Anthem Health Insurance Review (2026)

Anthem's 4.2 score is built primarily on its HMO plans. An HMO assigns you a primary care doctor who coordinates your care and refers you to specialists. You can only see providers inside Anthem's network, which keeps costs lower. That's why HMO averages $683 a month and Anthem's PPO, which allows out-of-network care at higher cost, averages $874.

For Medicare Advantage shoppers, Anthem's picture is weaker. CMS rates these plans from 1 to 5 stars on care quality and member satisfaction, with 4 stars or above considered strong. Anthem averaged 3.63 stars for 2026 and lost roughly 368,000 Medicare Advantage members that year, a decline that reflects those quality concerns.

CMS uses a Quality Rating System, called QRS, to score health plans on three dimensions: medical care quality, member satisfaction and billing accuracy. Scores run from 0 to 100. Anthem's HMO plans score 76.48, the highest result in our review for any Anthem plan type, and above the EPO score of 69.98 and the POS score of 69.40.

Anthem's HMO plan administration score is 93.08 out of 100. Plan administration tracks how accurately and quickly claims are processed and billing is handled. That is Anthem's strongest single result in our QRS data. Medical care scores are lower across all three rated plan types, between 65.67 and 72.09, placing Anthem in the average range for care quality.

* CSR-I shows that the QRS had insufficient data to calculate a rating.  

EPO and POS plans have no published QRS score for plan administration. CMS had insufficient data to calculate one. That means if you choose an EPO or POS plan, there is no quality benchmark for how Anthem processes billing and claims on those plan types.

Your plan choices with Anthem depend on your state. New Hampshire has 65 HMO and 26 PPO plans, the widest selection Anthem sells anywhere. Colorado offers 41 HMO plans and nothing else. Missouri has 20 EPO plans only. New York has eight HMO plans with no alternative option.

PPO plans, which allow out-of-network care, are available only in Connecticut, Maine and New Hampshire. California, Georgia, Kentucky and Colorado residents can choose only HMO or EPO plans, both of which cover in-network providers only. POS plans are sold only in Indiana and Wisconsin. California, Colorado, Georgia, Kentucky, Missouri, Nevada, New York and Ohio have no PPO or POS plans. Every Anthem plan type in those eight states covers only in-network care.

New Hampshire's 91 plans, including 26 PPOs, offer more flexibility than any other Anthem market. New York's eight HMO plans only and Missouri's 20 EPO-only plans are the narrowest we found. If you live in either state, I'd recommend comparing Anthem against other carriers before enrolling. The limited selection makes it harder to match a plan to your specific care needs and budget.

Anthem offers four plan types across six tiers, but your options depend entirely on your state. EPO is the only type available at every tier from Catastrophic through Platinum. HMO plans skip Bronze and Platinum tiers entirely. PPO covers Bronze through Platinum but only in Connecticut, Maine and New Hampshire. POS covers only Expanded Bronze, Silver and Gold.

The most important difference to understand: EPO covers every tier but restricts you entirely to Anthem's provider network. Going outside the network means Anthem pays nothing toward the bill. That restriction is the same as an HMO, without the referral requirement. Out-of-network access exists only through Anthem's PPO plans, available in Connecticut, Maine and New Hampshire only.

Metal tiers determine how you and Anthem split costs. Lower-tier plans like Bronze have smaller monthly premiums but higher out-of-pocket costs when you need care. Higher-tier plans like Gold require you to pay more per month but less at the point of care. Catastrophic plans are only accessible to people under 30 or who qualify for a hardship exemption.

Anthem ACA plans include the ConditionCare Program for members with chronic conditions, no-cost virtual visits through the Sydney Health app and free in-network preventive services. Members in California do not receive free prescription drug coverage.

• ConditionCare Program: Members managing chronic conditions such as diabetes, asthma, heart disease or depression get 24/7 access to a care team that includes nurses, dietitians, pharmacists and social workers. Members with chronic conditions who would otherwise manage care across multiple providers without coordination will get the most out of this benefit.
• Virtual Care: Board-certified doctors are available through video visits in the Sydney Health app at no added cost on most plans. This covers urgent situations like a sinus infection, rash or medication question without a copay or office visit. Members on high-deductible health plans and Catastrophic plans must meet their deductible before virtual care costs are covered.
• Mental Health Coverage: Anthem plans cover mental health and behavioral health visits, including video sessions with counselors, psychologists and psychiatrists through the Sydney Health app.
• Preventive Care at No Cost: In-network preventive services, including checkups, screenings and vaccines, are covered with no copay and no deductible requirement on all Anthem ACA plans.
• Prescription Drug Coverage: Some commonly used prescription drugs are available at no cost to members. California plans do not include this benefit. You can also price medications, find pharmacies and set up auto-refills through the Sydney Health app.
• Sydney Health App: Anthem's free mobile app lets you view your digital ID card, check claims, review deductibles and copays, and search for in-network doctors by location, specialty, gender or languages spoken.
• Dental and Vision Add-Ons: Add dental and vision coverage to most individual and family health plans, either bundled with a medical plan or purchased as standalone policies.

