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Kaiser Permanente vs. Anthem: Medicare Advantage Comparison
Kaiser Permanente’s star ratings are higher than Anthem’s, but member experience scores are low for both.
Kate Ashford, CSA® Lead Writer | Medicare, retirement, personal finance
Kate Ashford is a writer and NerdWallet authority on Medicare. She is a certified senior advisor (CSA)® and has more than 18 years of experience writing about personal finance. Previously, she was a freelance writer for both consumer and business publications, and her work has been published by the BBC, Forbes, Money, AARP, LearnVest and Parents, among others. She has a degree from the University of Virginia and a master’s degree in journalism from Northwestern’s Medill School of Journalism. Kate has appeared as a Medicare expert on the PennyWise podcast by Lee Enterprises, and she's been quoted in national publications including Healthline, Real Simple and SingleCare. She is based in New York.
Holly Carey joined NerdWallet in 2021 as an editor on the team responsible for expanding content to additional topics within personal finance. She currently leads the Medicare team. Previously, Holly wrote and edited content and developed digital media strategies as a public affairs officer for the U.S. Navy. She is based in Virginia Beach, Virginia.
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Kaiser Permanente Medicare Advantage plans are available in only eight states and Washington, D.C., while Anthem-branded plans are available in 14 states. While Kaiser Permanente’s average star ratings from the Centers for Medicare & Medicaid Services (CMS) are higher than those from Anthem, neither company is above the industry average. Member experience scores from CMS for both Kaiser Permanente and Anthem are lower than most major providers.
Here’s a look at how Kaiser Permanente and Anthem compare.
Kaiser Permanente Medicare Advantage
Kaiser Permanente
3.94
CMS Star RatingAverage Medicare star rating, weighted by enrollment. Star ratings are determined by the Centers for Medicare & Medicaid Services (CMS).
Kaiser Permanente plans get average star ratings — lower than last year — and the provider sells plans in only eight states and Washington, D.C.
Members in high-rated plansPercentage of members who are in rated contracts with a Medicare star rating of 4 or higher.
Medium (50% to 89%)
Member experienceThe average of CMS' star ratings for quality measures in the domain "Member Experience with the Health Plan," weighted by contract enrollment.
2.44 (Below average)
Pros
Earns above-average customer satisfaction scores in California, one of the major Medicare markets studied by J.D. Power.
Eight in 10 members are in a highly-rated plan.
Most plans include drug coverage.
Cons
Available in only eight states and Washington, D.C.
Offers mostly HMO plans, so most members must work within Kaiser’s network of medical providers.
Member experience ratings overall are below average.
States available
8 states and Washington, D.C.
Members in high-rated plansPercentage of members who are in rated contracts with a Medicare star rating of 4 or higher.
Medium (50% to 89%)
Member experienceThe average of CMS' star ratings for quality measures in the domain "Member Experience with the Health Plan," weighted by contract enrollment.
2.44 (Below average)
Pros
Earns above-average customer satisfaction scores in California, one of the major Medicare markets studied by J.D. Power.
Eight in 10 members are in a highly-rated plan.
Most plans include drug coverage.
Cons
Available in only eight states and Washington, D.C.
Offers mostly HMO plans, so most members must work within Kaiser’s network of medical providers.
Member experience ratings overall are below average.
CMS Star RatingAverage Medicare star rating, weighted by enrollment. Star ratings are determined by the Centers for Medicare & Medicaid Services (CMS).
Anthem's plans offer a range of benefits and flexible care, but plans are available in only 14 states and receive below-average star ratings.
Members in high-rated plansPercentage of members who are in rated contracts with a Medicare star rating of 4 or higher.
Low (49% or less)
Member experienceThe average of CMS' star ratings for quality measures in the domain "Member Experience with the Health Plan," weighted by contract enrollment.
2.89 (Below average)
Pros
Most plans cover prescription drugs and offer some coverage for dental, hearing and vision care.
Anthem's "Essential Extras" benefits let members choose extra plan benefits that meet their needs, such as $500/year toward assistive devices or $150/quarter toward household utilities.
Cons
Available in only 14 states.
Below-average overall star rating and member experience scores from CMS.
4-star rated plans available in only three states.
States available
14 states
Members in high-rated plansPercentage of members who are in rated contracts with a Medicare star rating of 4 or higher.
Low (49% or less)
Member experienceThe average of CMS' star ratings for quality measures in the domain "Member Experience with the Health Plan," weighted by contract enrollment.
2.89 (Below average)
Pros
Most plans cover prescription drugs and offer some coverage for dental, hearing and vision care.
Anthem's "Essential Extras" benefits let members choose extra plan benefits that meet their needs, such as $500/year toward assistive devices or $150/quarter toward household utilities.
Cons
Available in only 14 states.
Below-average overall star rating and member experience scores from CMS.
4-star rated plans available in only three states.
Other factors to consider
Provider size
Part of the Blue Cross Blue Shield collective, which is the 3rd-largest provider of Medicare Advantage plans.
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?
