Anthem Medicare Advantage Review (2026): Pros & Cons

Anthem offers four Medicare Advantage options for 2026. Federal mandates now require behavioral health cost-sharing to match or improve upon Original Medicare, insulin costs are capped with no deductible, and members enrolled in the Medicare Prescription Payment Plan will be automatically re-enrolled each year unless they opt out. 

• HMO: Members select a primary care doctor who coordinates all care and manages specialist referrals under Anthem's HMO plans. Coverage applies only to in-network providers except for emergencies. Care flows through a single physician who authorizes all specialist visits and procedures.
• HMO-POS: Combining primary care coordination with limited out-of-network access, Anthem's HMO-POS plans require a primary care doctor and referrals for in-network specialists. Members can see out-of-network providers for certain services at higher costs. This option provides more flexibility than standard HMO plans while keeping care coordinated.
• PPO: No primary care physician selection or specialist referrals are required under Anthem's PPO plans. Members can visit any provider who accepts Medicare, though in-network care costs less. Out-of-network care is covered at higher rates, giving members broad provider access without coordination requirements.
• Regional PPO: Coverage spans multiple states under Anthem's Regional PPO plans while keeping PPO provider flexibility. These multi-state plans work well for members who travel frequently or live in different states during the year while needing consistent coverage across locations.

Anthem offers Medicare Advantage plans in 12 states with varying coverage options. Plan types include HMO, HMO-POS, PPO, Regional PPO and PFFS, though availability differs by location. California has six HMO-POS plans, while Indiana offers 10 total plans across all five plan types. Visit anthem.com or call 1-844-717-1811 to confirm which plans serve your area for 2026 coverage.

Anthem Medicare Advantage plans score 3.3 to 3.89 out of 5 for 2026, based on CMS evaluations of customer service, care coordination, member satisfaction and health outcomes. HMO-POS options lag behind national benchmarks while HMO and PPO plans exceed them.

Anthem's HMO-POS plans score 0.71 points below the 4.01 national average. PPO plans beat the national benchmark by 0.17 points at 3.8. HMO plans edge past industry standards at 3.89 versus 3.86. Regional PPO options score near average at 3.5 compared to 3.53. The HMO-POS gap shows Anthem struggles with plans combining network restrictions and point-of-service flexibility.

Anthem's HMO-POS plans offer the strongest value, averaging $6 per month versus the $47 national average. About 64% charge no premium. These plans also have the lowest out-of-pocket limits, averaging $4,544, or $528 below the national average. 

HMO plans cost $16 monthly on average, $10 below the national rate, and 40% have no premium. Out-of-pocket limits average $6,560, which is $1,652 above the national average. PPO plans average $38 per month, $6 below the national average, though none offer $0 premiums. Maximum out-of-pocket limits for PPO plans average $7,344, or $1,078 above the national average.

The federal maximum out-of-pocket limit for 2026 is $9,250, down from $9,350 in 2025. All Anthem plan types fall below this cap. You'll also pay your Medicare Part B premium of $202.90 monthly for any plan you select.

Anthem Medicare Advantage plans provide supplemental benefits that Original Medicare doesn't cover. Anthem adds dental care, vision services, hearing coverage and fitness access to 2026 plans. Coverage varies by plan type and service area, so check your Evidence of Coverage document to confirm which benefits your Anthem plan includes. 

• Dental and vision coverage: Anthem covers routine dental care with two cleanings, one exam and X-rays annually. Anthem also covers fillings, bridges and dentures on certain plans. Vision benefits cover one eye exam per year. Eyeglass or contact lens allowances are available through Anthem. Preventive dental and vision services cost $0 on many Anthem plans.
• Hearing services: Anthem covers annual hearing exams and hearing aid fittings. Anthem's network providers offer hearing aid benefits with allowance amounts that vary by plan.
• Anthem Benefits Prepaid Card: Anthem gives you a flex card with monthly or quarterly allowances for over-the-counter health products, healthy foods and utility bills. Allowances reload each period based on your Anthem plan. Unused amounts don't roll over. The card works at participating pharmacies and retail locations.
• SilverSneakers fitness program: Anthem adds SilverSneakers membership at no extra cost. Access thousands of participating gyms and fitness centers nationwide plus virtual workout classes and the SilverSneakers GO mobile app through Anthem.
• 24/7 telehealth services: Anthem's LiveHealth Online connects you with doctors virtually through phone or video. Virtual visits through Anthem cost the same as in-office appointments for primary care and specialist consultations. Anthem covers routine follow-ups, prescription refills and behavioral health appointments.
• Transportation assistance: Anthem provides an annual allowance on certain plans for one-way trips to medical appointments, pharmacies and plan-approved locations. Coverage varies by Anthem plan.
• Meal delivery after hospitalization: Anthem provides up to seven days of home-delivered meals following discharge from a hospital or skilled nursing facility on certain plans to aid recovery transitions at no copay.

Anthem offers Medicare Advantage plans across multiple states, including HMO, PPO and SNP options. Use the table below to filter plans by state and compare coverage, costs and extra benefits to choose the plan that works for you.

*Plan availability and costs vary by location. Your actual premiums, benefits and out-of-pocket expenses may differ based on your specific circumstances, health needs and the plan you select.

We've answered frequently asked questions about Anthem Medicare Advantage, from plan costs and CMS ratings to coverage options across 12 states:

If you're reviewing Anthem Medicare Advantage for aging parents or your own retirement planning, you need clear comparisons of how Anthem's plans stack up on real costs and quality metrics. We analyzed Anthem's Medicare Advantage plans nationwide using data from the Centers for Medicare & Medicaid Services (CMS), focusing on three factors that determine whether Anthem delivers genuine value. 

• Affordability (50%): Healthcare costs directly impact retirement budgets. We reviewed Anthem's monthly premiums for combined Part C and Part D coverage (30% weight) and in-network maximum out-of-pocket limits (20% weight). Anthem plans with lower monthly costs and MOOP amounts score higher since they reduce baseline expenses and protect against unexpected medical bills.
• Star Ratings (40%): CMS ratings measure Anthem's plan performance across care effectiveness, customer service and member satisfaction. The Overall Star Rating combines both Part C medical coverage and Part D prescription drug ratings on a 1-to-5 scale. Higher-rated Anthem plans show consistent quality in areas that affect daily healthcare experience.
• Availability (10%): We track how many states Anthem operates in because broader geographic coverage provides flexibility if you relocate. Anthem's wide reach means stronger customer support infrastructure and resources for plan improvements. 
  

This methodology helps you compare Anthem Medicare Advantage plans using objective data rather than marketing promises. The weighting reflects what matters most: affordability to manage healthcare costs, quality ratings that predict your experience with Anthem, and availability that provides flexibility as circumstances change.