Anthem's HMO plans average $683 a month, $13 below the national HMO rate. That $13 saves $156 per year compared to the average HMO nationally. Combined with a CMS quality score of 76.48 out of 100, HMO is the only Anthem plan type where a below-average price comes with published quality data to support it.

EPO plans cost $777 a month, $39 above the national EPO average. That comes to $468 more per year. CMS has no published quality score for Anthem's EPO plans, so there is no data showing what the added monthly cost provides in return for the higher premium.

Indiana and Wisconsin residents have access to POS plans, which average $806 a month, $140 below the national POS rate. That $140 monthly saving works out to $1,680 less per year than the national average. But POS plans are available only in Indiana and Wisconsin and require a referral for specialist care. For residents of those two states, POS is Anthem's most affordable plan type with any out-of-network flexibility built in.

At $874 a month, Anthem's PPO is the most expensive plan type in its lineup, $235 above the national PPO average. A PPO lets you see any doctor in or out of Anthem's network without a referral, which is the main reason enrollees pay the higher cost.

Anthem health insurance is a brand of Elevance Health, which rebranded from Anthem Inc. in 2022. The Anthem name covers ACA Marketplace, Medicare Advantage, Medicare Supplement and Medicaid programs across 13 states. Elevance Health is the fourth-largest for-profit Medicare Advantage provider in the country, with roughly 1.9 million Medicare members as of 2026.

Blue Cross Blue Shield is Anthem's most direct ACA marketplace competitor. Both operate under the Blue Cross Blue Shield brand but are separate companies with different pricing, coverage reach and complaint histories. For a 40-year-old on a Silver plan, BCBS averages $654 a month, $29 less than Anthem's HMO average, and sells plans in all 50 states compared to Anthem's 13.

Aetna exited the ACA individual marketplace entirely in 2026. That ended coverage for roughly 1 million former members across 17 states. For ACA plan comparisons, BCBS is now the relevant benchmark.

BCBS posts a NAIC complaint ratio of 0.58 against the 1.00 industry average. The NAIC tracks formal complaints policyholders file with state regulators, then scores each company relative to its market size. A ratio below 1.00 means fewer complaints than expected for a company of that size. Anthem's NAIC complaint ratio is at or slightly above 1.00, meaning it draws more complaints relative to its size than BCBS.

Anthem offers individual and family health insurance plans across 13 states, with premiums, deductibles and network types varying by location and metal tier. Use the filters below to narrow plans by state, plan type and coverage level to find options that fit your budget and care needs.

We rate the best health insurance providers based on premiums, out-of-pocket expenses, customer experience, claims denial rates and plan selection.

MoneyGeek health insurance provider scores are weighted as follows:

• Affordability (60%): When scoring providers on affordability, we considered monthly premiums, deductibles and maximum out-of-pocket (MOOP) costs. We weighted these factors as follows within the affordability score: monthly premiums (66.67%), deductible (16.67%), MOOP (16.67%).
• Customer Experience (30%): The Centers for Medicare & Medicaid Services (CMS) Quality Rating System (QRS) overall rating for health insurance plans. This is a 5-star rating system used to help consumers compare health plans on the Health Insurance Marketplace. Ratings are calculated based on three main categories: Medical Care, Member Experience, and Plan Administration. Providers with the highest overall rating get the highest score
• Denial Rate (10%): Carriers with the lowest in-network claim denial rate score highest in this category. MoneyGeek sourced 2024 denial rate data from the CMS Transparency in Coverage Public Use File, published in 2025.

Data sources

We updated health insurance plan and provider data using CMS exchange data released in October 2025 for the 2026 enrollment period and manually collected health plan data from state insurance marketplaces for 22 states.

Sample consumer profile

We collected data on all available health plans for consumers ages 18, 26, 40, 50 and 60. We based monthly premiums on a 40-year-old buyer unless otherwise noted, such as for the seniors category. We analyzed plans for each cited metal tier, which include Catastrophic, Bronze, Expanded Bronze, Silver, Gold and Platinum.