Is Anthem good health insurance?

Editorial team Published on

Anthem is a large, widely accepted health insurance provider with extensive nationwide networks, but individual experiences vary depending on your specific plan and location.

Pros of Anthem Insurance

  • Widespread Network: As a major Blue Cross Blue Shield affiliate, Anthem offers broad provider access and out-of-state coverage through the Blue Card program.
  • Plan Variety: They offer diverse options including HMO, EPO, and PPO plans across multiple metal tiers (Bronze, Silver, Gold, Platinum) on and off the Marketplace.
  • Extra Benefits: Many plans include $0 virtual care via the Sydney Health app, $0 annual physicals, and wellness rewards.
  • Financial Stability: Anthem rates well for financial strength, meaning the company easily fulfills its financial obligations to pay claims.

Cons of Anthem Insurance

  • Customer Service Complaints: Like many major insurers, public review platforms (like Trustpilot and WalletHub) feature frequent complaints regarding claim processing delays and long phone wait times.
  • Prior Authorization Hurdles: Some members report difficulties or delays getting specialized procedures, tests, or specific medications approved.
  • Network Restrictions: Depending on whether you choose an HMO or EPO, your choice of doctors and hospitals is limited to in-network providers, and certain top-tier hospital systems may be excluded.

You can review specific plan structures and options directly through the Anthem Individual and Family Plans portal.

What's better, Anthem or Blue Cross?

Neither Anthem nor Blue Cross is universally better, because Anthem is actually a specific company that operates as part of the Blue Cross Blue Shield (BCBS) association.

Choosing between them depends on whether you are looking at Anthem versus other independent BCBS plans, or comparing your local plan options based on cost and flexibility.

Understanding the Difference

  • Blue Cross Blue Shield (BCBS): This is a national association of 36 independent, local health insurance companies across the United States.
  • Anthem: This is the largest for-profit company within the BCBS association. It provides coverage under the Anthem name in specific states (like California, New York, and others) and uses the national BCBS network.
  • Network Access: Most BCBS and Anthem plans give you access to the national BlueCard network, meaning out-of-state routine care is widely supported.

How to Choose Your Plan

  • Anthem (EPO/HMO): Often features slightly lower premiums and gives you out-of-state network access through EPO plans without needing specialist referrals. However, it may have more restrictive local hospital lists in certain regions compared to independent non-profit local plans.
  • Other Blue Cross / Blue Shield Plans: Depending on your state (such as Blue Shield of California), local non-profit sister companies may offer broader true PPO networks and access to specific top-tier academic medical centers, though usually for a higher monthly price.
  • Ratings: According to NerdWallet, Anthem's Medicare plans sometimes score lower on government quality and member experience ratings than other independent BCBS regional counterparts, though prices can be cheaper.

Which is better, Anthem or UnitedHealthcare?

Neither UnitedHealthcare nor Anthem is universally better; UnitedHealthcare offers broader nationwide availability, while Anthem often provides more affordable regional plan costs.

Availability and Coverage

  • UnitedHealthcare: Operates in all 50 states and holds the largest market share, especially for Medicare Advantage plans via its AARP partnership.
  • Anthem: Operates as an independent Blue Cross Blue Shield licensee in only 14 states, though it covers millions of members locally.

Costs and Pricing

  • UnitedHealthcare: Tends to have higher general plan costs and some prescription drug deductibles, but offers robust benefits.
  • Anthem: Frequently offers lower premiums and out-of-pocket costs, though customer satisfaction and experience ratings vary significantly by state.

Networks and Care

  • UnitedHealthcare: Best for people who travel or work remotely due to its massive nationwide provider network.
  • Anthem: Offers strong local provider access in its 14 active states, but network sizes (like EPOs in California) can be smaller or more restrictive.

Where does Anthem rank in health insurance?

Anthem (now officially operating as Elevance Health) ranks as the second-largest health insurance company in the United States by enrollment, direct premiums written, and overall market share.

National Rankings and Market Share

  • Overall Size: Ranked #2 in the U.S. behind UnitedHealth Group.
  • Market Share: Holds approximately 7% to 7.1% of the national health insurance market.
  • Direct Premiums Written: Generates over $107 billion annually in direct premiums.
  • Blue Cross Blue Shield: Operates as the largest for-profit member company within the Blue Cross Blue Shield Association, serving roughly 42 to 47 million medical members across 14 state-specific plans (such as California, New York, Ohio, and Virginia).

Is Anthem better or Aetna?

Neither Anthem nor Aetna is universally better; Anthem features larger PPO networks, while Aetna often provides higher government quality ratings and lower Medicare plan costs.

Anthem Strengths

  • Network Size: Anthem belongs to Blue Cross Blue Shield and offers massive PPO networks with wide doctor acceptance.
  • Extras: Many plans include extra perks like SilverSneakers gym memberships and vision packages.
  • Market Share: It is one of the largest health insurers in the U.S. and dominates enrollment in states like California.

Aetna Strengths

  • Ratings: Aetna routinely scores higher on Centers for Medicare & Medicaid Services (CMS) star ratings.
  • Affordability: It frequently offers lower average premiums and wide availability of $0-premium plans.
  • CVS Integration: Owned by CVS Health, it provides strong mail-order prescription options and pharmacy convenience. You can also read real member insights in discussions like Aetna VS Anthem?: r/medicare.

Anthem Health Insurance Review - Usage Experience

9 related questions found

Is Anthem a good medical plan?

Anthem medical plans offer extensive nationwide coverage through the Blue Cross Blue Shield network, though customer satisfaction and ratings vary widely by region.

