Cigna vs. Anthem: 2026 Comparison

Anthem sells ACA marketplace plans in 13 states with access to all major network structures. Cigna operates in 11 states with HMO and EPO plans only. Colorado, Georgia and Indiana are the three states where both Cigna and Anthem sell ACA plans. Shoppers in those states can compare plans from both carriers directly before enrolling.

Anthem sells PPO and POS plans that Cigna doesn't offer anywhere on the ACA marketplace. Anthem members with POS coverage can see out-of-network providers at higher cost; PPO members need no referrals at all. Plan types match coverage to your provider preferences and affect how you access care:   

• HMO plans: Coverage stays in-network except emergencies. You select a primary care physician who coordinates all medical care and issues specialist referrals.
• EPO plans: No primary care physician requirement and no referrals needed for specialists. Coverage remains in-network only except emergencies.
• POS plans: Primary care physician required with referral system, but out-of-network care available at increased cost.
• PPO plans: Maximum provider flexibility. Specialist visits require no referrals. Out-of-network care covered at reduced benefit levels.

Anthem's HMO premiums average $683 per month, which is $73 below Cigna's $756 and $5 above the national average of $678. Cigna saves EPO members $24 per month at $753 versus Anthem's $777, though both exceed the $731 national rate. Anthem's exclusive POS and PPO options cost $806 and $874, with both exceeding national benchmarks by $54 and $71. Cigna's EPO plans come in at $753, which is $24 below Anthem's $777 for members who skip the primary care physician requirement.

Anthem is the wrong ACA choice if you're prioritizing member experience over clinical quality. Cigna's 93.59 member experience score runs 4.6 points above Anthem's 88.99, the only scoring dimension where Cigna leads. If you're managing a chronic condition and expect frequent contact with your plan, that satisfaction difference is likely to show up in your day-to-day. Cigna's EPO plans average $753 per month versus Anthem's $777. That $24 monthly gap saves members $288 per year. The trade-off is no PPO access.

Skip Cigna if you need PPO or POS access. Cigna sells only HMO and EPO plans, so members who see specialists without referrals or want out-of-network flexibility have no path with Cigna on the ACA marketplace. Anthem's 83.3 Quality Rating System score also runs 9.6 points above Cigna's 73.71, a gap that matters most for members who weigh clinical performance over cost. In the three overlap states, Colorado, Georgia and Indiana, the data consistently favors Anthem on overall quality.

Cigna sells Medigap coverage in 43 states with consistent plan availability. The insurer offers Plans A, F, G and N in most markets, supplemented by Plans B, C and D in select states. Anthem operates in 12 states only, with all 12 falling within Cigna's service area. Maine is the only state where Anthem sells Medigap without Cigna competition. Cigna covers 31 additional states where Anthem has no presence.

State-specific structures apply in Minnesota and Wisconsin, where both insurers meet local requirements instead of selling standard lettered plans. Ohio is the only market where neither carrier provides Plan N. 

Anthem's 12-state Medigap footprint is concentrated in the Northeast and Midwest. In our review of state-by-state availability, the practical implication is that most Medicare enrollees outside California, Colorado and a handful of other states won't have Anthem as an option at all.

Anthem Medigap is not worth its premium for most enrollees who qualify in both carriers' markets. Cigna's Plan G runs $56 less per month at age 65 and $70 less at 75. Paying Anthem's rates requires a reason and on the four plans both carriers share, we didn't find one in the pricing data. Anthem's 12-state footprint also means most Medicare beneficiaries can't choose it at all.

Cigna doesn't offer high-deductible Plans F and G in every state, and its Medigap plan roster narrows outside its core 43-state footprint. If your state doesn't have Plan B, C or D availability through Cigna, check whether a local carrier fills that gap before enrolling.

• Cigna Availability: Alabama, Arizona, Arkansas, Colorado, Connecticut, Delaware, Florida, Georgia, Illinois, Kansas, Kentucky, Maryland, Mississippi, Missouri, Nevada, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Washington
• Anthem Availability: California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Missouri, Nevada, New York, Ohio, Virginia, Wisconsin
  Cigna sells Medicare Advantage coverage in 29 states, with nine of Anthem's 12 states falling within Cigna's territory. Colorado, Connecticut, Georgia, Kentucky, Missouri, Nevada, New York, Ohio and Virginia are markets where both carriers compete.

HMO plans favor Cigna on both premium costs and out-of-pocket limits. 85% of Cigna HMO plans charge nothing beyond Part B premiums, versus 40% for Anthem. Average monthly costs are $8 for Cigna and $29 for Anthem when premiums apply. The annual out-of-pocket cap is $5,585 with Cigna and $7,890 with Anthem, a $2,305 difference.

Anthem's $0-premium rate is 44% across all plan types, compared to Cigna's 86%. Anthem's PPO plans all charge a monthly premium (0% are premium-free). Cigna's PPO plans are 83% premium-free. California, Indiana and Wisconsin are Anthem-only markets between the two carriers. 

In the nine overlap states, Cigna's HMO premiums average $8 per month versus Anthem's $29. Cigna's PPO premiums average $1 versus Anthem's $37. Cigna's overall CMS star rating is 3.66, ahead of Anthem's 3.56.

Cigna's 3.01 PPO star rating trails Anthem's 3.8 by 0.79 stars, the largest quality gap between the two carriers across any plan type. Anthem's 3.8 PPO star rating leads Cigna's 3.01 by 0.79 stars, but Anthem's plans cost $37 per month versus Cigna's $1. That $36 monthly gap adds up to $432 per year.