coinsurance on an even playing field.
Hospital stays
Out-of-pocket costs for hospital stays are typically copays per day for a certain number of days. We used a seven-day hospital stay to compare costs. The average length of stay for Medicare Advantage beneficiaries is 7.1 days, according to a study published by the American Medical Association in 2025. Using this reference length of stay allows us to compare plans that charge out-of-pocket costs on a per-day basis against ones that charge per stay, regardless of length.
Scoring
For each service, we score plans more highly when they have lower out-of-pocket costs. Company-level averages are weighted by plan enrollment within the company.
Maximum out-of-pocket costs
Anthem Medicare Advantage plans have an average maximum out-of-pocket (MOOP) spending cap of $7,122, weighted by enrollment. The weighted average among all Medicare Advantage plans is about $6,505 for 2027.
The MOOP is the annual limit on what you’ll owe for out-of-pocket costs like copays, coinsurance and deductibles. If you expect to use a lot of medical care, it’s worth looking for a plan with a relatively low MOOP. But if you don’t use much medical care, this number might not be very important.
Compare against other providers
» More options in our roundup of the best Medicare Advantage plans
Compare against other providers
» More options in our roundup of the best Medicare Advantage plans
Why do people leave Anthem Medicare Advantage plans?
CMS surveys people who voluntarily leave their Medicare plans about their reasons for leaving. Here’s the breakdown of problems people identified with their former Anthem Medicare plans.
Problems getting covered care: 16% (All-company average: 16%).
Problems with doctor/hospital networks: 21% (All-company average: 21%).
Financial issues: 19% (All-company average: 19%).
Problems with prescription drug benefits: 9% (All-company average: 9%).
Problems getting information from the plan: 12% (All-company average: 12%).
(Members can give more than one reason for leaving on the survey and might leave plans for other reasons, so the categories won’t add up to 100%.)
Anthem Medicare Advantage plan types
Anthem offers Medicare Advantage prescription drug plans and Medicare Advantage plans without drug coverage.
Plan offerings include the following types:
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 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.
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.
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.
Third-party ratings of Anthem
AM Best Financial Strength Rating: A (Excellent)
AM Best is a credit rating agency that specializes in the insurance industry. In December 2025, AM Best affirmed its Financial Strength Rating of A for the insurance subsidiaries of parent company Elevance Health, collectively referred to as Anthem Health.
An A rating in this category indicates that AM Best believes the company has an excellent ability to meet its ongoing insurance obligations.
JD Power Ranking
JD Power releases an annual study measuring member satisfaction with Medicare Advantage plans. It uses eight factors, such as level of trust, ability to get health services, ease of doing business and resolving problems or complaints.
Here’s how Anthem ranked among major companies in the Medicare markets where it has enough market share to appear on the survey:
California: 5th out of 8.
Kentucky: 3rd out of 3.
Ohio: 2nd out of 4.
Anthem Medicare Advantage service area
Anthem offers Medicare Advantage plans in 13 states and covers about 1.3 million Medicare Advantage members. Its parent company, Elevance Health, is the fourth-largest for-profit Medicare Advantage company.
About Anthem
Anthem's parent company, Elevance Health, is headquartered in Indianapolis. It 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. Its Medicare products include Medicare Advantage and Medicare Supplement Insurance, but it recently stopped selling Medicare Part D plans. It also offers other products such as life, disability, dental and vision insurance.
» MORE: Read our review of Anthem Medicare Supplement Insurance
Compare Medicare Advantage companies
Get more information below about some of the major Medicare Advantage insurance companies. These insurers offer plans in most states. The plans you can choose from will depend on your ZIP code and county.
Check out NerdWallet's roundups of the best Medicare Advantage options in each state: | |||
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 preferred medical 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).
- Most plans have $0 out-of-pocket costs for Tier 1 and Tier 2 generic drugs.
- Average hospital copays are considerably cheaper than competitors.
- Below-average quality ratings from CMS.
- Subpar government ratings on measures of member experience.
- Prescription drugs on plans without $0 copays can be pricey.
