Anthem vs. Blue Cross Blue Shield: What's the Difference?

 Advantages of Anthem

• Medical care quality QRS score of 82.23 out of 100, about eight points above BCBS's 73.96
• EPO plans average $77 less per month than BCBS EPO plans
• More than two-thirds of HMO-POS Medicare Advantage plans carry a $0 premium
• Plan N Medigap costs less than BCBS at both age 65 and age 75
• Only Medicare Advantage choice of the two in nine states, including Connecticut, Ohio and Virginia
• AM Best A (Excellent) financial strength rating, affirmed December 2025

Disadvantages of Anthem

• ACA plans available in only 14 states. BCBS covers all 50
• Higher ACA claims denial rate than BCBS, increasing out-of-pocket billing risk
• Average CMS star rating of 3.56, below BCBS's 3.79 and short of the 4 stars that earn CMS quality bonus payments
• HMO Medicare Advantage out-of-pocket maximum of $7,890, compared to BCBS's $5,292
• Only four Medigap plan types, compared to BCBS's 10
• No PFFS Medicare Advantage plans

Advantages of BCBS

• ACA plans available in all 50 states, compared to Anthem's 14
• Lower ACA claims denial rate means fewer out-of-pocket billing surprises on first submission
• HMO-POS plans average 4.09 CMS stars, about 0.8 stars above Anthem's 3.3
• Ten Medigap plan types available, including high-deductible Plans F and G
• Lower HMO Medicare Advantage out-of-pocket maximum ($5,292 vs. Anthem's $7,890)
• PFFS plans available for members who want to see providers outside a fixed network

Disadvantages of BCBS

• HMO-POS Medicare Advantage averages $64 per month, compared to Anthem's $13
• Medical care quality QRS score (73.96) is about eight points below Anthem's
• Quality and service vary across 33 independent state companies operating separately
• No Medicare Advantage plans in nine of Anthem's 12 Medicare Advantage states, including Connecticut and Ohio
• BCBS EPO plans have a higher claims denial rate than BCBS PPO and POS plans

Federal law prohibits both Anthem and BCBS from setting lifetime or annual dollar limits on the 10 essential health benefits all ACA plans must cover, including emergency care, hospitalization, prescription drugs, maternity care and mental health services. Coverage limits are identical between the two carriers and are not a deciding factor.

Supplemental and short-term plans from either carrier are not subject to ACA coverage limit rules. Each product sets its own annual benefit cap. Check the annual maximum before buying any supplemental plan from Anthem or BCBS.

Essential health benefits both Anthem and BCBS must cover:

• Ambulatory patient services (outpatient care without hospitalization)
• Emergency services
• Hospitalization
• Pregnancy, maternity and newborn care
• Mental health and substance use disorder services
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services, including oral and vision care

Open enrollment for 2027 coverage on HealthCare.gov is Nov. 1 through Dec. 15, 2026, and every plan picked in that window starts Jan. 1. Anthem and BCBS also sell through state-run exchanges, such as Covered California and NY State of Health, which can set later deadlines.

Outside open enrollment, a qualifying life event opens a Special Enrollment Period (SEP) that gives you 60 days to enroll or switch carriers. Qualifying events include losing job-based coverage, marriage, having a child and moving to a new coverage area.

BCBS sells Medigap in 36 states. It doesn't sell in New York, Hawaii, Illinois, Wyoming, Washington, D.C., or the 10 states where Anthem is the only seller of the two. Anthem's 12 states are spread across the West, Northeast, South and Midwest.

The two carriers overlap in California, where both sell Plans A, F, G and N, and in Wisconsin, where both offer the state-specific Medigap Basic Plan instead of standard lettered options. If you live in either state, you can compare prices between the two carriers.

Anthem holds exclusive Medigap coverage in Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire and Ohio. BCBS sells up to 10 plan types in large markets like Florida, Maryland, Virginia and South Carolina. That's more choice than Anthem provides in any of its 12 states, where it sells four at most.

BCBS costs less than Anthem on every Medigap plan type except Plan N, per MoneyGeek's 2026 analysis. By age 75, the Plan G savings hold at $48 per month. The Plan F savings grow to $94 per month, or $1,128 per year. At age 65, BCBS's Plan G is $48 less per month and Plan F is $79 less.
These averages cover each carrier's full footprint. California is the only state where both sell lettered Medigap plans, so prices elsewhere reflect different markets. Your quote depends on your state, age and ZIP code.

Plan N is the exception. Anthem costs $6 less at age 65 and $20 less at age 75. Plan N charges copays for office visits and emergency room trips that Plan G covers. For low-care users, Anthem's Plan N is the more affordable option.

BCBS companies sell Medicare Advantage in 31 states, and Anthem sells in 12. The two overlap in only California, Georgia and New York. Anthem is the only choice of the two in nine states, including Connecticut, Ohio and Virginia. BCBS is the only choice in 28.

• Anthem Availability: California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Missouri, Nevada, New York, Ohio, Virginia, Wisconsin   
• Blue Cross Blue Shield Availability: Alabama, Arizona, Arkansas, California, Delaware, Florida, Georgia, Idaho, Illinois, Kansas, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nebraska, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Washington, West Virginia

HMO-POS is where the biggest pricing difference appears. More than two-thirds of Anthem's HMO-POS plans charge no monthly premium, compared to less than a third for BCBS. Anthem's average of $13 per month against BCBS's $64 makes HMO-POS a clear cost win for Anthem.

On PPO plans, Anthem's average is $37 per month against BCBS's $67, but 38% of BCBS PPO plans carry a $0 premium and none of Anthem's do.

BCBS PPO plans average a $6,289 maximum out-of-pocket (MOOP), compared to Anthem's $7,183. If you expect to hit that ceiling, BCBS's $894 lower MOOP outweighs its $30 higher monthly premium, which adds up to $360 a year.

BCBS's HMO-POS plans average 4.09 stars, which puts them in line for CMS quality bonus payments. Anthem's HMO-POS average of 3.3 falls short, which usually means less bonus money for extra benefits. CMS rates each contract separately, so check your plan's rating on Medicare.gov.

Anthem rates higher on standard HMO plans (3.89 vs. 3.73) and PPO plans (3.8 vs. 3.76). For HMO or PPO buyers, Anthem is the stronger quality pick.

Your MOOP is the annual ceiling on what you pay before your plan covers all remaining costs. On HMO plans, Anthem's MOOP is $7,890 and BCBS's is $5,292. An Anthem HMO member who reaches the $7,890 ceiling in a plan year pays $2,598 more than a BCBS HMO member would.