Kaiser Permanente vs. Anthem: 2026 Comparison

Kaiser Permanente vs. Anthem: ACA Health Insurance Marketplace

Kaiser Permanente provides superior ACA health insurance with a 94.6 Quality Rating System score compared to Anthem's 83.3. Kaiser Permanente denies just 8.3% of claims while Anthem denies 22.7%. Anthem operates in 13 states versus Kaiser Permanente's seven states. Kaiser Permanente leads on quality and claim approval rates. Anthem leads on availability and plan variety.

Kaiser Permanente and Anthem differ in plan flexibility. Anthem sells HMO, EPO, POS and PPO plans. Kaiser Permanente sells only HMO and EPO networks. Three states allow direct comparison: California, Colorado and Virginia.


Availability	7 States	13 States
Plan Types	HMO, EPO	HMO, EPO, POS, PPO
Avg. QRS Score	94.6	83.3
Avg. Denial Rate	8.3%	22.7%


ACA State Availability	California, Colorado, Hawaii, Maryland, Oregon, Virginia, Washington	California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Wisconsin
Plan Types	HMO, EPO	HMO, EPO, POS, PPO

Kaiser Permanente sells ACA plans in seven states with HMO and EPO options. Anthem offers coverage in 13 states across four plan types: HMO, EPO, POS and PPO.

HMO (Health Maintenance Organization): A primary care physician coordinates all medical services and issues referrals before members see specialists. Members receive care from network providers except during emergencies.
EPO (Exclusive Provider Organization): Members visit specialists without referrals and don't need a primary care physician managing treatment. Network-only coverage applies except in emergency situations.
POS (Point of Service): Primary care physicians coordinate care and provide specialist referrals similar to HMOs. Members can visit out-of-network doctors by paying higher out-of-pocket costs.
PPO (Preferred Provider Organization): Members get direct access to specialists without referrals or network restrictions for maximum provider choice. Out-of-network care costs more than staying in-network.

Kaiser Permanente's HMO plans cost $598 monthly, $80 below the $678 national average and $85 less than Anthem's $683 rate. This saves $960 to $1,020 annually. EPO coverage from Kaiser Permanente costs $548 per month, $183 below the national average and $229 cheaper than Anthem.
HMO
$598
$683
$678
EPO
$548
$777
$731
POS
N/A
$806
$752
PPO
N/A
$874
$803
Annual EPO savings reach $2,196 to $2,748 with Kaiser Permanente.

Anthem is the only option for POS and PPO plans. POS coverage averages $806 monthly, $54 above the national average. PPO plans cost $874 per month, $71 over the national benchmark. But PPO access requires Anthem. HMO and EPO networks cost less with Kaiser Permanente.
Kaiser Permanente has higher Quality Rating System scores at 94.6 overall compared to Anthem's 83.3, an 11.3-point advantage. Medical care quality shows the widest gap at 96.11 for Kaiser Permanente versus 82.23 for Anthem. Member experience ratings are 91.51 for Kaiser Permanente and 88.99 for Anthem. Plan administration performance is 91.68 for Kaiser Permanente and 81.9 for Anthem.
Overall QRS Score
94.6
83.3
Medical Care QRS Score
96.11
82.23
Member Experience QRS Score
91.51
88.99
Plan Administration QRS Score
91.68
81.9
Avg. Denial Rate
8.3%
22.7%
Claims get denied at vastly different rates between the two insurers. Kaiser Permanente denies 8.3% of claims, well below the 18% national average. Anthem denies 22.7%, above the national benchmark. Kaiser Permanente approves nearly three times more claims than Anthem. Comparing health insurance plans requires looking at both pricing and claims processing performance.


HMO	$598	$683	$678
EPO	$548	$777	$731
POS	N/A	$806	$752
PPO	N/A	$874	$803


Overall QRS Score	94.6	83.3
Medical Care QRS Score	96.11	82.23
Member Experience QRS Score	91.51	88.99
Plan Administration QRS Score	91.68	81.9
Avg. Denial Rate	8.3%	22.7%

Kaiser Permanente vs. Anthem Medicare Supplement

Anthem is the only option for Medicare Supplement coverage because Kaiser Permanente doesn't sell Medigap plans. Anthem offers Medicare Supplement plans in 12 states with four plan types, A, F, G and N, using Attained Age pricing where premiums increase as policyholders age.


Availability	N/A	12 States
Plan Types	N/A	A, F, G, N
High-Deductible F and G	N/A	No
Dominant Pricing Style	N/A	Attained Age

Anthem offers Plans A, F, G and N in most of its 12 Medicare Supplement markets. Ohio lacks Plan N availability from Anthem. Wisconsin follows state-specific Medigap rules rather than standard lettered plans. Medicare Supplement plans from multiple carriers fill Original Medicare's coverage gaps.