The Pros of Anthem Plans

  • Large Network: Members get access to a massive network of doctors, specialists, and hospitals across the United States.
  • Plan Variety: Anthem provides multiple types of plans, including HMO, PPO, and EPO options, depending on your state.
  • Digital Tools: The Sydney Health app lets you view ID cards, check benefits, chat with support, and find local care providers.
  • Extra Perks: Many plans include $0 preventive care screenings and virtual doctor visits.

The Cons of Anthem Plans

  • Customer Service: User ratings on platforms like Anthem Blue Cross Blue Shield Reviews highlight frequent complaints about long phone wait times and slow claim processing.
  • Approval Delays: Some members report difficulties or long wait times getting specialized procedures or medications approved.
  • Medicare Ratings: According to the Anthem Medicare Advantage Review from NerdWallet, their Medicare plans average a 3.3/5 rating with higher-than-average member complaints.

Is It Right for You?

Anthem is generally a solid choice if your preferred local doctors and hospitals accept their network. However, your experience will depend heavily on the specific tier of coverage you choose (Bronze, Silver, Gold, or Platinum) and your local state rules. Always check their provider directory before signing up.

What insurance owns Anthem?

Anthem is owned by its parent company, Elevance Health (formerly known as Anthem, Inc. until it rebranded in June 2022).

Key Details

  • Parent Company: Elevance Health is a major American health benefits company and the largest for-profit managed care organization in the Blue Cross Blue Shield Association.
  • Name Change: The corporation officially changed its name from Anthem, Inc. to Elevance Health in 2022 to reflect its expansion into broader healthcare services beyond traditional insurance.
  • Operations: Anthem Blue Cross and Blue Shield continues to operate as a leading health plan brand under Elevance Health across 14 states, alongside other subsidiaries like Wellpoint and Carelon.

Why are doctors leaving UnitedHealthcare?

Doctors and major health systems are leaving UnitedHealthcare's network primarily due to disagreements over reimbursement rates, excessive administrative burdens, and frequent care delays or denials.

Key Reasons for Network Splits

  • Low Reimbursement Rates: Health systems like Texas Tech Physicians and ECU Health noted that UnitedHealthcare's payout rates have failed to keep pace with soaring medical inflation and the rising cost of patient care.
  • Prior Authorization and Denials: Major providers, including Johns Hopkins Medicine, have cut ties because UnitedHealthcare frequently delays or denies care coverage and enforces strict, time-consuming prior authorization rules.
  • Delayed Payments: Doctors and clinics cite slow and problematic claims processing by the insurer, which strains the financial stability of independent and hospital-employed practices alike.
  • Medicare Advantage Cutbacks: Amid federal funding pressures and high clinical utilization, insurers are narrowing provider networks and scaling back or exiting unprofitable regional markets.

What insurance is better than UnitedHealthcare?

Other major health insurance companies like Blue Cross Blue Shield, Kaiser Permanente, and Aetna often rank better than UnitedHealthcare for customer satisfaction, integrated care, or local plan value.

Top Alternatives to UnitedHealthcare

  • Blue Cross Blue Shield (BCBS): Better for nationwide and global coverage, featuring robust PPO networks and strong regional availability across every U.S. state.
  • Kaiser Permanente: Better for integrated, high-quality care and affordability for individuals, though its services are restricted to specific regions where they operate their own medical facilities.
  • Aetna (CVS Health): Better for government and Medicare star ratings, often providing higher percentages of $0-premium plans.
  • Humana: Better for Medicare-focused coverage with high customer ratings for major specialized plans, though local availability varies.

How They Compare

  • Network Size: UnitedHealthcare has one of the largest provider networks in the country, but competitors like BCBS offer more flexible PPO options in many local markets.
  • Customer Satisfaction: UnitedHealthcare often scores below average on customer experience and satisfaction surveys compared to regional or integrated models like Kaiser Permanente.
  • Costs: Maximum out-of-pocket limits and zero-dollar premium availability vary significantly depending on your specific zip code and employer or marketplace options.

Which is better, Kaiser or Anthem?

Whether Kaiser Permanente or Anthem is better depends on your preference for cost, provider choice, and convenience. Neither is universally superior; they use fundamentally different care models.

Kaiser Permanente

  • Model: An integrated Health Maintenance Organization (HMO). Kaiser owns its facilities, employs its own doctors, and runs its own pharmacies under one roof.
  • Cost: Usually features lower monthly premiums and managed out-of-pocket expenses compared to equivalent traditional plans.
  • Convenience: Excellent internal coordination; labs, doctor visits, and prescriptions are streamlined through a unified online portal and centralized facilities.
  • Drawbacks: Strict network limitations. You must see Kaiser doctors at Kaiser facilities. Out-of-state care is generally restricted to true emergencies. It only offers HMO plans, meaning you need referrals to see specialists.

Anthem (Anthem Blue Cross / Blue Shield)

  • Model: A traditional health insurance carrier that contracts with independent doctors, medical groups, and hospitals.
  • Flexibility: Offers a wider selection of plan types, including HMOs and EPOs/PPOs that provide broader network choices and fewer restrictions on seeing specialists.
  • Travel: Access to the broader national Blue Card network makes Anthem a safer choice if you travel often or live away from home for part of the year.
  • Drawbacks: Premiums and out-of-pocket costs are typically higher. Care coordination can feel fragmented since the insurer, labs, and doctors operate as separate entities.

Quick Summary

  • Choose Kaiser if you live near a Kaiser facility, prefer an all-in-one coordinated system, want lower monthly costs, and rarely need out-of-state routine care.
  • Choose Anthem if you want the freedom to choose your own doctors and hospitals, prefer seeing specialists without strict referral hoops (on PPO/EPO plans), or need nationwide coverage for travel.