Anthem Health Insurance Review (2026)

Anthem offers HMO, EPO, PPO and POS plans across six metal tiers, though not every network type is available at every tier. Your options depend on where you live. When we mapped plan types against metal tiers across all 13 states, the most striking finding was how unevenly EPO coverage is distributed. It's the only type available at every tier from Catastrophic through Platinum, yet it comes with no out-of-network coverage at all. The table below shows the full range of plan types by metal tier.

EPO plans are the most flexible, with options at every tier from Catastrophic through Platinum. PPO plans cover Bronze through Platinum but aren't offered at the Catastrophic tier. HMO plans come in Catastrophic, Expanded Bronze, Silver and Gold tiers, but not at Bronze or Platinum. POS plans have the narrowest availability, covering only Expanded Bronze, Silver and Gold. 

The gap that matters most in practice: EPO plans cover every tier from Catastrophic through Platinum, yet EPO locks members into network-only care with no out-of-network option at all. Shoppers who want both tier flexibility and out-of-network access won't find that combination in most states Anthem serves. 

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 sells private health insurance in 13 states, but your plan options vary widely depending on where you live. New Hampshire has the broadest selection with 65 HMO and 26 PPO plans, while states like Missouri and Nevada offer far fewer choices. PPO plans, which give you the most flexibility to see out-of-network doctors, are only available in Connecticut, Maine and New Hampshire.   

California, Georgia, Kentucky and Colorado residents are limited to HMO or EPO plans, which require you to stay in-network for covered care. POS plans are the rarest option, only in Indiana and Wisconsin. If network flexibility matters to you, your state's plan types should factor heavily into whether Anthem is the right fit. 

In our review of Anthem's state-level offerings, Colorado builds its entire plan menu around HMO, with no other plan type available. New Hampshire runs the opposite: 65 HMO plans and 26 PPO plans, the broadest dual-access selection Anthem sells anywhere. That contrast was the sharpest we found across all 13 states.

New Hampshire has 65 HMO and 26 PPO plans. Missouri has exactly 20 plans, all EPO and New York has eight HMO plans with nothing else, so shoppers in those states should compare Anthem against other carriers before enrolling.

Anthem's HMO plans are its most affordable option at $683 per month on average and come in $13 below the national average cost. PPO plans cost the most at $874 monthly, though they offer the broadest network access. EPO and POS plans fall in between at $777 and $806 per month, respectively.   

Anthem's Gold HMO averages $797 per month but limits your deductible to $1,574, while a Catastrophic HMO runs $425 monthly with a $10,600 deductible. POS plans have a steep tier jump, with Silver averaging $951 per month and Gold climbing to $1,092. If you’re prioritizing lower monthly costs, you should weigh Catastrophic and Expanded Bronze plans carefully, because the premium savings come with much higher out-of-pocket exposure if you need care.

The clearest pattern in Anthem's pricing: its HMO advantage is real but narrow. HMO and POS are the only two plan types that come in below their national averages. HMO is $13 below; POS is $140 below. But POS is only available in Indiana and Wisconsin and carries no published QRS score.

The PPO is where the pricing argument collapses entirely. At $235 above the national average monthly, PPO members pay for network breadth with no published QRS score to support the cost. For price-focused shoppers, HMO is the only plan type where Anthem's below-average rate comes with a quality score to back it up.

Explore Anthem’s average cost, deductible and maximum out-of-pocket limits by plan type and metal tier:

Anthem includes several member benefits beyond standard medical coverage:

• 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.
• 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.
• 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.
• 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.
• Prescription Drug Coverage: Some commonly used prescription drugs are available at no cost to members, though you won’t get this benefit in California. You can also price medications, find pharmacies and set up auto-refills through the Sydney Health app.
• 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.
• 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 score best across all customer experience categories, earning an overall QRS score of 76.48 compared to 69.98 for EPO and 69.40 for POS plans. Plan administration is a strength for HMO members, with a 93.08 score pointing to smooth claims processing and billing. 

Medical care scores tell a different story. All three rated plan types range from the mid 60s to low 70s, showing that members have a more mixed experience with actual care delivery. Member experience scores are also low across the board, ranging from 65.6 to 72. If customer service matters to you, Anthem's HMO plans have a measurable edge over its other offerings.

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

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.

The number that most shaped our read of Anthem's customer experience: HMO plan administration scores 93.08, while EPO and POS plans show insufficient data rather than a low score. That gap means members on EPO or POS plans are choosing without a plan administration quality score to compare against HMO's 93.08. Medical care scores across all three rated plan types land between 65.67 and 72.09, a narrow range for a carrier of Anthem's size. Service is consistent but not a differentiator.

Anthem's ACA plans are available through HealthCare.gov, not through agents or brokers. Most applicants get a bindable plan selection in under 10 minutes by entering their ZIP code, household size and income. Anthem doesn't sell individual plans through a separate direct channel, so HealthCare.gov is the only starting point for new enrollments. 

When we reviewed Anthem's enrollment flow, the HealthCare.gov plan filter lets you sort by premium, metal tier and deductible before selecting. Any subsidy you qualify for calculates automatically from the income you enter, which lowers the displayed cost. Open Enrollment runs November 1 through January 15, with coverage starting the first of the following month.

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%): Centers for Medicare & Medicaid Services (CMS)’s 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%): Denial rate is the percentage of submitted claims or applications that are rejected instead of approved. Providers with the lowest denial rate get the highest score.

Data sources

Health insurance plan and provider data was updated with the Centers for Medicare & Medicaid Services (CMS) exchange data released in October for the 2026 enrollment period as well as manual collection of 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. Monthly premiums are based on a 40-year-old buyer unless otherwise noted, such as the category for seniors. We analyzed plans for each cited metal tier, which include Catastrophic, Bronze, Expanded Bronze, Silver, Gold and Platinum.