Anthem Medicare Advantage 2022 Review

Anthem offers flexible options for care and extra benefits, but it has below-average ratings and a limited service area.
Jan 28, 2022

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Anthem is one of the country’s largest health insurers. It offers Medicare Advantage plans in 14 states as part of the Blue Cross Blue Shield collective and in a handful of other states on its own. Anthem offers competitive premiums and plenty of $0-premium plans, but its ratings for both quality and member satisfaction are slightly 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 lets 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 offers a 24/7 nurse line and 24/7 online appointments for virtual care, as well as a house call program for qualifying members.

Cons

  • Available in relatively few states: Anthem offers its Blue Cross Blue Shield-branded Medicare Advantage plans in only 14 states, and its subsidiaries cover a few more states. Most of Anthem's competitors have a larger footprint.

  • Middling star and satisfaction ratings: Anthem’s average star rating from the Centers for Medicare & Medicaid Services is 3.9 stars (the national average for all providers is 4.37 stars), and Anthem came in fifth out of nine providers in J.D. Power’s member satisfaction study.

  • Fewer members in 4-star or better plans: Anthem reports that 72% of its members will be in plans rated 4 stars or better in 2022. That’s a lower rate than most other Medicare Advantage providers.

Available Medicare Advantage plans

Anthem offers several kinds of 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, or 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, or 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, 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.

SNPs

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 living 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 16 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 two plans compare:

Plan feature

Anthem MediBlue Rx Standard

Anthem MediBlue Rx Plus

Monthly premium

$49.70.

$78.10.

Annual deductible

$405.

None.

Drug copay, Tier 1*

$1.

$1.

Drug copay, Tier 2*

$4.

$3.

Drug copay, Tier 3*

$37.

$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.

  • Fitness tracking: Members can receive a fitness tracker and use online programs for fitness, activity and health coaching.

  • Food services: Members can receive monthly funds to spend on healthy groceries or have prepared meals delivered at home.

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

  • Pest control: Members can have their homes treated to control pests that might cause complications related to chronic medical conditions.

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

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

Customer service

Here’s how Anthem members can contact customer service:

Anthem Medicare Advantage service area

Anthem offers Blue Cross- or Blue Cross Blue Shield-branded Medicare Advantage plans in 14 states. Including those plans and Medicare Advantage plans from other subsidiaries, Anthem says it has a “Medicare presence” in 24 states and Puerto Rico. The company also offers Medicare prescription drug plans in 16 states.

Anthem is the second-largest health insurer in the country by market share [1]. Anthem reports that it has about 1.85 million Medicare Advantage beneficiaries as of late 2021 [2].

Cost

Costs for Medicare Advantage plans depend on your plan, your geographic location and your health needs. One of the costs to consider is the plan’s premium. About 3 in 5 (59.7%) Anthem Medicare Advantage plans have $0 premiums [3].

For 2022 Medicare Advantage plans with a premium, the monthly consolidated premium (including Part C and Part D) ranges from $2.10 to $172. For special needs plans, or SNPs, with a premium, monthly premiums range from $1.70 to $59 [4].

Even as a Medicare Advantage user, you’ll still be responsible for paying your Medicare Part B premium, which is $170.10 in 2022, 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 any 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 if 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: 3.9

The Centers for Medicare & Medicaid Services 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, Anthem’s 2022 Medicare Advantage and prescription drug plans both get average ratings of 3.9 stars [5]. The average star rating for plans from all providers was 4.37 [6]. Two Anthem plans scored overall ratings of 5 stars: HealthSun Health Plans and Optimum HealthCare, both of which operate in Florida.

Anthem says that it expects more than 70% of its Medicare Advantage members to be in plans rated 4 stars or better in 2022.

Where did Anthem outperform?

To get an overall star rating, the 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.

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

  • Reviewing appeals decisions.

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

  • Care for older adults — pain assessment.

  • Complaints about the health plan.

Where did Anthem struggle?

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

  • Annual flu vaccine.

  • Improving bladder control.

  • Medicare Plan Finder price accuracy.

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

Third-party ratings

There are a few companies that weigh in on health plans or on the strength of the company in question, and we’ve included three here:

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 Anthem’s core Blue Cross Blue Shield-branded insurance subsidiaries [7]. An A rating in this category indicates that AM Best believes Anthem has an excellent ability to meet its ongoing insurance obligations.

J.D. Power Ranking: 5th out of 9

In its 2021 U.S. Medicare Advantage Study — the seventh it's done so far — 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 scored 797 points out of 1,000 and came in fifth out of the top nine Medicare Advantage providers [8].

NCQA Score Range: 3.5 to 4.0 out of 5

The National Committee for Quality Assurance rates health insurance plans on a 5-point scale (with 5 being best) based on clinical quality, member satisfaction and results from the NCQA Accreditation Survey. The ratings highlight the results of care and what patients say about their care.

Most Anthem plans haven’t reported data to NCQA to be rated. But for the few plans that are rated — Freedom Health, HealthSun Health Plans, Optimum HealthCare and Simply Healthcare Plans — NCQA awarded ratings between 3.5 and 4.0 stars in its September 2021 ratings [9].

Compare alternatives

See how Medicare Advantage competitors compare to Anthem.

Compare Medicare Advantage providers

Company

Percent in a 4-star plan or higher

Service area

Average Medicare star rating (2022)

87%.

46 states and Washington, D.C.

3.8.

72%.

24 states and Puerto Rico.

3.9.

59%.

44 states.

4.1.

87%.

26 states and Washington, D.C.

4.2.

93%.

47 states and Puerto Rico.

4.1.

100%.

8 states and Washington, D.C.

5.

76%.

50 states, Washington, D.C., American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands.

4.2.

26%.

36 states.

3.6.

About Anthem

Anthem Inc., headquartered in Indianapolis, Indiana, was formed in 2004 out of a merger between WellPoint Health Networks and Anthem. The company operates Medicare Advantage plans under a variety of subsidiaries, many of which use Blue Cross Blue Shield trade names.

Anthem 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 2020, Anthem had $121.9 billion in annual revenue.

Find the right Medicare Advantage plan

It’s important to do your research before selecting a health 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).

ARTICLE SOURCES:

Works cited
  1. American Medical Association, “Competition in Health Insurance: A comprehensive study of U.S. markets,” accessed Jan. 26, 2022.

  2. Anthem, “Corporate Fact Sheet,” accessed Jan. 26, 2022.

  3. Centers for Medicare & Medicaid Services, “2022 MA Landscape Source Files (v 10 26 21) (ZIP),” accessed Jan. 26, 2022.

  4. Centers for Medicare & Medicaid Services, “2022 SNP Landscape Source Files (v 10 26 21) (ZIP),” accessed Jan. 26, 2022.

  5. Centers for Medicare & Medicaid Services, “2022 Star Ratings Data Table (Oct 06 2021) (ZIP),” accessed Jan. 26, 2022.

  6. Centers for Medicare & Medicaid Services, “2022 Star Ratings Fact Sheet_10_8_2021 (PDF),” accessed Jan. 26, 2022.

  7. NCQA, “Health Plans,” accessed Jan. 26, 2022.

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