NerdWallet writers are subject matter authorities who use primary, trustworthy sources to inform their work, including peer-reviewed studies, government websites, academic research and interviews with industry experts. All content is fact-checked for accuracy, timeliness and relevance. You can learn more about NerdWallet's high standards for journalism by reading our editorial guidelines.
- 1.NerdWallet analysis of CMS data. 2027 Star Ratings Data Tables. Accessed Oct 19, 2026.
- 2.NerdWallet analysis of CMS data. Monthly Enrollment by Plan. Accessed Oct 19, 2026.
- 3.NerdWallet analysis of CMS data. CY2027 Landscape 202609. Accessed Oct 19, 2026.
- 4.NerdWallet analysis of CMS data. Beneficiary Cost File. Accessed Oct 19, 2026.
- 5.NerdWallet analysis of CMS data. PBP Benefits-2027. Accessed Oct 19, 2026.
- 6.NerdWallet analysis of CMS data. Star Ratings Data Tables — Disenrollment Reasons. Accessed Oct 19, 2026.
- 7.AM Best. AM Best Takes Various Credit Rating Actions on Elevance Health, Inc. and Most of Its Subsidiaries. Accessed Oct 19, 2026.
- 8.JD Power. Medicare Advantage Plan Members Seek Stronger Patient Advocacy, Care Coordination. Accessed Oct 19, 2026.
- 9.HealthScape. Medicare Advantage Enrollment Depicts Industry at a Crossroads. Accessed Oct 19, 2026.
Medicare Advantage review methodology
NerdWallet’s Medicare Advantage ratings are based on premiums, out-of-pocket costs, prescription drug coverage, quality data from the Centers for Medicare & Medicaid Services, consumer experience and more. We analyze and calculate ratings for every Medicare Advantage plan sold throughout the U.S. on a curved 5-point scale.
At the national level, we calculate ratings for companies as the average of their plans’ scores, weighted by enrollment.
NerdWallet’s editorial team analyzed companies covering about 87% of all Medicare Advantage beneficiaries in the United States. We reviewed 23 Medicare Advantage brands, with some insurance companies having more than one brand under their umbrella. (For example, Blue Cross Blue Shield includes the brands Anthem and Highmark.)
The Medicare Advantage marketplace is concentrated among just a handful of companies. In many places, one company serves more than half of the market. At the national level, NerdWallet’s reviews include each of the 10 largest brands by enrollment.
We research and analyze all commercial Medicare Advantage plans and publish reviews for selected companies. At the state level, we review at least one major insurer in every state where Medicare Advantage plans are sold, and we review both of the top two insurers in 40 of those 49 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.
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 and full ratings methodology for Medicare Advantage.
Compare Medicare Advantage plans
Insurance company | NerdWallet rating | $0 plan availability | Members in high-quality plans | Member experience | Learn more |
|---|---|---|---|---|---|
 (855) 432-0512 / TTY 711 M-F 9AM-9PM, Sat 10AM-6PM ETSpeak to a licensed insurance agent on askchapter.orgon NerdWallet | 3.8/5 | 68% (Average) | Medium (50% to 84%) | 3.26 (Below average) | (855) 432-0512 / TTY 711 M-F 9AM-9PM, Sat 10AM-6PM ETSpeak to a licensed insurance agent on askchapter.orgon NerdWallet |
 (855) 432-0512 / TTY 711 M-F 9AM-9PM, Sat 10AM-6PM ETSpeak to a licensed insurance agent on askchapter.orgon NerdWallet | 4.6/5 | 80% (Above average) | High (85% to 100%) | 3.86 (Above average) | (855) 432-0512 / TTY 711 M-F 9AM-9PM, Sat 10AM-6PM ETSpeak to a licensed insurance agent on askchapter.orgon NerdWallet |
 (855) 432-0512 / TTY 711 M-F 9AM-9PM, Sat 10AM-6PM ETSpeak to a licensed insurance agent on askchapter.orgon NerdWallet | 4.2/5 | 78% (Above average) | Medium (50% to 84%) | 3.4 (Average) | (855) 432-0512 / TTY 711 M-F 9AM-9PM, Sat 10AM-6PM ETSpeak to a licensed insurance agent on askchapter.orgon NerdWallet |