California	A, F, G, N	N/A
Colorado	A, F, G, N	N/A
Connecticut	A, F, G, N	N/A
Georgia	A, F, G, N	N/A
Indiana	A, F, G, N	N/A
Kentucky	A, F, G, N	N/A
Maine	A, F, G, N	N/A
Missouri	A, F, G, N	N/A
Nevada	A, F, G, N	N/A
New Hampshire	A, F, G, N	N/A
Ohio	A, F, G	N/A
Wisconsin	Medigap Basic Plan	N/A

Anthem uses Attained Age pricing for Medicare Supplement plans. Plan G costs $218 monthly at age 65 and $273 at age 75. Monthly premiums for Plan F average $294 for 65-year-olds and $379 for 75-year-olds. Plan N costs $198 per month at 65 and $254 at 75. Plan A premiums start at $360 and increase to $406 over ten years.
A
$360
N/A
$406
N/A
F
$294
N/A
$379
N/A
G
$218
N/A
$273
N/A
N
$198
N/A
$254
N/A


A	$360	N/A	$406	N/A
F	$294	N/A	$379	N/A
G	$218	N/A	$273	N/A
N	$198	N/A	$254	N/A

Kaiser Permanente vs. Anthem Medicare Advantage

Kaiser Permanente has higher quality ratings with a 4.37 average CMS Star Rating compared to Anthem's 3.56. Anthem operates Medicare Advantage plans in 12 states while Kaiser Permanente covers eight states and is the only insurer selling Medicare Advantage in Hawaii. Anthem offers more zero-premium plans at 44% of its options versus 36% for Kaiser Permanente. Kaiser Permanente has stronger quality scores despite Anthem's upfront affordability advantage.


Availability	12 States	8 States
Plan Types	HMO, HMO-POS, PPO	HMO, HMO-POS
Avg. CMS Star Rating	3.56	4.37
Drug Benefits	Enhanced	Enhanced
% $0 Premium Plans	44%	36%

Kaiser Permanente sells Medicare Advantage plans in eight states with Hawaii as its exclusive market. Anthem covers 12 states, with four states where both insurers compete. Best Medicare Advantage plans vary by state and provider network.

Both insurers offer HMO and HMO-POS plans with enhanced prescription drug coverage. Kaiser Permanente requires in-network care with its two plan types. Anthem adds PPO options for beneficiaries who want out-of-network access without referrals.
- Kaiser Permanente Availability: California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington
- Anthem Availability: California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Missouri, Nevada, New York, Ohio, Virginia, Wisconsin

Anthem's monthly premiums average lower for HMO and HMO-POS plans but have much higher out-of-pocket maximums for HMO coverage. Anthem's HMO plans average $29 monthly versus $46 for Kaiser Permanente. Anthem's $7,890 maximum out-of-pocket limit runs $3,075 higher than Kaiser Permanente's $4,815. HMO-POS premiums average $13 for Anthem and $46 for Kaiser Permanente. Anthem's $5,205 MOOP sits slightly below Kaiser Permanente's $5,708.


HMO	40%	38%	$29	$46	$7,890	$4,815
HMO-POS	68%	31%	$13	$46	$5,205	$5,708
PPO	0%	N/A	$37	N/A	$7,183	N/A

Anthem's PPO plans cost $37 monthly with a $7,183 out-of-pocket maximum. Kaiser Permanente doesn't provide PPO options. Zero-premium plans represent 40% and 68% of Anthem's HMO and HMO-POS offerings versus Kaiser Permanente's 38% and 31%. Budget-focused beneficiaries pay less monthly with Anthem. Members who need frequent medical care pay less annually with Kaiser Permanente's lower HMO cost caps.

HMO
3.89
4.37
HMO-POS
3.3
4.37
PPO
3.8
N/A
Kaiser Permanente's HMO and HMO-POS Medicare Advantage plans both earn 4.37 stars, outperforming Anthem by 0.48 stars on HMO coverage and 1.07 stars on HMO-POS plans. Anthem scores 3.89 for HMOs, 3.3 for HMO-POS and 3.8 for PPOs. Special enrollment periods and additional member benefits come with plans rated 4.0 stars or higher, giving Kaiser Permanente members more flexibility to switch plans outside standard enrollment windows.


HMO	3.89	4.37
HMO-POS	3.3	4.37
PPO	3.8	N/A

Bottom Line

Kaiser Permanente leads on ACA health insurance and Medicare Advantage quality with a 94.6 QRS score, 4.37 CMS stars and an 8.3% claim denial rate. Anthem covers more states and is your only Medicare Supplement option. Kaiser Permanente offers lower premiums and better quality in its seven-state footprint. Anthem provides broader access, PPO flexibility and Medigap coverage.

About Mark Fitzpatrick

Mark Fitzpatrick, a Licensed Property and Casualty Insurance Producer, is MoneyGeek's resident Personal Finance Expert. He has analyzed the insurance market for over five years, conducting original research for insurance shoppers. His insights have been featured in CNBC, NBC News and Mashable.

Fitzpatrick holds a master’s degree in economics and international relations from Johns Hopkins University and a bachelor’s degree from Boston College. He's also a five-time Jeopardy champion!

He writes about economics and insurance, breaking down complex topics so people know what they're buying.

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Kaiser Permanente vs. Anthem: 2026 Comparison

Kaiser Permanente vs. Anthem: ACA Health Insurance Marketplace

Kaiser Permanente vs. Anthem Medicare Supplement

Kaiser Permanente vs. Anthem Medicare Advantage

Bottom Line

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